Weight loss and cachexia represent significant non-motor manifestations in Progressive Supranuclear Palsy (PSP), contributing to disease progression, quality of life decline, and increased mortality risk. Unlike simple malnutrition, cachexia in PSP involves a complex metabolic syndrome characterized by ongoing loss of skeletal muscle mass that cannot be fully reversed by conventional nutritional support[@litvan1996].
Epidemiology
Weight loss occurs in the majority of PSP patients and often begins early in the disease course:
Prevalence: 50-75% of PSP patients experience clinically significant weight loss (>5% body weight)[@dellipizzi2022]
Onset: Often begins within the first 2-3 years of symptom onset
Progression: Weight loss typically accelerates as disease advances
Severity: Up to 15-25% of body weight may be lost prior to death
Compared to Parkinson's disease (PD), PSP patients tend to experience more severe and earlier weight loss, with a median weight loss of 8-12% of baseline body weight over the disease course[@muELLER2017].
Pathophysiology
Multifactorial Mechanisms
The weight loss and cachexia in PSP result from multiple overlapping mechanisms:
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PSP Weight Loss and Cachexia
Weight loss and cachexia represent significant non-motor manifestations in Progressive Supranuclear Palsy (PSP), contributing to disease progression, quality of life decline, and increased mortality risk. Unlike simple malnutrition, cachexia in PSP involves a complex metabolic syndrome characterized by ongoing loss of skeletal muscle mass that cannot be fully reversed by conventional nutritional support[@litvan1996].
Epidemiology
Weight loss occurs in the majority of PSP patients and often begins early in the disease course:
Prevalence: 50-75% of PSP patients experience clinically significant weight loss (>5% body weight)[@dellipizzi2022]
Onset: Often begins within the first 2-3 years of symptom onset
Progression: Weight loss typically accelerates as disease advances
Severity: Up to 15-25% of body weight may be lost prior to death
Compared to Parkinson's disease (PD), PSP patients tend to experience more severe and earlier weight loss, with a median weight loss of 8-12% of baseline body weight over the disease course[@muELLER2017].
Pathophysiology
Multifactorial Mechanisms
The weight loss and cachexia in PSP result from multiple overlapping mechanisms:
1. Dysphagia and swallowing dysfunction
Progressive dysphagia affects 65-90% of PSP patients