MDS criteria for the diagnosis of progressive supranuclear palsy overemphasize Richardson syndrome.

MDS-criteria for clinical diagnosis of progressive supranuclear palsy (PSP) were recently published, their usability in a classical clinical setting is yet unknown. We retrospectively applied the new criteria using PSP patients' case files. Assignment of PSP diagnosis according to the MDS-criteria was possible in 57/80 cases. The main difference to former specialist classification was a lower phenotype diversity and higher representation of PSP-RS. Furthermore, we examined those patients' brain MRIs. While neuroradiologists' reports were suggestive of PSP only in 11/62, the analysis of a blinded rater revealed pathological midbrain-to-pons-ratio in 40/62 implying this imaging feature is often missed.