| Clinical feature | Suggested HPO term | Phenotype group(s) | Frequency / statistic from cohorts | Evidence |
|---|---|---|---|---|
| Vertical supranuclear gaze palsy / slow vertical saccades | **Vertical supranuclear gaze palsy** (HPO label); **Slow saccadic eye movements** (HPO label) | PSP-RS, PSP-OM | Vertical supranuclear gaze palsy is the classic defining sign of PSP; MDS criteria note ocular motor dysfunction as 1 of 4 core domains. In the Tunisian phenotype cohort, PSP-OM represented **2.7%** of all PSP cases; PSP-RS remained the most common phenotype group (48/112). (pqac-00000017, pqac-00000014) | (pqac-00000017, pqac-00000014) |
| Postural instability | **Postural instability** (HPO label) | PSP-RS, PSP-PI | MDS criteria identify postural instability as a core diagnostic domain. In the Tunisian cohort, PSP-PI accounted for **8.0%** of cases; in real-world records, **68.1%** had unsteady gait/gait impairment documented before diagnosis, with median onset **1.2 years before diagnosis**. (pqac-00000017, pqac-00000014, pqac-00000026) | (pqac-00000017, pqac-00000014, pqac-00000026) |
| Recurrent falls | **Frequent falls** (HPO label); **Recurrent falls** (HPO label) | PSP-RS, PSP-PI | In the US/Canada real-world cohort, falling was documented in **79.2%** before diagnosis and **97.2%** across the disease course; median time to first fall was **2.0 years before diagnosis**. Falls are central to Richardson syndrome and MDS/NINDS-SPSP-style criteria. (pqac-00000026, pqac-00000025, pqac-00000017) | (pqac-00000026, pqac-00000025, pqac-00000017) |
| Gait freezing / progressive gait freezing | **Freezing of gait** (HPO label) | PSP-PGF | PSP-PGF is an established variant in the MDS spectrum. In the Tunisian cohort, PSP-PGF represented **1.8%** of all PSP cases. Real-world records showed mobility problems in **51.4%** before diagnosis, with median onset **0.8 years before diagnosis**. (pqac-00000018, pqac-00000014, pqac-00000025) | (pqac-00000018, pqac-00000014, pqac-00000025) |
| Akinesia / bradykinesia / rigidity | **Bradykinesia** (HPO label); **Akinetic-rigid parkinsonism** (HPO label); **Rigidity** (HPO label) | PSP-RS, PSP-P | PSP-RS patients in the Tunisian cohort had more **akinetic-rigid and levodopa-resistant parkinsonism** (**p = 0.006**), while PSP-P made up **11.6%** of cases. PSP pathology/clinical descriptions consistently include akinesia and rigidity as key motor manifestations. (pqac-00000014, pqac-00000025, pqac-00000027) | (pqac-00000014, pqac-00000025, pqac-00000027) |
| Dysphagia | **Dysphagia** (HPO label) | PSP-RS, advanced PSP across phenotypes | Dysphagia is highlighted as an additional symptom emerging with progression in PSP-RS and contributes materially to disease burden and supportive-care needs. No cohort percentage was provided in the retrieved contexts, but it is repeatedly cited as a common progressive feature. (pqac-00000027, pqac-00000028) | (pqac-00000027, pqac-00000028) |
| Dysarthria | **Dysarthria** (HPO label) | PSP-RS, PSP-SL | Dysarthria is a common speech/bulbar manifestation of PSP and contributes to healthcare utilization and speech-therapy needs. No specific frequency was given in the retrieved cohort excerpts. (pqac-00000028, pqac-00000025) | (pqac-00000028, pqac-00000025) |
| Cognitive decline / dementia | **Cognitive impairment** (HPO label); **Dementia** (HPO label) | PSP-RS, PSP-F, PSP-SL, cortical PSP | Cognitive dysfunction is one of the 4 MDS core domains. In longitudinal follow-up, annual decline was faster in Richardson syndrome than variants on **MMSE: -1.8 vs -0.9/year** and **ACE-R: -5.3 vs -3.0/year**. PSP-cortical phenotypes showed greater cognitive alteration than PSP-subcortical phenotypes. (pqac-00000017, pqac-00000036, pqac-00000014) | (pqac-00000017, pqac-00000036, pqac-00000014) |
| Frontal behavioral changes / dysexecutive syndrome | **Behavioral abnormality** (HPO label); **Executive dysfunction** (HPO label); **Frontal lobe syndrome** (HPO label) | PSP-F | PSP with frontal presentation is a recognized MDS phenotype. In the Tunisian cohort, PSP-F accounted for **9.4%** of all cases; APOE ε4 carriers had more altered cognitive profiles. (pqac-00000018, pqac-00000014) | (pqac-00000018, pqac-00000014) |
| Speech/language impairment: nonfluent aphasia / apraxia of speech | **Nonfluent aphasia** (HPO label); **Apraxia of speech** (HPO label); **Speech impairment** (HPO label) | PSP-SL | PSP-SL is an established MDS phenotype overlapping with nonfluent/agrammatic PPA and apraxia of speech. In the Tunisian cohort, PSP-SL represented **8.2%** of all cases. (pqac-00000018, pqac-00000014) | (pqac-00000018, pqac-00000014) |
| Depression | **Depression** (HPO label) | Non-motor across phenotypes | In the FMT PSP-RS trial, depression improved significantly after treatment as a secondary outcome. In the US/Canada medical-record cohort, depression was a common comorbidity; the paper’s snippet cites **44.4%** comorbidity prevalence. (pqac-00000033, pqac-00000025) | (pqac-00000033, pqac-00000025) |
| Anxiety | **Anxiety** (HPO label) | Non-motor across phenotypes | Anxiety improved significantly in the FMT PSP-RS trial after 3-cycle intervention and remained improved for many participants at follow-up. No baseline prevalence percentage was provided in the retrieved snippets. (pqac-00000033) | (pqac-00000033) |
| Constipation | **Constipation** (HPO label) | Non-motor across phenotypes | GI dysfunction is frequent in PSP-RS; the FMT trial notes that **more than 80%** of PSP patients experience GI symptoms and reported significant improvement in constipation after FMT. (pqac-00000033) | (pqac-00000033) |
| Ocular motor dysfunction (broader category) | **Abnormality of eye movement** (HPO label) | PSP-RS, PSP-OM | Ocular motor dysfunction is one of the four MDS core functional domains and is especially relevant in PSP-RS and PSP-OM. In the Tunisian cohort, PSP-OM was **2.7%** of cases; APOE ε4 carriers had earlier oculomotor dysfunction (**p = 0.052**). (pqac-00000017, pqac-00000014) | (pqac-00000017, pqac-00000014) |


*Table: This table maps common progressive supranuclear palsy phenotypes and core symptoms to suggested HPO terms, while adding quantitative cohort data where available. It is useful for phenotype annotation in a disease knowledge base and for harmonizing clinical features across PSP subtypes.*