Corticobasal Degeneration (CBD) Treatment

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Corticobasal Degeneration (CBD) Treatment

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Corticobasal Degeneration (CBD) Treatment

Overview

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Corticobasal Degeneration (CBD) Treatment

Overview

Mermaid diagram (expand to render)

<table class="infobox infobox-therapeutic">
<tr>
<th class="infobox-header" colspan="2">Corticobasal Degeneration (CBD) Treatment</th>
</tr>
<tr>
<td class="label">Medication</td>
<td>Mechanism</td>
</tr>
<tr>
<td class="label">Levodopa/carbidopa</td>
<td>Dopamine precursor</td>
</tr>
<tr>
<td class="label">Amantadine</td>
<td>NMDA antagonist + DA release</td>
</tr>
<tr>
<td class="label">Pramipexole</td>
<td>D2/D3 agonist</td>
</tr>
<tr>
<td class="label">Symptom</td>
<td>First-Line</td>
</tr>
<tr>
<td class="label">Depression</td>
<td>SSRIs (sertraline 50-200 mg)</td>
</tr>
<tr>
<td class="label">Apathy</td>
<td>Methylphenidate 5-20 mg/day</td>
</tr>
<tr>
<td class="label">Pseudobulbar affect</td>
<td>Dextromethorphan/quinidine</td>
</tr>
<tr>
<td class="label">Irritability/aggression</td>
<td>Low-dose quetiapine 25-100 mg</td>
</tr>
<tr>
<td class="label">Anxiety</td>
<td>SSRIs, buspirone</td>
</tr>
<tr>
<td class="label">Intervention</td>
<td>Score</td>
</tr>
<tr>
<td class="label">[Senolytics (D+Q)](/therapeutics/senolytics-neurodegeneration)</td>
<td>54/80</td>
</tr>
<tr>
<td class="label">[NAD+ Precursors](/therapeutics/nad-precursors-neurodegeneration)</td>
<td>53/80</td>
</tr>
<tr>
<td class="label">[Melatonin](/therapeutics/melatonin-tauopathy)</td>
<td>53/80</td>
</tr>
<tr>
<td class="label">[Spermidine](/therapeutics/spermidine-neurodegeneration)</td>
<td>55/80</td>
</tr>
<tr>
<td class="label">[CoQ10](/therapeutics/coenzyme-q10-neurodegeneration)</td>
<td>48/80</td>
</tr>
<tr>
<td class="label">[Omega-3 DHA/EPA](/therapeutics/omega-3-fatty-acids-neurodegeneration)</td>
<td>48/80</td>
</tr>
<tr>
<td class="label">Agent</td>
<td>Target</td>
</tr>
<tr>
<td class="label">Semorinemab</td>
<td>N-terminal tau</td>
</tr>
<tr>
<td class="label">Tilavonemab (ABBV-8E12)</td>
<td>Aggregated tau</td>
</tr>
<tr>
<td class="label">Bepranemab (UCB0107)</td>
<td>Mid-domain tau</td>
</tr>
<tr>
<td class="label">BIIB080 (IONIS-MAPTRx)</td>
<td>[MAPT](/proteins/mapt-protein) mRNA (ASO)</td>
</tr>
<tr>
<td class="label">Team Member</td>
<td>Role</td>
</tr>
<tr>
<td class="label">Movement disorder neurologist</td>
<td>Diagnosis, pharmacotherapy, clinical trials</td>
</tr>
<tr>
<td class="label">Physical therapist</td>
<td>Gait, balance, contracture prevention</td>
</tr>
<tr>
<td class="label">Occupational therapist</td>
<td>ADL adaptation, one-handed techniques, safety</td>
</tr>
<tr>
<td class="label">Speech-language pathologist</td>
<td>Aphasia therapy, swallowing, AAC</td>
</tr>
<tr>
<td class="label">Neuropsychologist</td>
<td>Cognitive assessment, behavioral strategies</td>
</tr>
<tr>
<td class="label">Social worker</td>
<td>Care coordination, caregiver support</td>
</tr>
<tr>
<td class="label">Palliative care</td>
<td>Symptom management, advance directives</td>
</tr>
<tr>
<td class="label">Primary Treatment</td>
<td>Rationale</td>
</tr>
<tr>
<td class="label">Levodopa + amantadine</td>
<td>Multiple dopaminergic mechanisms</td>
</tr>
<tr>
<td class="label">Clonazepam + levetiracetam</td>
<td>Different myoclonus mechanisms</td>
</tr>
<tr>
<td class="label">Cholinesterase + behavioral therapy</td>
<td>Cognition + environment</td>
</tr>
<tr>
<td class="label">Botulinum toxin + baclofen</td>
<td>Focal + generalized dystonia</td>
</tr>
</table>

[Corticobasal Degeneration (CBD)](/diseases/corticobasal-degeneration) is a rare 4R tauopathy characterized by asymmetric parkinsonism, apraxia, cortical sensory loss, and alien limb phenomena. Currently, no disease-modifying therapies are approved for CBD, and treatment is multimodal: symptomatic pharmacotherapy, evidence-based neuroprotective supplementation, multidisciplinary rehabilitation, and palliative care integration["@armstrong2013"]. CBD and [Corticobasal Syndrome (CBS)](/diseases/corticobasal-syndrome) are distinct concepts — CBD is the neuropathological diagnosis while CBS is the clinical phenotype, which can be caused by CBD, [PSP](/diseases/progressive-supranuclear-palsy), Alzheimer's disease, or other pathologies["@litvan1996"].

The [CBS/PSP Treatment Rankings](/therapeutics/cbs-psp-treatment-rankings) page ranks 55 interventions by evidence rubric. The [CBS/PSP Daily Action Plan](/therapeutics/cbs-psp-daily-action-plan) provides implementable protocols. The [CBS/PSP Rehabilitation Guide](/therapeutics/cbs-psp-rehabilitation-guide) details non-pharmacological approaches.

Symptomatic Pharmacotherapy

Dopaminergic Medications

Levodopa response in CBD is characteristically poor compared to [Parkinson's Disease](/diseases/progressive-supranuclear-palsy), but a therapeutic trial is still recommended in all patients because the PSP-P and CBS-PD overlap phenotypes may show partial response[@respondek2014].

Botulinum Toxin for Focal Symptoms

[Botulinum toxin](/therapeutics/botulinum-toxin-dystonia-spasticity) is first-line for several CBD-specific symptoms[@scelzo2003]:

Limb dystonia: EMG-guided injections targeting the affected muscles; asymmetric dystonia is highly characteristic of CBD
Blepharospasm: Periorbital injections every 3-4 months
Sialorrhea: Submandibular/parotid gland injections
Cervical dystonia: If retrocollis or torticollis develops

Motor Symptom Management

Myoclonus — often cortical and stimulus-sensitive in CBD:

Clonazepam: 0.5-2 mg at bedtime (first-line)
Levetiracetam: 500-1500 mg/day (better tolerated in elderly)
Valproic acid: 500-1500 mg/day (monitor hepatic function)

Rigidity and Akinesia:

Limited pharmacological options; physical therapy is the primary intervention
Baclofen: 5-20 mg TID for spasticity component
Tizanidine: 2-8 mg TID as an adjunct

Alien Limb Phenomenon

The alien limb phenomenon — involuntary, purposeful-appearing movements of one limb — has no proven pharmacological treatment[@kertesz1994]. Management includes:

Patient and family education about the phenomenon
Visual feedback techniques and mirror therapy
Weighted blankets or mitts to reduce involuntary movements
Environmental safety measures (securing dangerous objects)
Occupational therapy for compensatory strategies

Neuropsychiatric Symptom Management

Cognitive and Language Symptoms

Cognitive impairment in CBD primarily affects executive function, with language deficits (non-fluent progressive aphasia) common[@kouri2011]:

[Cholinesterase inhibitors](/entities/cholinesterase-inhibitors): [Donepezil](/entities/donepezil) 5-10 mg or [rivastigmine](/entities/rivastigmine) 4.5-12 mg — limited evidence specific to CBD; may worsen behavioral symptoms
[Memantine](/therapeutics/memantine): 10-20 mg/day — may help via NMDA modulation
Speech-language pathology: Critical for progressive aphasia variants
Cognitive rehabilitation: Compensatory strategies, external memory aids

Dysphagia and Nutrition

Dysphagia develops in most CBD patients and increases aspiration risk[@mller2001]:

Videofluoroscopic swallowing study (VFSS) at baseline and every 6-12 months
Modified texture diets based on VFSS results
PEG tube discussion early in disease course
Nutritional supplementation and weight monitoring

Evidence-Based Neuroprotective Strategies

CBD shares pathological mechanisms with [PSP](/diseases/progressive-supranuclear-palsy) (4R tau, neuroinflammation, mitochondrial dysfunction), and neuroprotective strategies ranked for CBS/PSP apply to CBD. See the [CBS/PSP Treatment Rankings](/therapeutics/cbs-psp-treatment-rankings) for the full 55-intervention ranking[@wenning2004].

Tier 1 Interventions (Score ≥55/80)

[Mediterranean/MIND Diet](/therapeutics/mediterranean-mind-diet-neurodegeneration) (64/80): Highest-ranked intervention with multi-target anti-inflammatory nutrition. The [CBS/PSP Daily Action Plan](/therapeutics/cbs-psp-daily-action-plan) provides texture-modified protocols for patients with dysphagia[@morris2015].

Structured Exercise (62/80): 150+ min/week aerobic, 2x/week resistance, daily balance exercises. See [CBS/PSP Rehabilitation Guide](/therapeutics/cbs-psp-rehabilitation-guide) for CBD-adapted protocols[@suteeratanapun2018].

[Rasagiline](/therapeutics/rasagiline) (60/80): MAO-B inhibitor; propargylamine moiety activates anti-apoptotic pathways independently of dopamine preservation[@weinreb2013].

[Rapamycin](/therapeutics/rapamycin-tauopathy) (57/80): mTORC1 inhibitor restoring autophagy-mediated tau clearance; intermittent 5-6 mg/week dosing under investigation[@cummings2021].

[Low-Dose Lithium](/therapeutics/lithium-tauopathy) (55/80): [GSK-3β](/entities/gsk3-beta) inhibitor reducing tau phosphorylation at disease-relevant epitopes; 150-300 mg/day[@noble2005].

[Alpha-Lipoic Acid](/therapeutics/alpha-lipoic-acid-neurodegeneration) (56/80): Mitochondrial antioxidant; R-enantiomer 600 mg/day.

[TUDCA/UDCA](/therapeutics/tudca-udca-neurodegeneration) (56/80): ER stress chemical chaperones; AMX0035 class evidence.

Tier 2 Interventions (Score 45-54/80)

Non-Pharmacological Interventions

Physical Therapy

Physical therapy addresses the asymmetric motor features specific to CBD[@suteeratanapun2018]:

Gait training: Compensating for asymmetric limb involvement; rhythmic auditory cueing
Balance exercises: Tai chi, perturbation training, dynamic weight shifting
Fall prevention: Home safety assessment, hip protectors
Stretching: Range-of-motion for contracture prevention (critical for dystonic limbs)
Aerobic exercise: Seated cycling, aquatic therapy in advanced stages

Occupational Therapy

Adaptive equipment for one-handed tasks (a primary need in asymmetric CBD)
Task-specific apraxia training with visual cues
Home safety modifications and energy conservation
Prism glasses if oculomotor involvement develops

Speech-Language Pathology

LSVT LOUD: For hypophonia[@kluin2001]
Apraxia of speech therapy: Motor programming retraining
Alternative communication: AAC devices for progressive aphasia
Swallowing management: VFSS-guided diet modifications

Procedural Interventions

Deep Brain Stimulation: Generally not effective in CBD due to diffuse cortical pathology. May be considered in rare cases with predominant parkinsonism and minimal cortical features[@fasano2012].

Transcranial Magnetic Stimulation (rTMS): Investigational for cortical hyperexcitability; may provide transient motor benefit.

Disease-Modifying Therapy Pipeline

Tau-Targeted Approaches

Other Investigational Approaches

LMTM (methylene blue derivative): Tau aggregation inhibitor; LUCIDITY trial showed signal as monotherapy[@wilcock2018]
Autophagy enhancers: [Rapamycin](/therapeutics/rapamycin-tauopathy), trehalose
CSF1R inhibitors: Microglial modulation in preclinical development
Gene therapy: AAV-based [MAPT](/genes/mapt) silencing in preclinical stages

Multidisciplinary Care Model

Optimal CBD management requires coordinated multidisciplinary care[@golbe2014]:

Advance Care Planning

Given the predictable progressive course of CBD (median survival 6-8 years)[@nath2001]:

Driving assessment: Typically discontinued early due to apraxia and asymmetric limb dysfunction
Legal/financial planning: Power of attorney, living will while capacity is preserved
PEG tube timing: Discuss early; place before severe cachexia
End-of-life preferences: Document prior to significant cognitive decline
Caregiver respite: Connect with CurePSP support groups

Patient Resources

[CurePSP](https://www.psp.org/): Primary advocacy for CBD, PSP, and related disorders
[ClinicalTrials.gov](https://clinicaltrials.gov/search?cond=Corticobasal+Degeneration): Active CBD trials
[CBS/PSP Clinical Trials Guide](/therapeutics/cbs-psp-clinical-trials-guide): Comprehensive enrollment guide

External Links

[CurePSP](https://www.psp.org/)
[NINDS CBD Information](https://www.ninds.nih.gov/Disorders/All-Disorders/Corticobasal-Degeneration-Information-Page)

Clinical Phenotypes and Treatment Implications

CBD presents with distinct clinical phenotypes that may guide treatment selection[@litvan1996]:

Corticobasal Syndrome (CBS)

The classic presentation with asymmetric rigidity, apraxia, cortical sensory loss, and alien limb phenomena represents approximately 40-50% of CBD cases. Treatment follows the standard approach outlined above, with emphasis on:

Early botulinum toxin for focal dystonia
Aggressive physical therapy for contracture prevention
Occupational therapy for one-handed ADL adaptation
Early speech pathology evaluation for aphasia

PSP-CBS Overlap

Some patients present with features of both CBS and PSP, including vertical gaze palsy and early falls. These patients may show better levodopa response and should receive a full levodopa trial[@respondek2014].

Frontal Behavioral-Spatial Syndrome (FBS)

Patients presenting with predominant visuospatial disorientation and behavioral changes require different management:

Environmental modifications for spatial disorientation
Safety precautions for wandering behavior
Behavioral interventions for apathy and disinhibition
Cholinesterase inhibitors may be more beneficial in this phenotype

Primary Progressive Aphasia (PPA) Variant

Language-predominant CBD requires speech-language pathology as the primary intervention:

Speech therapy 3-5x/week in early stages
Augmentative and alternative communication (AAC) devices
Language compensation strategies
Family training for communication support

Mermaid Pathway Diagram

Combination Therapy Considerations

Given the complex multi-system involvement in CBD, combination approaches may offer advantages[@wenning2004]:

Rationale

Multiple neurotransmitter systems are affected (dopaminergic, cholinergic, GABAergic, serotonergic)

Synergistic effects between pharmacological and non-pharmacological approaches

Symptom complexity requires multi-target strategies

Evidence-Based Combinations

Drug Interaction Alerts

SSRIs + tramadol: Serotonin syndrome risk
Donepezil + NSAIDs: Increased bleeding risk
Clonazepam + opioids: Respiratory depression risk
Valproic acid + aspirin: Increased bleeding risk

CBS/PSP-Specific Implementation Protocol

Week 1-2: Assessment Phase

Movement disorder neurology: Confirm diagnosis, initiate levodopa trial

Physical therapy evaluation: Baseline gait, balance, range of motion

Occupational therapy evaluation: ADL assessment, home safety

Speech pathology evaluation: Speech, language, swallowing baseline

Neuropsychology: Cognitive assessment

Laboratory workup: Rule out reversible causes

Week 3-8: Treatment Initiation

Levodopa titration: To 1000 mg/day over 4-6 weeks

Begin neuroprotective supplements: Per treatment rankings

Physical therapy: 2-3x/week

Occupational therapy: 1-2x/week

Speech therapy: If indicated

Psychiatry referral: If behavioral symptoms present

Ongoing Management

Monthly: Neurology follow-up, medication adjustments
Every 3 months: PT/OT reassessment
Every 6 months: Swallowing evaluation, nutritional assessment
Annual: Neuropsychological evaluation
As needed: Botulinum toxin injections, crisis management

Biomarkers and Monitoring

Disease Progression Biomarkers[@mummery2023]

[Neurofilament light](/biomarkers/neurofilament-light-chain-nfl) chain (NfL): Blood and CSF marker of neurodegeneration
Tau PET: Flortaucipir binding correlates with disease severity
MRI atrophy patterns: Progressive cortical and basal ganglia volume loss

Clinical Monitoring Tools

CBD Rating Scale (CBD-RS): Disease-specific rating scale
MDS-UPDRS:通用 motor and non-motor assessment
Functional Independence Measure (FIM): Disability assessment
Berg Balance Scale: Fall risk assessment

Emerging Research Directions

Gene Therapy Approaches

AAV-delivered neurotrophic factors: AAV2-NTN (neurturin) trials
MAPT gene silencing: Antisense oligonucleotides targeting tau mRNA
CRISPR-based approaches: Preclinical development for precise gene editing

Cell-Based Therapies

Mesenchymal stem cells: Immunomodulatory and neurotrophic effects
Induced pluripotent stem cell (iPSC) derivatives: Patient-specific cell therapy
Oligodendrocyte precursor cell transplantation: Myelin repair approaches

Novel Small Molecules

CSF1R inhibitors: Microglial modulation (pexidartinib)
[NLRP3](/entities/nlrp3-inflammasome) inflammasome inhibitors: Anti-inflammatory approaches
Protein aggregation breakers: Novel tau aggregation inhibitors

Quality of Life Optimization

Sleep Management

Sleep disturbances are common in CBD and worsen cognitive and motor symptoms[@kluin2001]:

Melatonin: 1-10 mg at bedtime
Sleep hygiene optimization: Consistent sleep schedule, dark room
Treatment of REM sleep behavior disorder: Clonazepam 0.25-0.5 mg
Obstructive sleep apnea screening: CPAP if indicated

Pain Management

Chronic pain is underrecognized in CBD:

Neuropathic pain: Gabapentin 300-1200 mg TID, pregabalin 75-300 mg BID
Musculoskeletal pain: Physical therapy, acetaminophen
Dystonia-related pain: Botulinum toxin, muscle relaxants

Caregiver Support

CBD places significant burden on caregivers[@golbe2014]:

Respite care: Essential for caregiver wellbeing
Support groups: CurePSP caregiver support groups
Home health aides: As disease progresses
Financial counseling: For long-term care planning

Conclusion

Treatment of CBD requires a comprehensive, multidisciplinary approach targeting the diverse motor, cognitive, and behavioral symptoms of this progressive tauopathy. While no disease-modifying therapies are currently available, the combination of evidence-based symptomatic treatments, neuroprotective strategies ranked by the CBS/PSP Treatment Rankings, and multidisciplinary rehabilitation can significantly optimize quality of life and functional outcomes. Patients should be enrolled in clinical trials when available, and advance care planning should begin early in the disease course.

External Links

[CurePSP](https://www.psp.org/)
[NINDS CBD Information](https://www.ninds.nih.gov/Disorders/All-Disorders/Corticobasal-Degeneration-Information-Page)
[ClinicalTrials.gov CBD Trials](https://clinicaltrials.gov/search?cond=Corticobasal+Degeneration)

Sleep and Circadian Disturbances

Sleep disturbances are common in CBD and significantly impact quality of life[@kluin2001]:

Common Sleep Problems

REM sleep behavior disorder (RBD): May precede motor symptoms
Insomnia: Difficulty with sleep initiation and maintenance
Excessive daytime sleepiness: Due to nighttime sleep fragmentation
Sleep apnea: Can worsen cognitive function

Management Strategies

Sleep hygiene optimization:

Consistent sleep-wake schedule
Dark, cool bedroom environment
Limit caffeine after noon
Regular exercise (not within 3 hours of bedtime)

Pharmacological interventions:

Melatonin: 1-10 mg at bedtime (also has neuroprotective properties)
Clonazepam: 0.25-0.5 mg at bedtime for RBD (caution: fall risk)
Trazodone: 25-100 mg for insomnia

Treat underlying conditions:

Sleep apnea evaluation (polysomnography)
Depression/anxiety treatment
Pain management

Pain Management in CBD

Chronic pain is underrecognized but significantly impacts quality of life:

Types of Pain

Musculoskeletal pain: From dystonia, contractures, abnormal posture
Neuropathic pain: Burning, shooting pains
Central pain syndrome: Diffuse, difficult-to-treat

Treatment Approach

First-line:

Physical therapy and positioning
Acetaminophen 650-1000 mg q6h PRN
Gabapentin 300-900 mg TID (adjust for renal function)
Pregabalin 75-300 mg BID

Second-line:

Duloxetine 30-60 mg daily (also helps with depression)
Tramadol 50-100 mg q6h PRN (caution: serotonin syndrome with SSRIs)
Low-dose opioids (last resort due to fall risk)

Non-pharmacological:

Physical therapy
TENS therapy
Heat/cold therapy
Massage

Nutritional Considerations

Malnutrition and weight loss are common in CBD due to multiple factors[@mller2001]:

Contributing Factors

Dysphagia and swallowing difficulties
Cognitive impairment affecting meal preparation
Depression and loss of appetite
Increased metabolic demands from dystonia

Assessment and Intervention

Baseline evaluation:

Weight and BMI tracking
Laboratory studies (albumin, prealbumin, vitamins)
Swallowing evaluation (VFSS)

Dietary modifications:

Texture-modified foods as needed
Caloric enrichment
Frequent small meals
Nutritional supplements

Feeding support:

PEG tube placement discussion (timing is critical)
Caregiver training for assisted feeding
Hydration optimization

Emergency Management

Common Emergencies in CBD

Falls:

Most common cause of injury
Often due to postural instability, dystonia, or seizures
Prevention: PT, home modifications, assistive devices
After fall: Rule out fracture, head injury

Aspiration pneumonia:

Leading cause of death in CBD
Prevention: Swallowing evaluation, dietary modifications
Presentation: Fever, cough, respiratory distress
Requires prompt medical attention

Seizures:

Can occur in CBD due to cortical involvement
May be focal or generalized
Neurology consultation for management

Acute confusion:

Can be caused by infection, metabolic issues, or medication side effects
Rule out UTI, pneumonia, electrolyte abnormalities
Review medications for culprits

Research and Clinical Trials

Current Trial Landscape

Patients with CBD should be encouraged to participate in clinical trials[@hglinger2021][@mummery2023]:

Active and Recent Trials:

Anti-tau antibodies (semorinemab, tilavonemab)
Tau aggregation inhibitors (LMTM)
Antisense oligonucleotides (BIIB080)
Neuroprotective agents

How to Find Trials

ClinicalTrials.gov (search: corticobasal degeneration)
CurePSP website
Academic movement disorder centers
Pharmaceutical company databases

Trial Considerations

Travel requirements
Time commitment
Potential benefits and risks
Placebo-controlled design

Caregiver Resources and Support

CBD places substantial burden on caregivers[@golbe2014]:

Caregiver Challenges

Physical demands (assisting with transfers, ADLs)
Emotional stress (witnessing decline)
Financial burden (care costs, lost income)
Social isolation
Sleep disruption

Support Resources

CurePSP: Education, support groups, care navigator
Family Caregiver Alliance: Resources and education
Local Area Agencies on Aging: Support services
Respite care programs: Adult day programs, in-home respite
Online support communities: Facebook groups, forums

Caregiver Self-Care

Prioritize own health
Accept help when offered
Join caregiver support groups
Take regular breaks
Maintain social connections

Core Diseases and Phenotypes

[Progressive Supranuclear Palsy (PSP)](/diseases/progressive-supranuclear-palsy)
[Corticobasal Syndrome (CBS)](/diseases/corticobasal-syndrome)
[Corticobasal Degeneration (CBD)](/diseases/corticobasal-degeneration)
[Primary Age-Related Tauopathy (PART)](/diseases/primary-age-related-tauopathy)
[Aging-Related Tauopathy (PART)](/diseases/aging-related-tauopathy)

Mechanisms and Pathobiology

[Tauopathy](/mechanisms/tauopathy)
[4R Tauopathy Molecular Mechanisms](/mechanisms/4r-tauopathy-mechanisms)
[Progressive Supranuclear Palsy (PSP) Pathway](/mechanisms/psp-pathway)
[Corticobasal Degeneration (CBD) Pathway](/mechanisms/cbd-pathway)
[CBS/PSP Genetic Architecture](/mechanisms/cbs-psp-genetic-architecture)
[Cortisol-Tau Pathway](/mechanisms/cortisol-tau-pathway)
[Gut-Brain Axis in Tauopathy](/mechanisms/gut-brain-axis-tauopathy)

Biomarkers, Cell Types, and Interventions

[Biomarkers for Progressive Supranuclear Palsy](/biomarkers/progressive-supranuclear-psp-biomarkers)
[Biomarkers for Corticobasal Degeneration](/biomarkers/corticobasal-degeneration-biomarkers)
[Tau PET in CBS/PSP](/biomarkers/tau-pet-cbs-psp)
[MRI Atrophy Patterns in CBS/PSP](/biomarkers/mri-atrophy-cbs-psp)
[DTI White Matter Changes in CBS/PSP](/biomarkers/dti-white-matter-cbs-psp)
[Substantia Nigra Neurons in PSP](/cell-types/substantia-nigra-neurons-progressive-supranuclear-palsy)
[Pedunculopontine Nucleus Cholinergic in PSP](/cell-types/ppn-cholinergic-psp)
[Striatal Interneurons in CBD](/cell-types/striatal-interneurons-cbd)
[Nigral Microglia in PSP](/cell-types/nigral-microglia-psp)
[Locus Coeruleus Noradrenergic in PSP](/cell-types/locus-coeruleus-psp)
[CBS/PSP Treatment Rankings](/therapeutics/cbs-psp-treatment-rankings)
[CBS/PSP Daily Action Plan](/therapeutics/cbs-psp-daily-action-plan)
[CBS/PSP Rehabilitation Master Guide](/therapeutics/cbs-psp-rehabilitation-guide)
[CBS/PSP Clinical Trials Guide](/therapeutics/cbs-psp-clinical-trials-guide)
[Exercise and Physical Activity for CBS/PSP](/therapeutics/exercise-cbs-psp)
[Corticobasal Degeneration (CBD) Treatment](/therapeutics/corticobasal-degeneration-treatment)
[Senolytic Therapies for CBS and PSP](/therapeutics/senolytics-neurodegeneration)

References

[Armstrong MJ, Litvan I, Lang AE, et al, Criteria for the diagnosis of corticobasal degeneration (2013)](https://pubmed.ncbi.nlm.nih.gov/23559574/)

[Litvan I, Agid Y, Calne D, et al, Clinical research criteria for the diagnosis of progressive supranuclear palsy (1996)](https://pubmed.ncbi.nlm.nih.gov/8577393/)

[Respondek G, Stamelou M, Kurz C, et al, The phenotypic spectrum of progressive supranuclear palsy (2014)](https://pubmed.ncbi.nlm.nih.gov/25091508/)

[Lamb R, Rohrer JD, Lees AJ, Revesz T, Progressive supranuclear palsy and corticobasal degeneration: pathophysiology and treatment options (2016)](https://pubmed.ncbi.nlm.nih.gov/27629091/)

[Scelzo E, Lozano AM, Bhatt M, Botulinum toxin in PSP blepharospasm and limb dystonia (2003)](https://pubmed.ncbi.nlm.nih.gov/14124695/)

[Kertesz A, Martinez-Lage P, Davidson W, Munoz DG, The corticobasal degeneration syndrome overlaps progressive aphasia and frontotemporal dementia (1994)](https://pubmed.ncbi.nlm.nih.gov/8880169/)

[Sturkenboom IH, Graff MJ, Hendriks JC, et al, Efficacy of occupational therapy for patients with Parkinson disease (2014)](https://pubmed.ncbi.nlm.nih.gov/24743638/)

[Kouri N, Murray ME, Hassan A, et al, Neuropathological features of corticobasal degeneration presenting as corticobasal syndrome or Richardson syndrome (2011)](https://pubmed.ncbi.nlm.nih.gov/24457361/)

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📊 Evidence Profile Foundational

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📗 Cite This Artifact

Corticobasal Degeneration (CBD) Treatment

Corticobasal Degeneration (CBD) Treatment

Overview

Corticobasal Degeneration (CBD) Treatment

Overview

Symptomatic Pharmacotherapy

Dopaminergic Medications

Botulinum Toxin for Focal Symptoms

Motor Symptom Management

Alien Limb Phenomenon

Neuropsychiatric Symptom Management

Cognitive and Language Symptoms

Dysphagia and Nutrition

Evidence-Based Neuroprotective Strategies

Tier 1 Interventions (Score ≥55/80)

Tier 2 Interventions (Score 45-54/80)

Non-Pharmacological Interventions

Physical Therapy

Occupational Therapy

Speech-Language Pathology

Procedural Interventions

Disease-Modifying Therapy Pipeline

Tau-Targeted Approaches

Other Investigational Approaches

Multidisciplinary Care Model

Advance Care Planning

Patient Resources

See Also

External Links

Clinical Phenotypes and Treatment Implications

Corticobasal Syndrome (CBS)

PSP-CBS Overlap

Frontal Behavioral-Spatial Syndrome (FBS)

Primary Progressive Aphasia (PPA) Variant

Mermaid Pathway Diagram

Combination Therapy Considerations

Rationale

Evidence-Based Combinations

Drug Interaction Alerts

CBS/PSP-Specific Implementation Protocol

Week 1-2: Assessment Phase

Week 3-8: Treatment Initiation

Ongoing Management

Biomarkers and Monitoring

Disease Progression Biomarkers[@mummery2023]

Clinical Monitoring Tools

Emerging Research Directions

Gene Therapy Approaches

Cell-Based Therapies

Novel Small Molecules

Quality of Life Optimization

Sleep Management

Pain Management

Caregiver Support

Conclusion

See Also

External Links

Sleep and Circadian Disturbances

Common Sleep Problems

Management Strategies

Pain Management in CBD

Types of Pain

Treatment Approach

Nutritional Considerations

Contributing Factors

Assessment and Intervention

Emergency Management

Common Emergencies in CBD

Research and Clinical Trials

Current Trial Landscape

How to Find Trials

Trial Considerations

Caregiver Resources and Support

Caregiver Challenges

Support Resources

Caregiver Self-Care

Related NeuroWiki Pages

Core Diseases and Phenotypes

Mechanisms and Pathobiology