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Few studies have systematically evaluated the diagnostic process from symptom onset to death in representative cohorts.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>All PSP\/CBD cases (<jats:italic>n<\/jats:italic>\u2009=\u200928\/2) and age-sex matched Parkinson\u2019s disease (PD) cases (<jats:italic>n<\/jats:italic>\u2009=\u200930) were identified from a UK prospective incident Parkinsonism cohort. Medical and research records were reviewed to compare median times from first index symptom to key diagnostic milestones and the nature\/timing of secondary care referral and review.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Index symptoms were similar apart from more tremor in PD (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and more impaired balance (<jats:italic>p<\/jats:italic>\u2009=\u20090.008) and falls (<jats:italic>p<\/jats:italic>\u2009=\u20090.004) in PSP\/CBD. PD was diagnosed a median 0.96\u00a0years after index symptom. In PSP\/CBD the median times from index symptom to identifying parkinsonism and then including PSP\/CBD in the differential diagnosis and the final diagnosis were 1.88, 3.41 and 4.03\u00a0years, respectively (all <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Survival from symptom onset in PSP\/CBD and PD was not significantly different (5.98 vs 6.85\u00a0years, <jats:italic>p<\/jats:italic>\u2009=\u20090.72). More diagnoses (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) were considered in PSP\/CBD. Prior to diagnosis, PSP\/CBD patients had more recurrent emergency attendances (33.3% vs 10.0%, <jats:italic>p<\/jats:italic>\u2009=\u20090.01) and were referred to more specialities than PD (median 5 vs 2). Time to any outpatient referral (0.70 vs 0.03\u00a0years, <jats:italic>p<\/jats:italic>\u2009=\u20090.025) and to specialist movement disorder review (1.96 vs 0.57\u00a0years, <jats:italic>p<\/jats:italic>\u2009=\u20090.002) was longer in PSP\/CBD.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>The duration and complexity of the diagnostic journey were greater in PSP\/CBD than age-sex matched PD but can be improved. In this older cohort, there was little difference in survival from symptom onset in PSP\/CBD and age-sex matched PD.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00415-023-11629-x","type":"journal-article","created":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T15:03:29Z","timestamp":1679929409000},"page":"3464-3474","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["The evolution of diagnosis from symptom onset to death in progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD) compared to Parkinson\u2019s disease (PD)"],"prefix":"10.1007","volume":"270","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0994-3561","authenticated-orcid":false,"given":"Diane M. 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