Symptoms of PSP usually worsen gradually over time and can vary significantly between individuals. Early symptoms can sometimes be mistaken for normal aging or other conditions. Common symptoms include:

• Balance and Mobility Problems: This is often one of the first and most prominent symptoms, leading to frequent and unexplained falls, especially backward. People with PSP may experience muscle stiffness (axial rigidity), particularly in the neck and trunk, and have an unsteady or clumsy gait.
• Eye Movement Abnormalities (Supranuclear Gaze Palsy): This is a hallmark symptom of PSP. Individuals may have difficulty moving their eyes, especially up and down, and later from side to side. This can lead to blurred or double vision, difficulty focusing, and a tendency to move the head rather than the eyes to look in different directions. Eyelid problems like reduced blinking, involuntary blinking (blepharospasm), or difficulty opening the eyes are also common.
• Speech and Swallowing Difficulties (Dysarthria and Dysphagia): Speech may become slow, quiet, or slurred. Swallowing can become increasingly difficult, leading to choking and a higher risk of aspiration pneumonia (a chest infection caused by food or liquid entering the lungs).
• Cognitive and Behavioral Changes: These can include slowness of thought, mild-to-moderate memory problems, difficulty with reasoning and decision-making, impulsivity, poor judgment, irritability, apathy (lack of interest), and sometimes unexplained emotional outbursts (crying or laughing).
• Other Symptoms: Muscle stiffness, tremors (though less common and prominent than in Parkinson’s), a fixed or startled facial expression, dizziness, and sleep disturbances can also occur.