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A careful evaluation of symptoms can diagnose progressive supranuclear palsy (PSP), but PSP is difficult to diagnose in its early stages. Often, it may mimic either Parkinson's disease or an inner ear infection, because balance is so affected—diagnosis usually includes ruling out other conditions.
Balance problems and changes in gait are the clearest symptoms that can identify PSP, particularly when combined with an inability to control or move the eyes. However, these changes in eye movement may develop later in the progression of symptoms or are mild.
Often, a careful neurological examination, cognitive testing, and imaging test are done to evaluate a person suspected of having PSP.