Table 11.

Management of behavioral disturbances in PSP/CBS.

1. Pharmacologic management

a. Apathy:

i. Trial of modafinil or methylphenidate

b. Impulsivity

i. Behavioral approaches difficult because of frontal deficit.

ii. Reduce levodopa and other dopaminergic medications

iii. Trial of SSRI such as escitalopram or sertraline at standard dosages

iv. Mood stabilizers such as valproic acid and lamotrigine

v. ADHD drugs such as atomoxetine

c. Depression/Mood disorder

i Trial of SSRI at standard dosages

ii Avoid tricyclic antidepressants due to side effects

d. Pseudobulbar affect

i. Trial of SSRI at standard dosages

ii. Dextromethorphan-quinidine (second-line due to cost)

2. Non-pharmacologic management

a. Caregiver/family education emphasizing that deficit is part of disease

b. Occupational therapy

c. Cognitive behavioral therapy

d. Safety screening

i. Risk of medication mismanagement,

ii. Financial risk

iii. Use of a stove

iv. Driving

v. Exposure to unsecured firearms