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Dickerson BC, Atri A, Clevenger C, Karlawish J, Knopman D, Lin PJ, Norman M, Onyike C, Sano M, Scanland S, Carrillo M. The Alzheimer's Association clinical practice guideline for the Diagnostic Evaluation, Testing, Counseling, and Disclosure of Suspected Alzheimer's Disease and Related Disorders (DETeCD-ADRD): Executive summary of recommendations for specialty care. Alzheimers Dement 2024. [PMID: 39713957 DOI: 10.1002/alz.14337] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 09/19/2024] [Accepted: 09/21/2024] [Indexed: 12/24/2024]
Abstract
US clinical practice guidelines for the diagnostic evaluation of cognitive impairment due to Alzheimer's disease (AD) or a related dementia (ADRD) are two decades old. This evidence-based guideline was developed to empower all clinicians to implement a structured approach for evaluating a patient with symptoms that may represent clinical AD/ADRD. An expert workgroup conducted a review of 7374 publications (133 met inclusion criteria) and developed recommendations as steps in an evaluation process. This summary briefly reviews core recommendations and details specialist recommendations of a high-quality, evidence-supported evaluation process aimed at characterizing, diagnosing, and disclosing the patient's cognitive functional status, cognitive-behavioral syndrome, and likely underlying brain disease so that optimal care plans to maximize patient/care partner dyad quality of life can be developed; a companion article summarizes primary care recommendations. If clinicians use the recommendations in this guideline and health-care systems provide adequate resources, outcomes should improve in most patients in most practice settings. HIGHLIGHTS: US clinical practice guidelines for the diagnostic evaluation of cognitive impairment due to Alzheimer's disease (AD) or related dementias (ADRD) are decades old and aimed at specialists. This evidence-based guideline was developed to empower all-including primary care-clinicians to implement a structured approach for evaluating a patient with symptoms that may represent clinical AD/ADRD. This summary focuses on recommendations appropriate for specialty practice settings, forming key elements of a high-quality, evidence-supported evaluation process aimed at characterizing, diagnosing, and disclosing the patient's cognitive functional status, cognitive-behavioral syndrome, and likely underlying brain disease so that optimal care plans to maximize patient/care partner dyad quality of life can be developed; a companion article summarizes primary care recommendations. If clinicians use this guideline and health-care systems provide adequate resources, outcomes should improve in most patients in most practice settings.
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Affiliation(s)
- Bradford C Dickerson
- Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Alireza Atri
- Banner Sun Health Research Institute and Banner Alzheimer's Institute, Sun City, Arizona, USA
- Department of Neurology, Center for Brain/Mind Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Carolyn Clevenger
- Department of Neurology, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Jason Karlawish
- Departments of Medicine, Medical Ethics and Health Policy, and Neurology, Perelman School of Medicine, Penn Memory Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David Knopman
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Pei-Jung Lin
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
| | - Mary Norman
- Cedars-Sinai Medical Center, Culver City, California, USA
| | - Chiadi Onyike
- Division of Geriatric Psychiatry and Neuropsychiatry, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mary Sano
- James J. Peters VAMC, Bronx, New York, USA
- Department of Psychiatry, Alzheimer's Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Susan Scanland
- Dementia Connection, LLC, Clarks Summit, Pennsylvania, USA
| | - Maria Carrillo
- Medical & Scientific Relations Division, Alzheimer's Association, Chicago, Illinois, USA
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Atri A, Dickerson BC, Clevenger C, Karlawish J, Knopman D, Lin PJ, Norman M, Onyike C, Sano M, Scanland S, Carrillo M. Alzheimer's Association clinical practice guideline for the Diagnostic Evaluation, Testing, Counseling, and Disclosure of Suspected Alzheimer's Disease and Related Disorders (DETeCD-ADRD): Executive summary of recommendations for primary care. Alzheimers Dement 2024. [PMID: 39713942 DOI: 10.1002/alz.14333] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 09/18/2024] [Accepted: 09/21/2024] [Indexed: 12/24/2024]
Abstract
US clinical practice guidelines for the diagnostic evaluation of cognitive impairment due to Alzheimer's disease (AD) or AD and related dementias (ADRD) are decades old and aimed at specialists. This evidence-based guideline was developed to empower all-including primary care-clinicians to implement a structured approach for evaluating a patient with symptoms that may represent clinical AD/ADRD. Through a modified-Delphi approach and guideline-development process (7374 publications were reviewed; 133 met inclusion criteria) an expert workgroup developed recommendations as steps in a patient-centered evaluation process. This summary focuses on recommendations, appropriate for any practice setting, forming core elements of a high-quality, evidence-supported evaluation process aimed at characterizing, diagnosing, and disclosing the patient's cognitive functional status, cognitive-behavioral syndrome, and likely underlying brain disease so that optimal care plans to maximize patient/care partner dyad quality of life can be developed; a companion article summarizes specialist recommendations. If clinicians use this guideline and health-care systems provide adequate resources, outcomes should improve in most patients in most practice settings. Highlights US clinical practice guidelines for the diagnostic evaluation of cognitive impairment due to Alzheimer's disease (AD) or AD and related dementias (ADRD) are decades old and aimed at specialists. This evidence-based guideline was developed to empower all-including primary care-clinicians to implement a structured approach for evaluating a patient with symptoms that may represent clinical AD/ADRD. This summary focuses on recommendations, appropriate for any practice setting, forming core elements of a high-quality, evidence-supported evaluation process aimed at characterizing, diagnosing, and disclosing the patient's cognitive functional status, cognitive-behavioral syndrome, and likely underlying brain disease so that optimal care plans to maximize patient/care partner dyad quality of life can be developed; a companion article summarizes specialist recommendations. If clinicians use this guideline and health-care systems provide adequate resources, outcomes should improve in most patients in most practice settings.
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Affiliation(s)
- Alireza Atri
- Banner Sun Health Research Institute and Banner Alzheimer's Institute, Sun City, Arizona, USA
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Bradford C Dickerson
- Frontotemporal Disorders Unit and Alzheimer's Disease Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Carolyn Clevenger
- Department of Neurology, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Jason Karlawish
- Departments of Medicine, Medical Ethics and Health Policy, and Neurology, Perelman School of Medicine, Penn Memory Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David Knopman
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Pei-Jung Lin
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
| | - Mary Norman
- Cedars-Sinai Medical Center, Culver City, California, USA
| | - Chiadi Onyike
- Division of Geriatric Psychiatry and Neuropsychiatry, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mary Sano
- James J. Peters VAMC, Bronx, New York, USA
- Department of Psychiatry, Alzheimer's Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Maria Carrillo
- Medical & Scientific Relations Division, Alzheimer's Association, Chicago, Illinois, USA
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van Lonkhuizen PJC, Heemskerk AW, Slutter L, van Duijn E, de Bot ST, Chavannes NH, Meijer E. Shifting focus from ideality to reality: a qualitative study on how quality of life is defined by premanifest and manifest Huntington's disease gene expansion carriers. Orphanet J Rare Dis 2024; 19:444. [PMID: 39614274 DOI: 10.1186/s13023-024-03461-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 11/14/2024] [Indexed: 12/01/2024] Open
Abstract
BACKGROUND Understanding quality of life (QoL) is important in diseases for which there is no cure to date, such as Huntington's disease (HD). A deeper level of understanding is, however, compromised by the lack of studies examining QoL from the perspectives of HD gene expansion carriers (HDGECs). Only a few qualitative studies on QoL in HD have been performed, yet none investigated how QoL is defined by HDGECs themselves. OBJECTIVE This qualitative study explores how premanifest and manifest HDGECs define their QoL. METHODS Online semi-structured interviews were conducted with 6 premanifest and 6 manifest HDGECs in the Netherlands. Qualitative content analysis was used to explore participants' QoL definitions via inductive coding and the subsequent formulation of (sub)categories and (sub)themes. RESULTS Premanifest and manifest HDGECs had a different focus when defining QoL. Two subthemes were identified for premanifest HDGECs: Thoughts about a meaningful life regardless of HD and Concerns about the future progression and impact of HD. For manifest HDGECs, two other subthemes were identified: Coming to terms with HD and Shifting perspectives due to the impact of HD. One overall theme was generated, reflecting the difference and adaptive shift in focus between premanifest and manifest HDGECs: Shifting focus from ideality to reality. CONCLUSIONS In providing optimal care, HDGECs should be considered as part of a complex, continuously changing environment, thereby taking into account their individual QoL experiences and tailoring care accordingly. HDGECs might benefit from forming helpful beliefs about future adaptability and resilience and developing adaptive coping strategies.
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Affiliation(s)
- Pearl J C van Lonkhuizen
- Department of Public Health and Primary Care, Leiden University Medical Center, Postzone V0-P, PO Box 9600, 2300 RC, Leiden, The Netherlands.
- National eHealth Living Lab, Leiden University Medical Center, Leiden, The Netherlands.
- Huntington Center Topaz Overduin, Katwijk, The Netherlands.
| | - Anne-Wil Heemskerk
- Department of Public Health and Primary Care, Leiden University Medical Center, Postzone V0-P, PO Box 9600, 2300 RC, Leiden, The Netherlands
- Huntington Center Topaz Overduin, Katwijk, The Netherlands
| | - Leanne Slutter
- Department of Public Health and Primary Care, Leiden University Medical Center, Postzone V0-P, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Erik van Duijn
- Department of Public Health and Primary Care, Leiden University Medical Center, Postzone V0-P, PO Box 9600, 2300 RC, Leiden, The Netherlands
- Huntington Center Topaz Overduin, Katwijk, The Netherlands
| | - Susanne T de Bot
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Postzone V0-P, PO Box 9600, 2300 RC, Leiden, The Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, The Netherlands
| | - Eline Meijer
- Department of Public Health and Primary Care, Leiden University Medical Center, Postzone V0-P, PO Box 9600, 2300 RC, Leiden, The Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, The Netherlands
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Eaton JE, Claassen DO. Guidance on antipsychotic selection for agitation and aggressive behavior in persons with Huntington's disease. Expert Rev Neurother 2024; 24:937-940. [PMID: 38982803 DOI: 10.1080/14737175.2024.2376836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 07/02/2024] [Indexed: 07/11/2024]
Affiliation(s)
- James E Eaton
- Vanderbilt University Medical Center, Nashville, TN, USA
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Ruitenberg MF. Cognition and movement in neurodegenerative disorders: a dynamic duo. Neural Regen Res 2024; 19:2101-2102. [PMID: 38488538 PMCID: PMC11034590 DOI: 10.4103/1673-5374.392879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/20/2023] [Accepted: 12/05/2023] [Indexed: 04/24/2024] Open
Affiliation(s)
- Marit F.L. Ruitenberg
- Department of Health, Medical and Neuropsychology, Leiden University, Leiden, the Netherlands Leiden Institute for Brain and Cognition, Leiden, the Netherlands
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McDonnell EI, Xie S, Marder K, Cui F, Wang Y. Dynamic undirected graphical models for time-varying clinical symptom and neuroimaging networks. Stat Med 2024; 43:4131-4147. [PMID: 39007408 PMCID: PMC11502120 DOI: 10.1002/sim.10143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/24/2024] [Accepted: 05/27/2024] [Indexed: 07/16/2024]
Abstract
In this work, we propose methods to examine how the complex interrelationships between clinical symptoms and, separately, brain imaging biomarkers change over time leading up to the diagnosis of a disease in subjects with a known genetic near-certainty of disease. We propose a time-dependent undirected graphical model that ensures temporal and structural smoothness across time-specific networks to examine the trajectories of interactions between markers aligned at the time of disease onset. Specifically, we anchor subjects relative to the time of disease diagnosis (anchoring time) as in a revival process, and we estimate networks at each time point of interest relative to the anchoring time. To use all available data, we apply kernel weights to borrow information across observations that are close to the time of interest. Adaptive lasso weights are introduced to encourage temporal smoothness in edge strength, while a novel elastic fused-l 0 $$ {l}_0 $$ penalty removes spurious edges and encourages temporal smoothness in network structure. Our approach can handle practical complications such as unbalanced visit times. We conduct simulation studies to compare our approach with existing methods. We then apply our method to data from PREDICT-HD, a large prospective observational study of pre-manifest Huntington's disease (HD) patients, to identify symptom and imaging network changes that precede clinical diagnosis of HD.
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Affiliation(s)
- Erin I. McDonnell
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Shanghong Xie
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
- Department of Statistics, University of South Carolina, Columbia, South Carolina, USA
| | - Karen Marder
- Department of Neurology, Columbia University Medical Center, New York, New York
- Department of Psychiatry, Columbia University Medical Center, New York, New York
- The Taub Institute for Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, New York
- Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, New York
| | - Fanyu Cui
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Yuanjia Wang
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
- Department of Psychiatry, Columbia University Medical Center, New York, New York
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van Lonkhuizen PJC, Heemskerk AW, Meijer E, van Duijn E, de Bot ST, Klempir J, Landwehrmeyer GB, Mühlbäck A, Hoblyn J, Squitieri F, Chavannes NH, Vegt NJH. Development of the Huntington Support App (HD-eHelp study): a human-centered and co-design approach. Front Neurol 2024; 15:1399126. [PMID: 39011363 PMCID: PMC11246862 DOI: 10.3389/fneur.2024.1399126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/10/2024] [Indexed: 07/17/2024] Open
Abstract
Introduction eHealth seems promising in addressing challenges in the provision of care for Huntington's disease (HD) across Europe. By harnessing information and communication technologies, eHealth can partially relocate care from specialized centers to the patients' home, thereby increasing the availability and accessibility of specialty care services beyond regional borders. Previous research on eHealth (development) in HD is however limited, especially when it comes to including eHealth services specifically designed together with HD gene expansion carriers (HDGECs) and their partners to fit their needs and expectations. Methods This article describes the qualitative human-centered design process and first evaluations of the Huntington Support App prototype: a web-app aimed to support the quality of life (QoL) of HDGECs and their partners in Europe. Prospective end-users, i.e., HDGECs, their partners, and healthcare providers (HCPs), from different countries were involved throughout the development process. Through interviews, we captured people's experiences with the disease, quality of life (QoL), and eHealth. We translated their stories into design directions that were further co-designed and subsequently evaluated with the user groups. Results The resulting prototype centralizes clear and reliable information on the disease, HD-related news and events, as well as direct contact possibilities with HCPs via an online walk-in hour or by scheduling an appointment. The app's prototype was positively received and rated as (very) appealing, pleasant, easy to use and helpful by both HDGECs and partners. Discussion By involving end-users in every step, we developed a healthcare app that meets relevant needs of individuals affected by HD and therefore may lead to high adoption and retention rates. As a result, the app provides low-threshold access to reliable information and specialized care for HD in Europe. A description of the Huntington Support App as well as implications for further development of the app's prototype are provided.
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Affiliation(s)
- Pearl J C van Lonkhuizen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
- Huntington Center Topaz Overduin, Katwijk, Netherlands
| | - Anne-Wil Heemskerk
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- Huntington Center Topaz Overduin, Katwijk, Netherlands
| | - Eline Meijer
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Erik van Duijn
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- Huntington Center Topaz Overduin, Katwijk, Netherlands
| | - Susanne T de Bot
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
| | - Jiri Klempir
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia
| | | | - Alzbeta Mühlbäck
- Department of Neurology, University Hospital Ulm, Ulm, Germany
- Isar-Amper-Klinikum, Huntington-Zentrum-Süd, Klinik Taufkirchen, Munich, Germany
| | - Jennifer Hoblyn
- St. John of God Hospital, Trinity College Dublin, Dublin, Ireland
| | - Ferdinando Squitieri
- Huntington and Rare Diseases Unit, Fondazione IRCCS Casa Sollievo della Sofferenza Research Hospital, San Giovanni Rotondo, Italy
- Centro Malattie Neurologiche Rare (CMNR), Italian League for Research on Huntington (LIRH) Foundation, Rome, Italy
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Niko J H Vegt
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
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Le Stanc L, Lunven M, Giavazzi M, Sliwinski A, Youssov K, Bachoud-Lévi AC, Jacquemot C. Cognitive reserve involves decision making and is associated with left parietal and hippocampal hypertrophy in neurodegeneration. Commun Biol 2024; 7:741. [PMID: 38890487 PMCID: PMC11189446 DOI: 10.1038/s42003-024-06416-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 06/05/2024] [Indexed: 06/20/2024] Open
Abstract
Cognitive reserve is the ability to actively cope with brain deterioration and delay cognitive decline in neurodegenerative diseases. It operates by optimizing performance through differential recruitment of brain networks or alternative cognitive strategies. We investigated cognitive reserve using Huntington's disease (HD) as a genetic model of neurodegeneration to compare premanifest HD, manifest HD, and controls. Contrary to manifest HD, premanifest HD behave as controls despite neurodegeneration. By decomposing the cognitive processes underlying decision making, drift diffusion models revealed a response profile that differs progressively from controls to premanifest and manifest HD. Here, we show that cognitive reserve in premanifest HD is supported by an increased rate of evidence accumulation compensating for the abnormal increase in the amount of evidence needed to make a decision. This higher rate is associated with left superior parietal and hippocampal hypertrophy, and exhibits a bell shape over the course of disease progression, characteristic of compensation.
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Affiliation(s)
- Lorna Le Stanc
- Département d'Études Cognitives, École Normale Supérieure-PSL, Paris, France
- Institut Mondor de Recherche Biomédicale, Inserm U955, Equipe E01 Neuropsychologie Interventionnelle, Créteil, France
- Université Paris-Est Créteil, Faculté de Santé, Créteil, France
- Université Paris Cité, LaPsyDÉ, CNRS, F-75005 Paris, France
| | - Marine Lunven
- Département d'Études Cognitives, École Normale Supérieure-PSL, Paris, France
- Institut Mondor de Recherche Biomédicale, Inserm U955, Equipe E01 Neuropsychologie Interventionnelle, Créteil, France
- Université Paris-Est Créteil, Faculté de Santé, Créteil, France
| | - Maria Giavazzi
- Département d'Études Cognitives, École Normale Supérieure-PSL, Paris, France
- Institut Mondor de Recherche Biomédicale, Inserm U955, Equipe E01 Neuropsychologie Interventionnelle, Créteil, France
- Université Paris-Est Créteil, Faculté de Santé, Créteil, France
| | - Agnès Sliwinski
- Département d'Études Cognitives, École Normale Supérieure-PSL, Paris, France
- Institut Mondor de Recherche Biomédicale, Inserm U955, Equipe E01 Neuropsychologie Interventionnelle, Créteil, France
- Université Paris-Est Créteil, Faculté de Santé, Créteil, France
- AP-HP, Centre de Référence Maladie de Huntington, Service de Neurologie, Hôpital Henri Mondor-Albert Chenevier, Créteil, France
| | - Katia Youssov
- Département d'Études Cognitives, École Normale Supérieure-PSL, Paris, France
- Institut Mondor de Recherche Biomédicale, Inserm U955, Equipe E01 Neuropsychologie Interventionnelle, Créteil, France
- Université Paris-Est Créteil, Faculté de Santé, Créteil, France
- AP-HP, Centre de Référence Maladie de Huntington, Service de Neurologie, Hôpital Henri Mondor-Albert Chenevier, Créteil, France
| | - Anne-Catherine Bachoud-Lévi
- Département d'Études Cognitives, École Normale Supérieure-PSL, Paris, France
- Institut Mondor de Recherche Biomédicale, Inserm U955, Equipe E01 Neuropsychologie Interventionnelle, Créteil, France
- Université Paris-Est Créteil, Faculté de Santé, Créteil, France
- AP-HP, Centre de Référence Maladie de Huntington, Service de Neurologie, Hôpital Henri Mondor-Albert Chenevier, Créteil, France
| | - Charlotte Jacquemot
- Département d'Études Cognitives, École Normale Supérieure-PSL, Paris, France.
- Institut Mondor de Recherche Biomédicale, Inserm U955, Equipe E01 Neuropsychologie Interventionnelle, Créteil, France.
- Université Paris-Est Créteil, Faculté de Santé, Créteil, France.
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Considine CM, Rossetti MA, Anderson K, Del Bene VA, Anderson SA, Celka AS, Edmondson MC, Sheese ALN, Piccolino A, Teixeira AL, Stout JC. Huntington study group's neuropsychology working group position on best practice recommendations for the clinical neuropsychological evaluation of patients with Huntington disease. Clin Neuropsychol 2024; 38:984-1006. [PMID: 37849335 DOI: 10.1080/13854046.2023.2267789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 10/02/2023] [Indexed: 10/19/2023]
Abstract
Objective: Neuropsychological evaluation is critical to detection and management of cognitive and neuropsychiatric changes associated with Huntington disease (HD). Accurate assessment of non-motor complications of HD is critical given the prominent impact on functional disability, frequently commensurate with or exceeding that of motor symptoms. The increasing emphasis on developing disease-modifying therapies targeting cognitive decline in HD requires consensus on clinical neuropsychological assessment methods. The Neuropsychology Working Group (NPWG) of the Huntington Study Group (HSG) sought to provide evidence and consensus-based, practical guidelines for the evaluation of cognitive and neuropsychiatric symptoms associated with HD. Method: The NPWG recruited a multi-disciplinary group of neuropsychologists, neurologists, and psychiatrists to inform best practices in assessing, diagnosing, and treating the non-motor symptoms in HD. A review was circulated among the NPWG, and in an iterative process informed by reviewed literature, best practices in neuropsychological evaluation of patients with HD were identified. Results: A brief review of the available literature and rational for a clinical consensus battery is offered. Conclusion: Clinical neuropsychologists are uniquely positioned to both detect and characterize the non-motor symptoms in HD, and further, provide neurologists and allied health professions with clinically meaningful information that impacts functional outcomes and quality of life. The NPWG provides guidance on best practices to clinical neuropsychologists in this statement. A companion paper operationalizing clinical application of previous research-based non-motor diagnostic criteria for HD is forthcoming, which also advises on non-motor symptom screening methods for the non-neuropsychologist working with HD.
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Affiliation(s)
- Ciaran M Considine
- Department of Neurology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - M Agustina Rossetti
- Department of Neurology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Kendra Anderson
- Department of Neurology, McGovern Medical School UT Health, The University of Texas Health Science Center, Houston, TX, USA
| | - Victor A Del Bene
- Department of Neurology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Sharlet A Anderson
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Andrea S Celka
- Department of Neurology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | | | - Amelia L Nelson Sheese
- Department of Neurological Sciences, University of Nebraska Medical Center College of Medicine, Omaha, NE, USA
| | - Adam Piccolino
- Psychology, Piccolino Psychological Services, Burnsville, MN, USA
| | - Antonio L Teixeira
- Department of Neurology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Julie C Stout
- Turner Institute for Brain and Mental Health, and School of Psychological Science, Monash University, Melbourne, Australia
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Migliore S, Bianco SD, Scocchia M, Maffi S, Busi LC, Ceccarelli C, Curcio G, Mazza T, Squitieri F. Prodromal Cognitive Changes as a Prognostic Indicator of Forthcoming Huntington's Disease Severity: A Retrospective Longitudinal Study. Mov Disord Clin Pract 2024; 11:363-372. [PMID: 38264920 PMCID: PMC10982604 DOI: 10.1002/mdc3.13975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 11/30/2023] [Accepted: 01/02/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Cognitive changes in Huntington's disease (HD) precede motor manifestations. ENROLL-HD platform includes four cognitive measures of information processing speed (IPS). Our group is eager to seek clinical markers in the life stage that is as close as possible to the age of onset (ie, the so called prodromal HD phase) because this is the best time for therapeutic interventions. OBJECTIVES Our study aimed to test whether cognitive scores in prodromal ENROLL-HD mutation carriers show the potential to predict the severity of motor and behavioral changes once HD became fully manifested. METHODS From the global ENROLL-HD cohort of 21,343 participants, we first selected a premanifest Cohort#1 (ie, subjects with Total Motor Score (TMS) <10 and Diagnostic Confidence Level (DCL) <4, N = 1.222). From this cohort, we then focused on a prodromal Cohort#2 of subjects who were ascertained to phenoconvert into manifest HD at follow-up visits (ie, subjects from 6 ≤ TMS≤9 and DCL <4 to TMS≥10 and DCL = 4, n = 206). RESULTS The main results of our study showed that low IPS before phenoconversion in Cohort#2 predicted the severity of motor and behavioral manifestations. By combining the four IPS cognitive measures (eg, the Categorical Verbal Fluency Test; Stroop Color Naming Test; Stroop Word Reading; Symbol Digit Modalities Test), we generated a Composite Cognition Score (CCS). The lower the CCS score the higher the TMS and the apathy scores in the same longitudinally followed-up patients after phenoconversion. CONCLUSIONS CCS might represent a clinical instrument to predict the prognosis of mutation carriers who are close to manifesting HD.
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Affiliation(s)
- Simone Migliore
- Huntington and Rare Diseases Unit, Fondazione IRCCS Casa Sollievo Della Sofferenza HospitalSan Giovanni RotondoItaly
| | | | - Marta Scocchia
- Rare Neurological Diseases Centre (CMNR)Fondazione Italian League for Research on Huntington (LIRH)RomeItaly
| | - Sabrina Maffi
- Huntington and Rare Diseases Unit, Fondazione IRCCS Casa Sollievo Della Sofferenza HospitalSan Giovanni RotondoItaly
| | - Ludovica Camilla Busi
- Rare Neurological Diseases Centre (CMNR)Fondazione Italian League for Research on Huntington (LIRH)RomeItaly
| | - Consuelo Ceccarelli
- Rare Neurological Diseases Centre (CMNR)Fondazione Italian League for Research on Huntington (LIRH)RomeItaly
| | - Giuseppe Curcio
- Department of Biotechnological and Applied Clinical SciencesUniversity of L'AquilaL'AquilaItaly
| | - Tommaso Mazza
- Bioinformatics Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza"San Giovanni RotondoItaly
| | - Ferdinando Squitieri
- Huntington and Rare Diseases Unit, Fondazione IRCCS Casa Sollievo Della Sofferenza HospitalSan Giovanni RotondoItaly
- Rare Neurological Diseases Centre (CMNR)Fondazione Italian League for Research on Huntington (LIRH)RomeItaly
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11
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Shin C, Kim R, Yoo D, Oh E, Moon J, Kim M, Lee JY, Kim JM, Koh SB, Kim M, Jeon B. A Practical Guide for Clinical Approach to Patients With Huntington's Disease in Korea. J Mov Disord 2024; 17:138-149. [PMID: 38467449 PMCID: PMC11082599 DOI: 10.14802/jmd.24040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/08/2024] [Accepted: 03/12/2024] [Indexed: 03/13/2024] Open
Affiliation(s)
- Chaewon Shin
- Department of Neurology, Chungnam National University Sejong Hospital, Sejong, Korea
- Department of Neurology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Ryul Kim
- Department of Neurology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Dallah Yoo
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - Eungseok Oh
- Department of Neurology, Chungnam National University College of Medicine, Daejeon, Korea
- Department of Neurology, Chungnam National University Hospital, Daejeon, Korea
| | - Jangsup Moon
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Genomic Medicine, Seoul National University Hospital, Seoul, Korea
| | - Minkyeong Kim
- Department of Neurology, Gyeongsang National University Hospital, Jinju, Korea
| | - Jee-Young Lee
- Department of Neurology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jong-Min Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seong-Beom Koh
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Manho Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Beomseok Jeon
- Department of Neurology, BJ Center for Comprehensive Parkinson Care and Rare Movement Disorders, Chung-Ang University Health Care System, Hyundae Hospital, Namyangju, Korea
| | - on behalf of the Korean Huntington’s Disease Society
- Department of Neurology, Chungnam National University Sejong Hospital, Sejong, Korea
- Department of Neurology, Chungnam National University College of Medicine, Daejeon, Korea
- Department of Neurology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
- Department of Neurology, Chungnam National University Hospital, Daejeon, Korea
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Genomic Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Neurology, Gyeongsang National University Hospital, Jinju, Korea
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
- Department of Neurology, BJ Center for Comprehensive Parkinson Care and Rare Movement Disorders, Chung-Ang University Health Care System, Hyundae Hospital, Namyangju, Korea
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12
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Bilal H, McDonald SJ, Stout JC, Harding IH. Associations of inflammatory cytokines and cortisol with nonmotor features of Huntington's disease. Ann Clin Transl Neurol 2024; 11:989-999. [PMID: 38356101 PMCID: PMC11021624 DOI: 10.1002/acn3.52016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/26/2023] [Accepted: 01/25/2024] [Indexed: 02/16/2024] Open
Abstract
OBJECTIVE Huntington's disease (HD) is an inherited neurodegenerative disease involving progressive motor abnormalities, cognitive decline, and psychiatric disturbances. Depression and cognitive difficulties are among the most impactful symptoms of HD, yet the pathogenesis of these symptoms is not fully understood. HD involves low-level chronic inflammation and dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, which are linked to depression and cognitive impairment in non-HD populations. However, previous research on the relationships of these pathologies with depression and cognition in HD is limited and inconsistent. METHODS Fifty-three adults with the HD gene expansion (30 premanifest and 23 manifest) completed measures of depression and cognitive functioning. Forty-eight out of 53 participants provided hair samples for quantification of cortisol, and 34 participants provided blood samples for quantification of peripheral inflammatory cytokines. We examined the associations of four cytokines (interleukin [IL]-6, IL-10, IL-1β, and tumor necrosis factor [TNF]-α) and cortisol levels with depression and cognitive scores. RESULTS In unadjusted models, higher levels of plasma IL-6, IL-10, and TNF-α correlated with higher depression scores, and higher levels of IL-10 and TNF-α correlated with poorer cognitive performance. After controlling for age, sex, and body mass index, only the correlations of IL-10 with depression and cognitive performance remained significant. No correlations were evident with hair cortisol. INTERPRETATIONS Peripheral inflammation is associated with depression symptoms and cognitive impairment in HD. Our findings suggest that interactions between the immune and nervous systems are important in HD, and highlight the potential of chronic inflammation as a therapeutic target in early stages of HD.
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Affiliation(s)
- Hiba Bilal
- School of Psychological Sciences, and Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Stuart J McDonald
- Department of Neuroscience, Central Clinical School, Monash University, Prahran, Victoria, Australia
| | - Julie C Stout
- School of Psychological Sciences, and Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Ian H Harding
- Department of Neuroscience, Central Clinical School, Monash University, Prahran, Victoria, Australia
- Monash Biomedical Imaging, Monash University, Clayton, Victoria, Australia
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Paz-Rodríguez F, Chávez-Oliveros M, Bernal-Pérez A, Ochoa-Morales A, Martínez-Ruano L, Camacho-Molina A, Rodríguez-Agudelo Y. Neuropsychological performance and disease burden in individuals at risk of developing Huntington disease. Neurologia 2024; 39:127-134. [PMID: 38272259 DOI: 10.1016/j.nrleng.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/31/2021] [Accepted: 04/06/2021] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION Huntington disease (HD) is a hereditary neurodegenerative disorder. Thanks to predictive diagnosis, incipient clinical characteristics have been described in the prodromal phase. OBJECTIVE To compare performance in cognitive tasks of carriers (HDC) and non-carriers (non-HDC) of the huntingtin gene and to analyse the variability in performance as a function of disease burden and proximity to the manifest stage (age of symptom onset). METHOD A sample of 146 participants in a predictive diagnosis of HD programme were divided into the HDC (41.1%) and non-HDC groups (58.9%). Mathematical formulae were used to calculate disease burden and proximity to the manifest stage in the HDC group; these parameters were correlated with neuropsychological performance. RESULTS Significant differences were observed between groups in performance on the Mini-Mental State Examination (MMSE), Stroop-B, Symbol-Digit Modalities Test (SDMT), and phonological fluency. In the HDC group, correlations were observed between disease burden and performance on the MMSE, Stroop-B, and SDMT. The group of patients close to the manifest stage scored lowest on the MMSE, Stroop-B, Stroop-C, SDMT, and semantic verbal fluency. According to the multivariate analysis of covariance, the MMSE effect shows statistically significant differences in disease burden and proximity to onset of symptoms. CONCLUSIONS Members of the HDC group close to the manifest phase performed more poorly on tests assessing information processing speed and attention. Prefrontal cognitive dysfunction appears early, several years before the motor diagnosis of HD.
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Affiliation(s)
- F Paz-Rodríguez
- Laboratorio de Neuropsicología, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, Mexico
| | - M Chávez-Oliveros
- Laboratorio de Neuropsicología, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, Mexico
| | - A Bernal-Pérez
- Laboratorio de Neuropsicología, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, Mexico
| | - A Ochoa-Morales
- Departamento de Genética, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, Mexico
| | - L Martínez-Ruano
- Departamento de Genética, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, Mexico
| | - A Camacho-Molina
- Departamento de Genética, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, Mexico
| | - Y Rodríguez-Agudelo
- Laboratorio de Neuropsicología, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, Mexico.
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14
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Joseph S, Robbins CB, Haystead A, Hemesath A, Allen A, Kundu A, Ma JP, Scott BL, Moore KPL, Agrawal R, Gunasan V, Stinnett SS, Grewal DS, Fekrat S. Characterizing differences in retinal and choroidal microvasculature and structure in individuals with Huntington's Disease compared to healthy controls: A cross-sectional prospective study. PLoS One 2024; 19:e0296742. [PMID: 38289919 PMCID: PMC10826956 DOI: 10.1371/journal.pone.0296742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 12/18/2023] [Indexed: 02/01/2024] Open
Abstract
OBJECTIVE To characterize retinal and choroidal microvascular and structural changes in patients who are gene positive for mutant huntingtin protein (mHtt) with symptoms of Huntington's Disease (HD). METHODS This study is a cross-sectional comparison of patients who are gene positive for mHtt and exhibit symptoms of HD, either motor manifest or prodromal (HD group), and cognitively normal individuals without a family history of HD (control group). HD patients were diagnosed by Duke movement disorder neurologists based on the Unified Huntington's Disease Rating Scale (UHDRS). Fovea and optic nerve centered OCT and OCTA images were captured using Zeiss Cirrus HD-5000 with AngioPlex. Outcome metrics included central subfield thickness (CST), peripapillary retinal nerve fiber layer (pRNFL) thickness, ganglion cell-inner plexiform layer (GCIPL) thickness, and choroidal vascularity index (CVI) on OCT, and foveal avascular zone (FAZ) area, vessel density (VD), perfusion density (PD), capillary perfusion density (CPD), and capillary flux index (CFI) on OCTA. Generalized estimating equation (GEE) models were used to account for inter-eye correlation. RESULTS Forty-four eyes of 23 patients in the HD group and 77 eyes of 39 patients in the control group were analyzed. Average GCIPL thickness and FAZ area were decreased in the HD group compared to controls (p = 0.001, p < 0.001). No other imaging metrics were significantly different between groups. CONCLUSIONS Patients in the HD group had decreased GCIPL thickness and smaller FAZ area, highlighting the potential use of retinal biomarkers in detecting neurodegenerative changes in HD.
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Affiliation(s)
- Suzanna Joseph
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, United States of America
- iMIND Research Group, Durham, NC, United States of America
| | - Cason B. Robbins
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, United States of America
- iMIND Research Group, Durham, NC, United States of America
| | - Alice Haystead
- iMIND Research Group, Durham, NC, United States of America
| | - Angela Hemesath
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, United States of America
- iMIND Research Group, Durham, NC, United States of America
| | - Ariana Allen
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, United States of America
- iMIND Research Group, Durham, NC, United States of America
| | - Anita Kundu
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, United States of America
- iMIND Research Group, Durham, NC, United States of America
| | - Justin P. Ma
- iMIND Research Group, Durham, NC, United States of America
| | - Burton L. Scott
- Department of Neurology, Duke University School of Medicine, Durham, NC, United States of America
| | - Kathryn P. L. Moore
- Department of Neurology, Duke University School of Medicine, Durham, NC, United States of America
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Vithiya Gunasan
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Sandra S. Stinnett
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, United States of America
- iMIND Research Group, Durham, NC, United States of America
| | - Dilraj S. Grewal
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, United States of America
- iMIND Research Group, Durham, NC, United States of America
| | - Sharon Fekrat
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, United States of America
- iMIND Research Group, Durham, NC, United States of America
- Department of Neurology, Duke University School of Medicine, Durham, NC, United States of America
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15
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Sampaio C, Kostyk SK, Tabrizi SJ, Rosser AE. Refining the Language of Huntington's Disease Progression with the Huntington's Disease Integrated Staging System (HD-ISS). J Huntingtons Dis 2024; 13:115-118. [PMID: 38968053 PMCID: PMC11307057 DOI: 10.3233/jhd-240043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2024] [Indexed: 07/07/2024]
Affiliation(s)
- Cristina Sampaio
- CHDI Management, Inc. Advisors to CHDI Foundation, Princeton, NJ, USA
- Faculdade Medicina da Universidade de Lisboa (FMUL), Portugal
| | - Sandra K. Kostyk
- Department of Neurology, The Ohio State University, College of Medicine, Columbus, OH, USA
- Department of Neuroscience, The Ohio State University, College of Medicine, Columbus, OH, USA
| | - Sarah J. Tabrizi
- Department of Neurodegenerative Disease, Huntington’s Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
- Dementia Research Institute at UCL, London, UK
| | - Anne E. Rosser
- Division of Psychological Medicine and Clinical Neurosciences, Brain Repair and Intracranial Neurotherapeutics (B.R.A.I.N.) Biomedical Research Unit, Cardiff University, Cardiff, UK
- Brain Repair Group, School of Biosciences, Cardiff University, Cardiff, UK
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16
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Bilal H, Harding IH, Stout JC. The relationship between disease-specific psychosocial stressors and depressive symptoms in Huntington's disease. J Neurol 2024; 271:289-299. [PMID: 37695532 PMCID: PMC10769991 DOI: 10.1007/s00415-023-11982-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Huntington's disease (HD) is an inherited neurodegenerative disease involving motor abnormalities, cognitive decline, and psychological difficulties. Depression is among the most common psychological difficulties in HD. People with HD encounter numerous stressors related to their diagnosis and the impact of HD on their daily lives. Understanding the relationship between HD-specific psychosocial stressors and depression symptoms is critical for optimising treatment and developing a holistic, disease-specific model of depression in HD. METHODS Fifty-seven adults with the HD gene expansion (33 pre-symptomatic, 24 symptomatic) completed a self-report depression questionnaire and rated how much stress they experienced in relation to 20 psychosocial challenges commonly associated with HD. We examined associations between depression symptoms and each stressor individually, and after clustering using principal components analysis. RESULTS Depression symptoms were significantly associated with most of the psychosocial stressors assessed. Clustering with principal components analysis revealed that higher depression scores had significant independent associations with greater stress related to the future implications of HD (β = .44, p = .001) and sleep and psychological difficulties (β = .28, p = .005), but not with stress related to functional limitations (β = .11, p = .33) or interpersonal issues caused by HD (β = .15, p = .21). CONCLUSIONS Stressful experiences associated with HD constitute an important risk factor for depression in HD. Our findings support the use of more psychologically informed models of depression in HD and necessitate further research on tailored psychosocial interventions for HD patients with depression.
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Affiliation(s)
- Hiba Bilal
- School of Psychological Sciences, and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Clayton, VIC, 3800, Australia
| | - Ian H Harding
- Monash Biomedical Imaging, Monash University, Clayton, VIC, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Prahran, VIC, Australia
| | - Julie C Stout
- School of Psychological Sciences, and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Clayton, VIC, 3800, Australia.
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Considine CM, Rossetti MA, Del Bene VA, Anderson K, Anderson SA, Celka AS, Edmondson MC, Nelson‐Sheese AL, Piccolino A, Teixeira AL, Stout JC. Huntington Study Group's Neuropsychology Working Group: Implementing Non-Motor Diagnostic Criteria. Mov Disord Clin Pract 2023; 10:1714-1724. [PMID: 38094638 PMCID: PMC10715363 DOI: 10.1002/mdc3.13910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 09/08/2023] [Accepted: 10/10/2023] [Indexed: 11/10/2024] Open
Abstract
Background The clinical diagnosis of manifest Huntington's disease (HD) relies on a high level of clinical confidence (99% confidence) of HD-consistent motor signs. Longitudinal data have reliably identified cognitive and behavioral dysfunction predating clinical motor diagnosis by up to 15 years. Reliance on motor signs to establish a diagnosis of HD increases risk of early misdiagnosis or delayed diagnosis. Clinical neuropsychologists are uniquely positioned to advise on the clinical application of the Movement Disorder Society Task Force's recently proposed non-motor diagnostic criteria for HD. Objectives To provide (1) a recommended clinical approach toward non-motor diagnostic criteria in persons with HD and facilitation of accurate diagnosis; (2) recommended practices for medical treatment providers to screen and longitudinally monitor non-motor signs of HD. Methods The Huntington Study Group re-established the Neuropsychology Working Group, then recruited a multi-disciplinary group of neuropsychologists, neurologists, and psychiatrists to conduct an unstructured literature review and discuss expert opinions on practice, to facilitate an informal consensus opinion to accomplish the objectives. Results The opinion and an example protocol for medical treatment providers to screen, monitor, and triage non-motor signs and symptoms of Huntington's disease is provided. Conclusions Clinical diagnosis of non-motor HD is empirically justified and clinically important. Screening and triage by non-neuropsychologist clinicians can aid in detecting and monitoring non-motor Huntington's disease manifestation. The Neuropsychology Working Group consensus advances good clinical practice, clinical research, and quality of life. A companion position paper presenting the details of our consensus opinion regarding evidence-based guidelines for neuropsychological practice is forthcoming.
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Affiliation(s)
- Ciaran M. Considine
- Department of NeurologyVanderbilt University School of MedicineNashvilleTennesseeUSA
| | - M. Agustina Rossetti
- Department of NeurologyUniversity of Virginia School of MedicineCharlottesvilleVirginiaUSA
| | - Victor A. Del Bene
- Department of NeurologyUniversity of Alabama at Birmingham Heersink School of MedicineBirminghamAlabamaUSA
| | - Kendra Anderson
- Department of Neurology, McGovern Medical School UT HealthThe University of Texas Health Science CenterHoustonTexasUSA
| | - Sharlet A. Anderson
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
| | - Andrea S. Celka
- Department of NeurologyUniversity of Alabama at Birmingham Heersink School of MedicineBirminghamAlabamaUSA
| | | | - Amelia L. Nelson‐Sheese
- Department of Neurological SciencesUniversity of Nebraska Medical Center College of MedicineOmahaNebraskaUSA
| | | | - Antonio L. Teixeira
- Department of Neurology, McGovern Medical School UT HealthThe University of Texas Health Science CenterHoustonTexasUSA
| | - Julie C. Stout
- Turner Institute for Brain and Mental Health, and School of Psychological ScienceMonash UniversityMelbourneVictoriaAustralia
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Mendizabal A, Singh AP, Perlman S, Brown A, Bordelon Y. Disparities in Huntington Disease Severity: Analysis Using the ENROLL-HD Dataset. Neurol Clin Pract 2023; 13:e200200. [PMID: 37795504 PMCID: PMC10547468 DOI: 10.1212/cpj.0000000000200200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 09/06/2023] [Indexed: 10/06/2023]
Abstract
Background and Objectives Social and structural determinants of health (SDOH) have been associated with disability in neurologic diseases. However, the association between these factors and disability in Huntington disease (HD) has not been studied. This study aimed to evaluate the association of racial and sociodemographic factors with disease severity in patients with HD in North America. Methods We conducted a cross-sectional study of genetically confirmed participants with HD (36+ CAG repeats) in the North American region using the ENROLL-HD 2020 periodic dataset. In this analysis, our exposure variable was the participant's race/ethnicity. The main outcome measure was disease severity, as measured by the Total Functional Capacity Score (TFC), which measures the level of disability of patients with HD. We used multivariate regression models to adjust for sociodemographic factors that may mediate or moderate a causal effect between race/ethnicity and disease severity. Results Among 4,717 gene-positive participants in the North American region, 89.5% identified as White, 3.4% as Hispanic or Latino, and 2.3% as African American/Black. The average TFC score was 10.22 (SD 3.22); 48% of participants completed either secondary education (including college) or a professional degree, and 55% lived in a city and not in a town, village, or rural location. In multivariate regression models, we found that Black participants and those with less than a high school degree entered the ENROLL-HD study with lower TFC scores than White participants. We also found that compared with those with at least a high school degree, those who completed some form of higher education or professional degree had higher TFC scores (p < 0.001). This multivariate analysis did not find an association between geographic location and TFC score. Discussion Our study found that Black participants in North America presented to ENROLL-HD with more advanced disease than White patients. We also found that higher education was associated with less advanced disease when entering the ENROLL-HD study. The role of race/ethnicity and education in HD symptom severity warrants further investigation. These findings underscore the importance of further studying the role of social and structural determinants of health in patients with HD, particularly those from historically marginalized communities.
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Affiliation(s)
- Adys Mendizabal
- Department of Neurology (AM, APS, SP, YB), David Geffen School of Medicine; Institute of Society and Genetics (AM); Interdepartmental Undergraduate Neuroscience Program (AM); and Division of General Internal Medicine and Health Services Research (AB), Department of Medicine, David Geffen School of Medicine, UCLA
| | - Alvin P Singh
- Department of Neurology (AM, APS, SP, YB), David Geffen School of Medicine; Institute of Society and Genetics (AM); Interdepartmental Undergraduate Neuroscience Program (AM); and Division of General Internal Medicine and Health Services Research (AB), Department of Medicine, David Geffen School of Medicine, UCLA
| | - Susan Perlman
- Department of Neurology (AM, APS, SP, YB), David Geffen School of Medicine; Institute of Society and Genetics (AM); Interdepartmental Undergraduate Neuroscience Program (AM); and Division of General Internal Medicine and Health Services Research (AB), Department of Medicine, David Geffen School of Medicine, UCLA
| | - Arleen Brown
- Department of Neurology (AM, APS, SP, YB), David Geffen School of Medicine; Institute of Society and Genetics (AM); Interdepartmental Undergraduate Neuroscience Program (AM); and Division of General Internal Medicine and Health Services Research (AB), Department of Medicine, David Geffen School of Medicine, UCLA
| | - Yvette Bordelon
- Department of Neurology (AM, APS, SP, YB), David Geffen School of Medicine; Institute of Society and Genetics (AM); Interdepartmental Undergraduate Neuroscience Program (AM); and Division of General Internal Medicine and Health Services Research (AB), Department of Medicine, David Geffen School of Medicine, UCLA
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Horta-Barba A, Martinez-Horta S, Pérez-Pérez J, Puig-Davi A, de Lucia N, de Michele G, Salvatore E, Kehrer S, Priller J, Migliore S, Squitieri F, Castaldo A, Mariotti C, Mañanes V, Lopez-Sendon JL, Rodriguez N, Martinez-Descals A, Júlio F, Januário C, Delussi M, de Tommaso M, Noguera S, Ruiz-Idiago J, Sitek EJ, Wallner R, Nuzzi A, Pagonabarraga J, Kulisevsky J. Measuring cognitive impairment and monitoring cognitive decline in Huntington's disease: a comparison of assessment instruments. J Neurol 2023; 270:5408-5417. [PMID: 37462754 PMCID: PMC10576674 DOI: 10.1007/s00415-023-11804-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Progressive cognitive decline is an inevitable feature of Huntington's disease (HD) but specific criteria and instruments are still insufficiently developed to reliably classify patients into categories of cognitive severity and to monitor the progression of cognitive impairment. METHODS We collected data from a cohort of 180 positive gene-carriers: 33 with premanifest HD and 147 with manifest HD. Using a specifically developed gold-standard for cognitive status we classified participants into those with normal cognition, those with mild cognitive impairment, and those with dementia. We administered the Parkinson's Disease-Cognitive Rating Scale (PD-CRS), the MMSE and the UHDRS cogscore at baseline, and at 6-month and 12-month follow-up visits. Cutoff scores discriminating between the three cognitive categories were calculated for each instrument. For each cognitive group and instrument we addressed cognitive progression, sensitivity to change, and the minimally clinical important difference corresponding to conversion from one category to another. RESULTS The PD-CRS cutoff scores for MCI and dementia showed excellent sensitivity and specificity ratios that were not achieved with the other instruments. Throughout follow-up, in all cognitive groups, PD-CRS captured the rate of conversion from one cognitive category to another and also the different patterns in terms of cognitive trajectories. CONCLUSION The PD-CRS is a valid and reliable instrument to capture MCI and dementia syndromes in HD. It captures the different trajectories of cognitive progression as a function of cognitive status and shows sensitivity to change in MCI and dementia.
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Affiliation(s)
- Andrea Horta-Barba
- Department of Medicine, Autonomous University of Barcelona (UAB), Bellaterra, Spain
- Movement Disorders Unit, Neurology Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
- Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- European Huntington's Disease Network (EHDN), Ulm, Germany
| | - Saul Martinez-Horta
- Department of Medicine, Autonomous University of Barcelona (UAB), Bellaterra, Spain
- Movement Disorders Unit, Neurology Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
- Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- European Huntington's Disease Network (EHDN), Ulm, Germany
| | - Jesús Pérez-Pérez
- Department of Medicine, Autonomous University of Barcelona (UAB), Bellaterra, Spain
- Movement Disorders Unit, Neurology Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
- Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- European Huntington's Disease Network (EHDN), Ulm, Germany
| | - Arnau Puig-Davi
- Movement Disorders Unit, Neurology Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
- Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- European Huntington's Disease Network (EHDN), Ulm, Germany
| | - Natascia de Lucia
- European Huntington's Disease Network (EHDN), Ulm, Germany
- University of Naples "Federico II", Naples, Italy
| | - Giuseppe de Michele
- European Huntington's Disease Network (EHDN), Ulm, Germany
- University of Naples "Federico II", Naples, Italy
| | - Elena Salvatore
- European Huntington's Disease Network (EHDN), Ulm, Germany
- University of Naples "Federico II", Naples, Italy
| | - Stefanie Kehrer
- European Huntington's Disease Network (EHDN), Ulm, Germany
- Department of Neuropsychiatry, Charité-Universitätsmedizin, Berlin, Germany
| | - Josef Priller
- European Huntington's Disease Network (EHDN), Ulm, Germany
- Department of Neuropsychiatry, Charité-Universitätsmedizin, Berlin, Germany
| | - Simone Migliore
- Huntington and Rare Diseases Unit, Fondazione IRCCS Casa Sollievo Della Sofferenza Research Hospital, San Giovanni Rotondo, Italy
| | - Ferdinando Squitieri
- Huntington and Rare Diseases Unit, Fondazione IRCCS Casa Sollievo Della Sofferenza Research Hospital, San Giovanni Rotondo, Italy
| | - Anna Castaldo
- European Huntington's Disease Network (EHDN), Ulm, Germany
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Caterina Mariotti
- European Huntington's Disease Network (EHDN), Ulm, Germany
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Veronica Mañanes
- European Huntington's Disease Network (EHDN), Ulm, Germany
- Department of Neurology, Hospital Universitario Ramon Y Cajal, Madrid, Spain
| | - Jose Luis Lopez-Sendon
- European Huntington's Disease Network (EHDN), Ulm, Germany
- Department of Neurology, Hospital Universitario Ramon Y Cajal, Madrid, Spain
| | - Noelia Rodriguez
- European Huntington's Disease Network (EHDN), Ulm, Germany
- Department of Neurology, Fundación Jimenez Diaz, Madrid, Spain
| | - Asunción Martinez-Descals
- European Huntington's Disease Network (EHDN), Ulm, Germany
- Department of Neurology, Fundación Jimenez Diaz, Madrid, Spain
| | - Filipa Júlio
- European Huntington's Disease Network (EHDN), Ulm, Germany
- Coimbra Institute for Biomedical Imaging and Translational Research-CIBIT, University of Coimbra, Coimbra, Portugal
- Neurology Department, Coimbra University Hospital, Coimbra, Portugal
| | - Cristina Januário
- European Huntington's Disease Network (EHDN), Ulm, Germany
- Coimbra Institute for Biomedical Imaging and Translational Research-CIBIT, University of Coimbra, Coimbra, Portugal
- Neurology Department, Coimbra University Hospital, Coimbra, Portugal
| | - Marianna Delussi
- European Huntington's Disease Network (EHDN), Ulm, Germany
- Applied Neurophysiology and Pain Unit, Apulian Center for Huntington's Disease SMBNOS Department, "Aldo Moro" University, Bari, Italy
| | - Marina de Tommaso
- European Huntington's Disease Network (EHDN), Ulm, Germany
- Applied Neurophysiology and Pain Unit, Apulian Center for Huntington's Disease SMBNOS Department, "Aldo Moro" University, Bari, Italy
| | - Sandra Noguera
- European Huntington's Disease Network (EHDN), Ulm, Germany
- Hospital Mare de Deu de La Mercè, Barcelona, Spain
| | - Jesús Ruiz-Idiago
- European Huntington's Disease Network (EHDN), Ulm, Germany
- Hospital Mare de Deu de La Mercè, Barcelona, Spain
| | - Emilia J Sitek
- European Huntington's Disease Network (EHDN), Ulm, Germany
- Department of Neurological and Psychiatric Nursing, Faculty of Health Science Medical, University of Gdansk, Gdańsk, Poland
- Department of Neurology, St. Adalbert Hospital, Copernicus, Gdańsk, Poland
| | - Renata Wallner
- Department of Psychiatry, Medical University of Wroclaw, Wroclaw, Poland
| | - Angela Nuzzi
- European Huntington's Disease Network (EHDN), Ulm, Germany
| | - Javier Pagonabarraga
- Department of Medicine, Autonomous University of Barcelona (UAB), Bellaterra, Spain
- Movement Disorders Unit, Neurology Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
- Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- European Huntington's Disease Network (EHDN), Ulm, Germany
| | - Jaime Kulisevsky
- Department of Medicine, Autonomous University of Barcelona (UAB), Bellaterra, Spain.
- Movement Disorders Unit, Neurology Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain.
- Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain.
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.
- European Huntington's Disease Network (EHDN), Ulm, Germany.
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20
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Davis MC, Hill AT, Fitzgerald PB, Bailey NW, Stout JC, Hoy KE. Neurophysiological correlates of non-motor symptoms in late premanifest and early-stage manifest huntington's disease. Clin Neurophysiol 2023; 153:166-176. [PMID: 37506604 DOI: 10.1016/j.clinph.2023.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 05/22/2023] [Accepted: 06/18/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVE To find sensitive neurophysiological correlates of non-motor symptoms in Huntington's disease (HD), which are essential for the development and assessment of novel treatments. METHODS We used resting state EEG to examine differences in oscillatory activity (analysing the isolated periodic as well as the complete EEG signal) and functional connectivity in 22 late premanifest and early stage people with HD and 20 neurotypical controls. We then assessed the correlations between these neurophysiological markers and clinical measures of apathy and processing speed. RESULTS Significantly lower theta and greater delta resting state power was seen in the HD group, as well as significantly greater delta connectivity. There was a significant positive correlation between theta power and processing speed, however there were no associations between the neurophysiological and apathy measures. CONCLUSIONS We speculate that these changes in oscillatory power and connectivity reflect ongoing, frontally concentrated degenerative and compensatory processes associated with HD. SIGNIFICANCE Our findings support the potential utility of quantitative EEG as a proximate marker of processing speed, but not apathy in HD.
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Affiliation(s)
- Marie-Claire Davis
- Central Clinical School, Department of Psychiatry, Monash University, Victoria, Australia; Statewide Progressive Neurological Disease Service, Calvary Health Care Bethlehem, Victoria, Australia.
| | - Aron T Hill
- Central Clinical School, Department of Psychiatry, Monash University, Victoria, Australia; Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Victoria, Australia.
| | - Paul B Fitzgerald
- Central Clinical School, Department of Psychiatry, Monash University, Victoria, Australia; School of Medicine and Psychology, Australian National University, Canberra, ACT, Australia.
| | - Neil W Bailey
- Central Clinical School, Department of Psychiatry, Monash University, Victoria, Australia; School of Medicine and Psychology, Australian National University, Canberra, ACT, Australia; Monarch Research Institute Monarch Mental Health Group, 225 Clarence Street, Sydney, NSW 2000, Australia.
| | - Julie C Stout
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Clayton Campus, Wellington Road, Clayton, VIC 3800, Australia.
| | - Kate E Hoy
- Central Clinical School, Department of Psychiatry, Monash University, Victoria, Australia; The Bionics Institute of Australia, 384-388 Albert St, East Melbourne, VIC 3002, Australia.
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21
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Le Stanc L, Youssov K, Giavazzi M, Sliwinski A, Bachoud-Lévi AC, Jacquemot C. Language disorders in patients with striatal lesions: Deciphering the role of the striatum in language performance. Cortex 2023; 166:91-106. [PMID: 37354871 DOI: 10.1016/j.cortex.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/22/2023] [Accepted: 04/13/2023] [Indexed: 06/26/2023]
Abstract
The classical neural model of language refers to a cortical network involving frontal, parietal and temporal regions. However, patients with subcortical lesions of the striatum have language difficulties. We investigated whether the striatum is directly involved in language or whether its role in decision-making has an indirect effect on language performance, by testing carriers of Huntington's disease (HD) mutations and controls. HD is a genetic neurodegenerative disease primarily affecting the striatum and causing language disorders. We asked carriers of the HD mutation in the premanifest (before clinical diagnosis) and early disease stages, and controls to perform two discrimination tasks, one involving linguistic and the other non-linguistic stimuli. We used the hierarchical drift diffusion model (HDDM) to analyze the participants' responses and to assess the decision and non-decision parameters separately. We hypothesized that any language deficits related to decision-making impairments would be reflected in the decision parameters of linguistic and non-linguistic tasks. We also assessed the relative contributions of both HDDM decision and non-decision parameters to the participants' behavioral data (response time and discriminability). Finally, we investigated whether the decision and non-decision parameters of the HDDM were correlated with brain atrophy. The HDDM analysis showed that patients with early HD have impaired decision parameters relative to controls, regardless of the task. In both tasks, decision parameters better explained the variance of response time and discriminability performance than non-decision parameters. In the linguistic task, decision parameters were positively correlated with gray matter volume in the ventral striatum and putamen, whereas non-decision parameters were not. Language impairment in patients with striatal atrophy is better explained by a deficit of decision-making than by a deficit of core linguistic processing. These results suggest that the striatum is involved in language through the modulation of decision-making, presumably by regulating the process of choice between linguistic alternatives.
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Affiliation(s)
- Lorna Le Stanc
- Département d'Études Cognitives, École Normale Supérieure-PSL, Paris, France; Institut Mondor de Recherche Biomédicale, Inserm U955, Equipe E01 Neuropsychologie Interventionnelle, Créteil, France; Université Paris-Est Créteil, Faculté de Médecine, Créteil, France; Université Paris Cité, LaPsyDÉ, CNRS, Paris, France
| | - Katia Youssov
- Département d'Études Cognitives, École Normale Supérieure-PSL, Paris, France; Institut Mondor de Recherche Biomédicale, Inserm U955, Equipe E01 Neuropsychologie Interventionnelle, Créteil, France; Université Paris-Est Créteil, Faculté de Médecine, Créteil, France; AP-HP, Centre de Référence Maladie de Huntington, Service de Neurologie, Hôpital Henri Mondor-Albert Chenevier, Créteil, France
| | - Maria Giavazzi
- Département d'Études Cognitives, École Normale Supérieure-PSL, Paris, France; Institut Mondor de Recherche Biomédicale, Inserm U955, Equipe E01 Neuropsychologie Interventionnelle, Créteil, France; Université Paris-Est Créteil, Faculté de Médecine, Créteil, France
| | - Agnès Sliwinski
- Département d'Études Cognitives, École Normale Supérieure-PSL, Paris, France; Institut Mondor de Recherche Biomédicale, Inserm U955, Equipe E01 Neuropsychologie Interventionnelle, Créteil, France; Université Paris-Est Créteil, Faculté de Médecine, Créteil, France; AP-HP, Centre de Référence Maladie de Huntington, Service de Neurologie, Hôpital Henri Mondor-Albert Chenevier, Créteil, France
| | - Anne-Catherine Bachoud-Lévi
- Département d'Études Cognitives, École Normale Supérieure-PSL, Paris, France; Institut Mondor de Recherche Biomédicale, Inserm U955, Equipe E01 Neuropsychologie Interventionnelle, Créteil, France; Université Paris-Est Créteil, Faculté de Médecine, Créteil, France; AP-HP, Centre de Référence Maladie de Huntington, Service de Neurologie, Hôpital Henri Mondor-Albert Chenevier, Créteil, France
| | - Charlotte Jacquemot
- Département d'Études Cognitives, École Normale Supérieure-PSL, Paris, France; Institut Mondor de Recherche Biomédicale, Inserm U955, Equipe E01 Neuropsychologie Interventionnelle, Créteil, France; Université Paris-Est Créteil, Faculté de Médecine, Créteil, France.
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22
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Ferrari C, Capacci E, Bagnoli S, Ingannato A, Sorbi S, Nacmias B. The Huntington's Disease Gene in an Italian Cohort of Patients with Bipolar Disorder. Genes (Basel) 2023; 14:1681. [PMID: 37761821 PMCID: PMC10531383 DOI: 10.3390/genes14091681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Huntington's disease (HD) is characterized by motor, cognitive and psychiatric manifestations and caused by an expansion of CAG repeats over 35 triplets on the huntingtin (HTT) gene. However, expansions in the range 27-35 repeats (intermediate allele) can be associated with pathological phenotypes. The onset of HD is conventionally defined by the onset of motor symptoms, but psychiatric disturbances can precede the motor phase by up to twenty years. The aims of the present study are to identify HD patients in the pre-motor phase of the disease among patients diagnosed with bipolar disorders and evaluate any differences between bipolar patients carrying the normal HTT allele and patients with the expanded HTT gene. METHODS We assessed the HTT genotype in an Italian cohort of 69 patients who were affected by either type 1 or type 2 bipolar disorder. RESULTS No patient was found to be a carrier of the pathological HTT allele, but 10% of bipolar subjects carried an intermediate allele. Carriers of the intermediate allele were older at the onset of psychiatric symptoms than non-carriers. CONCLUSION The pathological HTT gene was not associated with bipolar disorder, while we found a higher frequency of the intermediate allele among the bipolar population with respect to healthy controls. The identification of this subset of bipolar subjects has implications for the clinical management of patients and their family members and promotes further investigation into possible pathological mechanisms common to both HD and bipolar disorder.
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Affiliation(s)
- Camilla Ferrari
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, 50139 Florence, Italy; (E.C.); (S.B.); (A.I.); (S.S.); (B.N.)
| | - Elena Capacci
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, 50139 Florence, Italy; (E.C.); (S.B.); (A.I.); (S.S.); (B.N.)
| | - Silvia Bagnoli
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, 50139 Florence, Italy; (E.C.); (S.B.); (A.I.); (S.S.); (B.N.)
| | - Assunta Ingannato
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, 50139 Florence, Italy; (E.C.); (S.B.); (A.I.); (S.S.); (B.N.)
| | - Sandro Sorbi
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, 50139 Florence, Italy; (E.C.); (S.B.); (A.I.); (S.S.); (B.N.)
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Florence, Italy
| | - Benedetta Nacmias
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, 50139 Florence, Italy; (E.C.); (S.B.); (A.I.); (S.S.); (B.N.)
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Florence, Italy
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23
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Liu CF, Younes L, Tong XJ, Hinkle JT, Wang M, Phatak S, Xu X, Bu X, Looi V, Bang J, Tabrizi SJ, Scahill RI, Paulsen JS, Georgiou-Karistianis N, Faria AV, Miller MI, Ratnanather JT, Ross CA. Longitudinal imaging highlights preferential basal ganglia circuit atrophy in Huntington's disease. Brain Commun 2023; 5:fcad214. [PMID: 37744022 PMCID: PMC10516592 DOI: 10.1093/braincomms/fcad214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/09/2023] [Accepted: 08/17/2023] [Indexed: 09/26/2023] Open
Abstract
Huntington's disease is caused by a CAG repeat expansion in the Huntingtin gene (HTT), coding for polyglutamine in the Huntingtin protein, with longer CAG repeats causing earlier age of onset. The variable 'Age' × ('CAG'-L), where 'Age' is the current age of the individual, 'CAG' is the repeat length and L is a constant (reflecting an approximation of the threshold), termed the 'CAG Age Product' (CAP) enables the consideration of many individuals with different CAG repeat expansions at the same time for analysis of any variable and graphing using the CAG Age Product score as the X axis. Structural MRI studies have showed that progressive striatal atrophy begins many years prior to the onset of diagnosable motor Huntington's disease, confirmed by longitudinal multicentre studies on three continents, including PREDICT-HD, TRACK-HD and IMAGE-HD. However, previous studies have not clarified the relationship between striatal atrophy, atrophy of other basal ganglia structures, and atrophy of other brain regions. The present study has analysed all three longitudinal datasets together using a single image segmentation algorithm and combining data from a large number of subjects across a range of CAG Age Product score. In addition, we have used a strategy of normalizing regional atrophy to atrophy of the whole brain, in order to determine which regions may undergo preferential degeneration. This made possible the detailed characterization of regional brain atrophy in relation to CAG Age Product score. There is dramatic selective atrophy of regions involved in the basal ganglia circuit-caudate, putamen, nucleus accumbens, globus pallidus and substantia nigra. Most other regions of the brain appear to have slower but steady degeneration. These results support (but certainly do not prove) the hypothesis of circuit-based spread of pathology in Huntington's disease, possibly due to spread of mutant Htt protein, though other connection-based mechanisms are possible. Therapeutic targets related to prion-like spread of pathology or other mechanisms may be suggested. In addition, they have implications for current neurosurgical therapeutic approaches, since delivery of therapeutic agents solely to the caudate and putamen may miss other structures affected early, such as nucleus accumbens and output nuclei of the striatum, the substantia nigra and the globus pallidus.
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Affiliation(s)
- Chin-Fu Liu
- Center for Imaging Science, Johns Hopkins University, Baltimore, MD 21218, USA
- Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Laurent Younes
- Center for Imaging Science, Johns Hopkins University, Baltimore, MD 21218, USA
- Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Xiao J Tong
- Division of Neurobiology, Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore MD 21287, USA
| | - Jared T Hinkle
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21218, USA
- Medical Scientist Training Program, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Maggie Wang
- Center for Imaging Science, Johns Hopkins University, Baltimore, MD 21218, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Sanika Phatak
- Center for Imaging Science, Johns Hopkins University, Baltimore, MD 21218, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Xin Xu
- Division of Magnetic Resonance, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Xuan Bu
- Center for Imaging Science, Johns Hopkins University, Baltimore, MD 21218, USA
- Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Vivian Looi
- Center for Imaging Science, Johns Hopkins University, Baltimore, MD 21218, USA
- Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Jee Bang
- Division of Neurobiology, Department of Psychiatry, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Sarah J Tabrizi
- HD Research Centre, University College London Queen Square Institute of Neurology, UCL, London, UK
| | - Rachael I Scahill
- HD Research Centre, University College London Queen Square Institute of Neurology, UCL, London, UK
| | - Jane S Paulsen
- Department of Neurology, University of Wisconsin, Madison, WI 53705, USA
| | - Nellie Georgiou-Karistianis
- School of Psychological Sciences and The Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria 3800, Australia
| | - Andreia V Faria
- Division of Magnetic Resonance, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Michael I Miller
- Center for Imaging Science, Johns Hopkins University, Baltimore, MD 21218, USA
- Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - J Tilak Ratnanather
- Center for Imaging Science, Johns Hopkins University, Baltimore, MD 21218, USA
- Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Christopher A Ross
- Division of Neurobiology, Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore MD 21287, USA
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21218, USA
- Division of Neurobiology, Department of Psychiatry, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Department of Pharmacology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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24
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Hu B, Younes L, Bu X, Liu CF, Ratnanather JT, Paulsen J, Georgiou-Karistianis N, Miller MI, Ross C, Faria AV. Mixed longitudinal and cross-sectional analyses of deep gray matter and white matter using diffusion weighted images in premanifest and manifest Huntington's disease. Neuroimage Clin 2023; 39:103493. [PMID: 37582307 PMCID: PMC10448214 DOI: 10.1016/j.nicl.2023.103493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/29/2023] [Accepted: 08/07/2023] [Indexed: 08/17/2023]
Abstract
Changes in the brain of patients with Huntington's disease (HD) begin years before clinical onset, so it remains critical to identify biomarkers to track these early changes. Metrics derived from tensor modeling of diffusion-weighted MRIs (DTI), that indicate the microscopic brain structure, can add important information to regional volumetric measurements. This study uses two large-scale longitudinal, multicenter datasets, PREDICT-HD and IMAGE-HD, to trace changes in DTI of HD participants with a broad range of CAP scores (a product of CAG repeat expansion and age), including those with pre-manifest disease (i.e., prior to clinical onset). Utilizing a fully automated data-driven approach to study the whole brain divided in regions of interest, we traced changes in DTI metrics (diffusivity and fractional anisotropy) versus CAP scores, using sigmoidal and linear regression models. We identified points of inflection in the sigmoidal regression using change-point analysis. The deep gray matter showed more evident and earlier changes in DTI metrics over CAP scores, compared to the deep white matter. In the deep white matter, these changes were more evident and occurred earlier in superior and posterior areas, compared to anterior and inferior areas. The curves of mean diffusivity vs. age of HD participants within a fixed CAP score were different from those of controls, indicating that the disease has an additional effect to age on the microscopic brain structure. These results show the regional and temporal vulnerability of the white matter and deep gray matter in HD, with potential implications for experimental therapeutics.
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Affiliation(s)
- Beini Hu
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Laurent Younes
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD, USA
| | - Xuan Bu
- Department of Radiology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Chin-Fu Liu
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - J Tilak Ratnanather
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Jane Paulsen
- Department of Psychiatry, Neurology, Psychological Brain Sciences, University of Iowa, USA; Department Neurology, University of Wisconsin-Madison, USA
| | - Nellie Georgiou-Karistianis
- School of Psychological Sciences and Turner Institute of Brain and Mental Health, Monash University, Australia
| | - Michael I Miller
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Christopher Ross
- Department of Psychiatry, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Andreia V Faria
- Department of Radiology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
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Sierra LA, Ullman CJ, Baselga-Garriga C, Pandeya SR, Frank SA, Laganiere S. Prevalence of neurocognitive disorder in Huntington's disease using the Enroll-HD dataset. Front Neurol 2023; 14:1198145. [PMID: 37521291 PMCID: PMC10375015 DOI: 10.3389/fneur.2023.1198145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/25/2023] [Indexed: 08/01/2023] Open
Abstract
Background Cognitive decline in Huntington's disease (HD) begins early in the disease course, however the reported prevalence and severity of cognitive impairment varies based on diagnostic approach. A Movement Disorders Society Task Force recently endorsed the use of standardized DSM-5-based criteria to diagnose neurocognitive disorder (NCD) in Huntington's disease. Objectives To determine the prevalence and severity of cognitive impairment across different stages of HD by applying NCD criteria (mild and major) to participant data from the Enroll-HD database. Methods Enroll-HD participants were triaged into either premanifest (preHD), manifest or control groups. PreHD was further dichotomized into preHD near or preHD far based on predicted time to diagnosis using the scaled CAG-age product score (CAPs). Embedded cognitive performance and functional independence measures were used to determine prevalence of NCD (mild and major) for all groups. Results Prevalence of NCD-mild was 25.2%-38.4% for manifest HD, 22.8%-47.3% for preHD near, 11.5%-25.1% for preHD far, and 8.8%-19.1% for controls. Prevalence of NCD-major was 21.1%-57.7% for manifest HD, 0.5%-16.3% for preHD near, 0.0%-4.5% for preHD far, and 0.0%-3.0% for controls. Conclusion The prevalence of NCD in HD is elevated in preHD and demonstrates a sharp rise prior to diagnosis. In manifest HD, the vast majority of participants meet criteria for NCD. These findings are important for optimizing clinical care and/or anticipating the need for supportive services.
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Affiliation(s)
- Luis A. Sierra
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Clementina J. Ullman
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | | | - Sarbesh R. Pandeya
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Samuel A. Frank
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Simon Laganiere
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
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Barer Y, Ribalov R, Yaari A, Maor R, Arow Q, Logan J, Chodick G, Gurevich T. Healthcare utilization, costs, and epidemiology of Huntington's disease in Israel. Clin Park Relat Disord 2023; 9:100208. [PMID: 37497383 PMCID: PMC10366633 DOI: 10.1016/j.prdoa.2023.100208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 06/01/2023] [Accepted: 06/26/2023] [Indexed: 07/28/2023] Open
Abstract
Introduction Data on Huntington's disease (HD) epidemiology, treatment patterns, and economic burden in Israel are scarce. Methods Annual prevalence and incidence of HD (ICD-9-CM 333.4) were assessed in the Israel-based Maccabi Healthcare Services (MHS) database 2016-2018. Adherence (medication possession rate [MPR], proportion of disease covered) were assessed for adult people with HD (PwHD) 2013-2018. Healthcare resources utilization (HCRU) and costs related to inpatient and outpatient visits and all medications in 2018 were assessed for PwHD, who were randomly matched to MHS members without HD (1:3) by birth-year and sex. Results Overall, 164 patients had at least one HD diagnosis. Annual prevalence and incidence were 4.45 and 0.24/100,000, respectively. A total of 67.0% of adult patients (n = 106) were taking tetrabenazine (median MPR and proportion of disease covered, 74.3% and 30.2%, respectively), 65.1% benzodiazepines (75.8% and 32.3%), and 11.3% amantadine (79.2% and 6.0%). Over a 1-year follow-up, PwHD (n = 81) had significantly more neurologist, psychiatrist, physiotherapist, and speech therapist visits (P < 0.05 for each) and more hospitalization days (P < 0.0001) compared with matched controls (n = 243). Total healthcare and medication costs per patient (US dollars) were significantly higher for PwHD than controls ($7,343 vs. $3,625; P < 0.001). Discussion/Conclusion PwHD have greater annual HCRU and medical costs than MHS members without HD in Israel. Among those who have taken medications, adherence was lower than 80% (both MPR and proportion of disease covered), which may translate into suboptimal symptom relief and quality of life.
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Affiliation(s)
- Yael Barer
- Maccabi Institute for Research & Innovation, Maccabi Healthcare Services, 27 Ha'Mered St., Tel Aviv 6812509, Israel
| | - Rinat Ribalov
- Teva Pharmaceutical Industries Ltd., Global Health Economics and Outcomes Research, P.O. 3190, 124 Deborah HaNaviya, Tel Aviv 6944020, Israel
| | - Ayelet Yaari
- Teva Pharmaceutical Industries Ltd., International Markets Medical Affairs, 124 Deborah HaNavi’a St., Tel Aviv 6944020, Israel
| | - Ron Maor
- Teva Pharmaceutical Industries Ltd., International Markets Medical Affairs, 124 Deborah HaNavi’a St., Tel Aviv 6944020, Israel
| | - Qais Arow
- Teva Pharmaceutical Industries Ltd., International Markets Medical Affairs, 124 Deborah HaNavi’a St., Tel Aviv 6944020, Israel
| | - John Logan
- Teva Branded Pharmaceutical Products R&D, Inc., SCD Statistics, 145 Brandywine Pkwy, West Chester, PA 19380, USA
| | - Gabriel Chodick
- Maccabi Institute for Research & Innovation, Maccabi Healthcare Services, 27 Ha'Mered St., Tel Aviv 6812509, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tanya Gurevich
- Movement Disorders Unit, Neurological Institute, Tel Aviv Medical Center, Sagol School of Neuroscience, Tel Aviv University, P.O. Box 39040, Ramat Aviv, Tel Aviv 69978, Israel
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The temporal dynamics of mood and their association with depressive symptoms in Huntington's disease. J Affect Disord 2023; 328:22-28. [PMID: 36791969 DOI: 10.1016/j.jad.2023.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Huntington's disease (HD) is an inherited neurodegenerative disorder characterised by progressive motor abnormalities, cognitive decline, and neuropsychiatric disturbances. Depression is among the most common neuropsychiatric syndromes in HD. Research in neurologically healthy samples has shown that depression is associated with distinct patterns of short-term fluctuations in mood, which may exacerbate negative effects on psychological wellbeing. The short-term dynamics of mood and their relationship with depression have not yet been investigated in HD. METHODS Fifty-five adults with the HD CAG expansion (33 pre-manifest, 22 manifest) completed single timepoint measures of depression, demographic factors, and clinical disease outcomes on day 1, then rated their mood daily for 28 consecutive days. Average mood, mood variability, and mood inertia (auto-correlation) were calculated across the 28 days. RESULTS Depression severity on day 1 was significantly associated with average mood across the 28 days, but not with day-to-day mood variability or inertia. Additionally, female HD CAG expansion carriers experienced more day-to-day variability in mood compared to males. LIMITATIONS Our sample did not include HD CAG expansion carriers with severe depressive symptoms or advanced HD, which limits the generalisability of the findings. Additionally, findings may have been affected by antidepressant and antipsychotic medication use among many participants. CONCLUSIONS In HD, short-term patterns of change in mood appear to be relatively independent of depression severity. Moreover, in female CAG-expansion carriers particularly, mood variability may warrant further clinical attention. These findings should be replicated in larger and more diverse samples, with different timescales and measures for assessing mood.
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Davis MC, Fitzgerald PB, Bailey NW, Sullivan C, Stout JC, Hill AT, Hoy KE. Effects of medial prefrontal transcranial alternating current stimulation on neural activity and connectivity in people with Huntington's disease and neurotypical controls. Brain Res 2023; 1811:148379. [PMID: 37121424 DOI: 10.1016/j.brainres.2023.148379] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 03/30/2023] [Accepted: 04/25/2023] [Indexed: 05/02/2023]
Abstract
We investigated the effects of transcranial alternating current stimulation (tACS) targeted to the medial prefrontal cortex (mPFC) on resting electroencephalographic (EEG) indices of oscillatory power, aperiodic exponent and offset, and functional connectivity in 22 late premanifest and early manifest stage individuals with HD and 20 neurotypical controls. Participants underwent three 20-minute sessions of tACS at least 72 hours apart; one session at alpha frequency (either each participant's Individualised Alpha Frequency (IAF), or 10Hz when an IAF was not detected); one session at delta frequency (2Hz); and a session of sham tACS. Session order was randomised and counterbalanced across participants. EEG recordings revealed a reduction of the spectral exponent ('flattening' of the 1/f slope) of the eyes-open aperiodic signal in participants with HD following alpha-tACS, suggestive of an enhancement in excitatory tone. Contrary to expectation, there were no changes in oscillatory power or functional connectivity in response to any of the tACS conditions in the participants with HD. By contrast, alpha-tACS increased delta power in neurotypical controls, who further demonstrated significant increases in theta power and theta functional connectivity in response to delta-tACS. This study contributes to the rapidly growing literature on the potential experimental and therapeutic applications of tACS by examining neurophysiological outcome measures in people with HD as well as neurotypical controls.
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Affiliation(s)
- Marie-Claire Davis
- Central Clinical School, Department of Psychiatry, Monash University, Victoria, Australia; Statewide Progressive Neurological Disease Service, Calvary Health Care Bethlehem, Victoria Australia.
| | - Paul B Fitzgerald
- School of Medicine and Psychology, Australian National University, Canberra, ACT, Australia
| | - Neil W Bailey
- Central Clinical School, Department of Psychiatry, Monash University, Victoria, Australia; School of Medicine and Psychology, Australian National University, Canberra, ACT, Australia; Monarch Research Institute Monarch Mental Health Group, Sydney, NSW, Australia
| | - Caley Sullivan
- Central Clinical School, Department of Psychiatry, Monash University, Victoria, Australia
| | - Julie C Stout
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Aron T Hill
- Central Clinical School, Department of Psychiatry, Monash University, Victoria, Australia; Cognitive Neuroscience Unit, School of Psychology, Deakin University, Melbourne, Australia
| | - Kate E Hoy
- Central Clinical School, Department of Psychiatry, Monash University, Victoria, Australia; The Bionics Institute of Australia, 384-388 Albert St, East Melbourne, VIC, 3002, Australia
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Davis MC, Hill AT, Fitzgerald PB, Bailey NW, Sullivan C, Stout JC, Hoy KE. Medial prefrontal transcranial alternating current stimulation for apathy in Huntington's disease. Prog Neuropsychopharmacol Biol Psychiatry 2023; 126:110776. [PMID: 37120005 DOI: 10.1016/j.pnpbp.2023.110776] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 05/01/2023]
Abstract
We investigated the effects of transcranial alternating current stimulation (tACS) targeted to the bilateral medial prefrontal cortex (mPFC) and administered at either delta or alpha frequencies, on brain activity and apathy in people with Huntington's disease (HD) (n = 17). Given the novelty of the protocol, neurotypical controls (n = 20) were also recruited. All participants underwent three 20-min sessions of tACS; one session at alpha frequency (Individualised Alpha Frequency (IAF), or 10 Hz when an IAF was not detected); one session at delta frequency (2 Hz); and a session of sham tACS. Participants completed the Monetary Incentive Delay (MID) task with simultaneous recording of EEG immediately before and after each tACS condition. The MID task presents participants with cues signalling potential monetary gains or losses that increase activity in key regions of the cortico-basal ganglia-thalamocortical networks, with dysfunction of the latter network being implicated in the pathophysiology of apathy. We used the P300 and Contingent Negative Variation (CNV) event-related potentials elicited during the MID task as markers of mPFC engagement. HD participants' CNV amplitude significantly increased in response to alpha-tACS, but not delta-tACS or sham. Neurotypical controls' P300 and CNV were not modulated by any of the tACS conditions, but they did demonstrate a significant decrease in post-target response times following alpha-tACS. We present this as preliminary evidence of the ability of alpha-tACS to modulate brain activity associated with apathy in HD.
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Affiliation(s)
- Marie-Claire Davis
- Central Clinical School, Department of Psychiatry, Monash University, Victoria, Australia; Statewide Progressive Neurological Disease Service, Calvary Health Care Bethlehem, Victoria, Australia.
| | - Aron T Hill
- Central Clinical School, Department of Psychiatry, Monash University, Victoria, Australia; Cognitive Neuroscience Unit, School of Psychology, Deakin University, Melbourne, Australia
| | - Paul B Fitzgerald
- Central Clinical School, Department of Psychiatry, Monash University, Victoria, Australia; School of Medicine and Psychology, Australian National University, Canberra, ACT, Australia
| | - Neil W Bailey
- Central Clinical School, Department of Psychiatry, Monash University, Victoria, Australia; School of Medicine and Psychology, Australian National University, Canberra, ACT, Australia; Monarch Research Institute Monarch Mental Health Group, Sydney, NSW, Australia
| | - Caley Sullivan
- Central Clinical School, Department of Psychiatry, Monash University, Victoria, Australia
| | - Julie C Stout
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Kate E Hoy
- Central Clinical School, Department of Psychiatry, Monash University, Victoria, Australia; The Bionics Institute of Australia, 384-388 Albert St, East Melbourne, VIC 3002, Australia
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Kouba T, Frank W, Tykalova T, Mühlbäck A, Klempíř J, Lindenberg KS, Landwehrmeyer GB, Rusz J. Speech biomarkers in Huntington's disease: A cross-sectional study in pre-symptomatic, prodromal and early manifest stages. Eur J Neurol 2023; 30:1262-1271. [PMID: 36732902 DOI: 10.1111/ene.15726] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/25/2023] [Accepted: 01/28/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE Motor speech alterations are a prominent feature of clinically manifest Huntington's disease (HD). Objective acoustic analysis of speech can quantify speech alterations. It is currently unknown, however, at what stage of HD speech alterations can be reliably detected. We aimed to explore the patterns and extent of speech alterations using objective acoustic analysis in HD and to assess correlations with both rater-assessed phenotypical features and biological determinants of HD. METHODS Speech samples were acquired from 44 premanifest (29 pre-symptomatic and 15 prodromal) and 25 manifest HD gene expansion carriers, and 25 matched healthy controls. A quantitative automated acoustic analysis of 10 speech dimensions was performed. RESULTS Automated speech analysis allowed us to differentiate between participants with HD and controls, with areas under the curve of 0.74 for pre-symptomatic, 0.92 for prodromal, and 0.97 for manifest stages. In addition to irregular alternating motion rates and prolonged pauses seen only in manifest HD, both prodromal and manifest HD displayed slowed articulation rate, slowed alternating motion rates, increased loudness variability, and unstable steady-state position of articulators. In participants with premanifest HD, speech alteration severity was associated with cognitive slowing (r = -0.52, p < 0.001) and the extent of bradykinesia (r = 0.43, p = 0.004). Speech alterations correlated with a measure of exposure to mutant gene products (CAG-age-product score; r = 0.60, p < 0.001). CONCLUSION Speech abnormalities in HD are associated with other motor and cognitive deficits and are measurable already in premanifest stages of HD. Therefore, automated speech analysis might represent a quantitative HD biomarker with potential for assessing disease progression.
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Affiliation(s)
- Tomas Kouba
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Wiebke Frank
- Department of Neurology, University Ulm, Ulm, Germany
| | - Tereza Tykalova
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Alzbeta Mühlbäck
- Department of Neurology, University Ulm, Ulm, Germany.,Department of Neuropsychiatry, Huntington Center South, kbo-Isar-Amper-Klinikum Taufkirchen (Vils), Taufkirchen, Germany.,Department of Neurology and Center of Clinical Neuroscience, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jiří Klempíř
- Department of Neurology and Center of Clinical Neuroscience, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | | | | | - Jan Rusz
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic.,Department of Neurology and Center of Clinical Neuroscience, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.,Department of Neurology & ARTORG Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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31
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van Lonkhuizen PJC, Frank W, Heemskerk AW, van Duijn E, de Bot ST, Mühlbäck A, Landwehrmeyer GB, Chavannes NH, Meijer E. Quality of life, health-related quality of life, and associated factors in Huntington's disease: a systematic review. J Neurol 2023; 270:2416-2437. [PMID: 36715747 PMCID: PMC10129943 DOI: 10.1007/s00415-022-11551-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/23/2022] [Accepted: 12/24/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Huntington's disease (HD) is a genetic, neurodegenerative disease. Due to the progressive nature of HD and the absence of a cure, (health-related) quality of life ((HR)QoL) is an important topic. Several studies have investigated (HR)QoL in HD, yet a clear synthesis of the existing literature is lacking to date. We performed a systematic review on self-reported (HR)QoL, and factors and intervention effects associated with (HR)QoL in premanifest and manifest HD gene expansion carriers (pHDGECs and mHDGECs, respectively). METHODS PubMed, EMBASE, Web of Science, and PsycINFO were searched systematically from September 17th, 2021, up to August 11th, 2022. Methodological and conceptual quality of the included studies was assessed with two appraisal tools. RESULTS 30 out of 70 eligible articles were included. mHDGECs experienced lower (HR)QoL compared to pHDGECs and controls, whereas mixed findings were reported when compared to other neurological diseases. Several factors were associated with (HR)QoL that might contribute to lower (HR)QoL in mHDGECs, including depressive symptoms, physical and psychological symptoms, lower functional capacity, lower support, and unmet needs. Multidisciplinary rehabilitation programs and a respiratory muscle training were beneficial for (HR)QoL in mHDGECs. DISCUSSION (HR)QoL is experienced differently across the course of the disease. Although (HR)QoL is key for understanding the impact of HD and the effect of symptomatic treatment, there is a need to improve the methodological and conceptual shortcomings that were found in most studies, especially regarding the conceptual clarity when reporting on QoL and HRQoL. Suggestions for strengthening these shortcomings are provided in this review.
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Affiliation(s)
- Pearl J C van Lonkhuizen
- Department of Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands. .,National eHealth Living Lab, Leiden University Medical Center, Leiden, The Netherlands. .,Huntington Center Topaz Overduin, 2225 SX, Katwijk aan Zee, The Netherlands.
| | - Wiebke Frank
- Department of Neurology, University Hospital Ulm, 89081, Ulm, Germany
| | - Anne-Wil Heemskerk
- Department of Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.,Huntington Center Topaz Overduin, 2225 SX, Katwijk aan Zee, The Netherlands
| | - Erik van Duijn
- Huntington Center Topaz Overduin, 2225 SX, Katwijk aan Zee, The Netherlands.,Department of Psychiatry, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands
| | - Susanne T de Bot
- Department of Neurology, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands
| | - Alzbeta Mühlbäck
- Department of Neurology, University Hospital Ulm, 89081, Ulm, Germany.,Department of Neuropsychiatry, kbo-Isar-Amper-Klinikum, 84416, Taufkirchen (Vils), Germany.,Department of Neurology and Center of Clinical Neuroscience, 1st Faculty of Medicine, Charles University and General University Hospital in Prague, 12821, Prague, Czech Republic
| | | | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.,National eHealth Living Lab, Leiden University Medical Center, Leiden, The Netherlands
| | - Eline Meijer
- Department of Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.,National eHealth Living Lab, Leiden University Medical Center, Leiden, The Netherlands
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Harrison MB, Morrissey DL, Dalrymple WA, D'Abreu A, Daly FN. Primary Palliative Care in Huntington's Disease. Mov Disord Clin Pract 2023; 10:55-63. [PMID: 36698999 PMCID: PMC9847290 DOI: 10.1002/mdc3.13589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 09/12/2022] [Accepted: 09/23/2022] [Indexed: 01/28/2023] Open
Abstract
Background Palliative care practices, including communication about patient-centered goals of care and advance care planning (ACP), have the potential to enhance care throughout the course of Huntington's disease (HD) and related disorders. The goal of our project was to develop a pilot program that integrates primary palliative care practices with interdisciplinary care for HD. Objectives (1) To train HD team members to facilitate goals of care and ACP conversations at all stages of HD; (2) To create materials for care planning in HD focused on patient-centered goals of care and health-related quality of life; and (3) To modify clinic workflow to include goals of care and ACP discussions. Methods We defined planning domains to expand care planning beyond end-of-life concerns. We created a patient and family guide to advance care planning in HD. We conducted VitalTalk communications training with the HD team. We modified the interdisciplinary clinic workflow to include ACP and developed an EMR template for documentation. Results After communication training, more team members felt well prepared to discuss serious news (12.5% to 50%) and manage difficult conversations (25% to 62.5%). The proportion of clinic visits including advance care planning discussions increased from 12.5% to 30.6% during the pilot phase. Conclusions Provision of primary palliative care for HD in an interdisciplinary clinic is feasible. Integration of palliative care practices into HD specialty care requires additional training and modification of clinic operations.
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Affiliation(s)
| | - Dana L. Morrissey
- Department of NeurologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - W. Alex Dalrymple
- Department of NeurologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - Anelyssa D'Abreu
- Department of NeurologyUniversity of VirginiaCharlottesvilleVirginiaUSA
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Medina A, Mahjoub Y, Shaver L, Pringsheim T. Prevalence and Incidence of Huntington's Disease: An Updated Systematic Review and Meta-Analysis. Mov Disord 2022; 37:2327-2335. [PMID: 36161673 PMCID: PMC10086981 DOI: 10.1002/mds.29228] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/03/2022] [Accepted: 08/29/2022] [Indexed: 01/13/2023] Open
Abstract
The incidence and prevalence of Huntington's disease (HD) based on a systematic review and meta-analysis of 20 studies published from 1985 to 2010 was estimated at 0.38 per 100,000 person-years (95% confidence interval [CI], 0.16-0.94) and 2.71 per 100,000 persons (95% CI, 1.55-4.72), respectively. Since 2010, there have been many new epidemiological studies of HD. We sought to update the global estimates of HD incidence and prevalence using data published up to February 2022 and perform additional analyses based on study continent. Medline and Embase were searched for epidemiological studies of HD published between 2010 and 2022. Risk of bias was assessed using a quality assessment tool. Estimated pooled prevalence or incidence was calculated using a random-effects meta-analysis. A total of 33 studies published between 2010 and 2022 were included. Pooled incidence was 0.48 cases per 100,000 person-years (95% CI, 0.33-0.63). Subgroup analysis by continent demonstrated a significantly higher incidence of HD in Europe and North America than in Asia. Pooled prevalence was 4.88 per 100,000 (95% CI, 3.38-7.06). Subanalyses by continent demonstrated that the prevalence of HD was significantly higher in Europe and North America than in Africa. The minor increase in prevalence (more so than incidence) demonstrated in this updated review could relate to the enhanced availability of molecular testing, earlier diagnosis, increased life expectancy, and de novo mutations. Limitations include variable case ascertainment methods and lacking case validation data. © 2022 Her Majesty the Queen in Right of Canada. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society. Reproduced with the permission of the Minister of Public Health Agency of Canada.
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Affiliation(s)
- Alex Medina
- Department of Clinical Neurosciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Yasamin Mahjoub
- Department of Clinical Neurosciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Larry Shaver
- Adult Chronic Diseases and Conditions DivisionPublic Health Agency of CanadaNepeanOntarioCanada
| | - Tamara Pringsheim
- Department of Clinical Neurosciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Department of Psychiatry, Pediatrics, Community Health SciencesUniversity of CalgaryCalgaryAlbertaCanada
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Stimming EF, Bega D. Chorea. Continuum (Minneap Minn) 2022; 28:1379-1408. [DOI: 10.1212/con.0000000000001169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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35
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Tabrizi SJ, Schobel S, Gantman EC, Mansbach A, Borowsky B, Konstantinova P, Mestre TA, Panagoulias J, Ross CA, Zauderer M, Mullin AP, Romero K, Sivakumaran S, Turner EC, Long JD, Sampaio C. A biological classification of Huntington's disease: the Integrated Staging System. Lancet Neurol 2022; 21:632-644. [PMID: 35716693 DOI: 10.1016/s1474-4422(22)00120-x] [Citation(s) in RCA: 112] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 02/11/2022] [Accepted: 03/11/2022] [Indexed: 12/24/2022]
Abstract
The current research paradigm for Huntington's disease is based on participants with overt clinical phenotypes and does not address its pathophysiology nor the biomarker changes that can precede by decades the functional decline. We have generated a new research framework to standardise clinical research and enable interventional studies earlier in the disease course. The Huntington's Disease Integrated Staging System (HD-ISS) comprises a biological research definition and evidence-based staging centred on biological, clinical, and functional assessments. We used a formal consensus method that involved representatives from academia, industry, and non-profit organisations. The HD-ISS characterises individuals for research purposes from birth, starting at Stage 0 (ie, individuals with the Huntington's disease genetic mutation without any detectable pathological change) by using a genetic definition of Huntington's disease. Huntington's disease progression is then marked by measurable indicators of underlying pathophysiology (Stage 1), a detectable clinical phenotype (Stage 2), and then decline in function (Stage 3). Individuals can be precisely classified into stages based on thresholds of stage-specific landmark assessments. We also demonstrated the internal validity of this system. The adoption of the HD-ISS could facilitate the design of clinical trials targeting populations before clinical motor diagnosis and enable data standardisation across ongoing and future studies.
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Affiliation(s)
- Sarah J Tabrizi
- UCL Huntington's Disease Centre, Department of Neurodegenerative Diseases, UCL Queen Square Institute of Neurology, UK Dementia Research Institute, University College London, UK.
| | - Scott Schobel
- Product Development Neuroscience, F Hoffmann-La Roche, Basel, Switzerland
| | | | | | | | | | - Tiago A Mestre
- Parkinson's Disease and Movement Disorders Centre, Division of Neurology, Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada
| | | | - Christopher A Ross
- Division of Neurobiology, Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Departments of Neurology, Neuroscience, and Pharmacology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Klaus Romero
- Critical Path Institute, Tucson, Arizona 85718, USA
| | | | | | - Jeffrey D Long
- Department of Psychiatry, Department of Biostatistics, University of Iowa, Iowa City, IA, USA
| | - Cristina Sampaio
- CHDI Management/CHDI Foundation, Princeton, NJ, USA; Clinical Pharmacology Laboratory, Faculdade de Medicina de Lisboa, University of Lisbon, Lisbon, Portugal.
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Hewitt SRC, White AJ, Mason SL, Barker RA. Metacognitive insight into cognitive performance in Huntington's disease gene carriers. BMJ Neurol Open 2022; 4:e000268. [PMID: 35463389 PMCID: PMC8987702 DOI: 10.1136/bmjno-2022-000268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/10/2022] [Indexed: 11/24/2022] Open
Abstract
Objectives Insight is an important predictor of quality of life in Huntington's disease and other neurodegenerative conditions. However, estimating insight with traditional methods such as questionnaires is challenging and subjected to limitations. This cross-sectional study experimentally quantified metacognitive insight into cognitive performance in Huntington's disease gene carriers. Methods We dissociated perceptual decision-making performance and metacognitive insight into performance in healthy controls (n=29), premanifest (n=19) and early-manifest (n=10) Huntington's disease gene carriers. Insight was operationalised as the degree to which a participant's confidence in their performance was informative of their actual performance (metacognitive efficiency) and estimated using a computational model (HMeta-d'). Results We found that premanifest and early-manifest Huntington's disease gene carriers were impaired in making perceptual decisions compared with controls. Gene carriers required more evidence in favour of the correct choice to achieve similar performance and perceptual impairments were increased in those with manifest disease. Surprisingly, despite marked perceptual impairments, Huntington's disease gene carriers retained metacognitive insight into their perceptual performance. This was the case after controlling for confounding variables and regardless of disease stage. Conclusion We report for the first time a dissociation between impaired cognition and intact metacognition (trial-by-trial insight) in the early stages of a neurodegenerative disease. This unexpected finding contrasts with the prevailing assumption that cognitive deficits are associated with impaired insight. Future studies should investigate how intact metacognitive insight could be used by some early Huntington's disease gene carriers to positively impact their quality of life.
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Affiliation(s)
- Samuel RC Hewitt
- John Van Geest Centre for Brain Repair, Department of Clinical Neuroscience, University of Cambridge, Cambridge, Cambridgeshire, UK
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, London, UK
- Wellcome Centre for Human Neuroimaging, University College London, London, UK
| | - Alice J White
- John Van Geest Centre for Brain Repair, Department of Clinical Neuroscience, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Sarah L Mason
- John Van Geest Centre for Brain Repair, Department of Clinical Neuroscience, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Roger A Barker
- John Van Geest Centre for Brain Repair, Department of Clinical Neuroscience, University of Cambridge, Cambridge, Cambridgeshire, UK
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Benatar M, Wuu J, McHutchison C, Postuma RB, Boeve BF, Petersen R, Ross CA, Rosen H, Arias JJ, Fradette S, McDermott MP, Shefner J, Stanislaw C, Abrahams S, Cosentino S, Andersen PM, Finkel RS, Granit V, Grignon AL, Rohrer JD, McMillan CT, Grossman M, Al-Chalabi A, Turner MR. Preventing amyotrophic lateral sclerosis: insights from pre-symptomatic neurodegenerative diseases. Brain 2022; 145:27-44. [PMID: 34677606 PMCID: PMC8967095 DOI: 10.1093/brain/awab404] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/16/2021] [Accepted: 10/08/2021] [Indexed: 11/12/2022] Open
Abstract
Significant progress has been made in understanding the pre-symptomatic phase of amyotrophic lateral sclerosis. While much is still unknown, advances in other neurodegenerative diseases offer valuable insights. Indeed, it is increasingly clear that the well-recognized clinical syndromes of Alzheimer's disease, Parkinson's disease, Huntington's disease, spinal muscular atrophy and frontotemporal dementia are also each preceded by a pre-symptomatic or prodromal period of varying duration, during which the underlying disease process unfolds, with associated compensatory changes and loss of inherent system redundancy. Key insights from these diseases highlight opportunities for discovery in amyotrophic lateral sclerosis. The development of biomarkers reflecting amyloid and tau has led to a shift in defining Alzheimer's disease based on inferred underlying histopathology. Parkinson's disease is unique among neurodegenerative diseases in the number and diversity of non-genetic biomarkers of pre-symptomatic disease, most notably REM sleep behaviour disorder. Huntington's disease benefits from an ability to predict the likely timing of clinically manifest disease based on age and CAG-repeat length alongside reliable neuroimaging markers of atrophy. Spinal muscular atrophy clinical trials have highlighted the transformational value of early therapeutic intervention, and studies in frontotemporal dementia illustrate the differential role of biomarkers based on genotype. Similar advances in amyotrophic lateral sclerosis would transform our understanding of key events in pathogenesis, thereby dramatically accelerating progress towards disease prevention. Deciphering the biology of pre-symptomatic amyotrophic lateral sclerosis relies on a clear conceptual framework for defining the earliest stages of disease. Clinically manifest amyotrophic lateral sclerosis may emerge abruptly, especially among those who harbour genetic mutations associated with rapidly progressive amyotrophic lateral sclerosis. However, the disease may also evolve more gradually, revealing a prodromal period of mild motor impairment preceding phenoconversion to clinically manifest disease. Similarly, cognitive and behavioural impairment, when present, may emerge gradually, evolving through a prodromal period of mild cognitive impairment or mild behavioural impairment before progression to amyotrophic lateral sclerosis. Biomarkers are critically important to studying pre-symptomatic amyotrophic lateral sclerosis and essential to efforts to intervene therapeutically before clinically manifest disease emerges. The use of non-genetic biomarkers, however, presents challenges related to counselling, informed consent, communication of results and limited protections afforded by existing legislation. Experiences from pre-symptomatic genetic testing and counselling, and the legal protections against discrimination based on genetic data, may serve as a guide. Building on what we have learned-more broadly from other pre-symptomatic neurodegenerative diseases and specifically from amyotrophic lateral sclerosis gene mutation carriers-we present a road map to early intervention, and perhaps even disease prevention, for all forms of amyotrophic lateral sclerosis.
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Affiliation(s)
- Michael Benatar
- Department of Neurology, University of Miami, Miami, FL, USA
| | - Joanne Wuu
- Department of Neurology, University of Miami, Miami, FL, USA
| | - Caroline McHutchison
- Human Cognitive Neuroscience, Department of Psychology, University of Edinburgh, Edinburgh, UK
- Euan MacDonald Centre for MND Research, University of Edinburgh, Edinburgh, UK
| | - Ronald B Postuma
- Department of Neurology, Montreal Neurological Institute, McGill University, Montreal, Canada
| | | | | | - Christopher A Ross
- Division of Neurobiology, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Howard Rosen
- Department of Neurology, University of California San Francisco, CA, USA
| | - Jalayne J Arias
- Department of Neurology, University of California San Francisco, CA, USA
| | | | - Michael P McDermott
- Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
- Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Jeremy Shefner
- Department of Neurology, Barrow Neurological Institute, Phoenix, AZ, USA
| | | | - Sharon Abrahams
- Human Cognitive Neuroscience, Department of Psychology, University of Edinburgh, Edinburgh, UK
- Euan MacDonald Centre for MND Research, University of Edinburgh, Edinburgh, UK
| | | | - Peter M Andersen
- Department of Clinical Science, Neurosciences, Umeå University, Sweden
| | - Richard S Finkel
- Department of Pediatric Medicine, Center for Experimental Neurotherapeutics, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Volkan Granit
- Department of Neurology, University of Miami, Miami, FL, USA
| | | | - Jonathan D Rohrer
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, UK
| | - Corey T McMillan
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Murray Grossman
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Ammar Al-Chalabi
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King’s College London, London, UK
- Department of Neurology, King's College Hospital, London, UK
| | - Martin R Turner
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Mustafa AI, Corey-Bloom J, Howell S, Gilbert PE, Goble DJ. Differences in body sway can be identified in Huntington's disease using a practical balance assessment device. Parkinsonism Relat Disord 2022; 103:115-118. [DOI: 10.1016/j.parkreldis.2022.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 02/23/2022] [Accepted: 02/27/2022] [Indexed: 11/25/2022]
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Abstract
OBJECTIVE Discrepancies exist in reports of social cognition deficits in individuals with premanifest Huntington's disease (HD); however, the reason for this variability has not been investigated. The aims of this study were to (1) evaluate group- and individual-level social cognitive performance and (2) examine intra-individual variability (dispersion) across social cognitive domains in individuals with premanifest HD. METHOD Theory of mind (ToM), social perception, empathy, and social connectedness were evaluated in 35 individuals with premanifest HD and 29 healthy controls. Cut-off values beneath the median and 1.5 × the interquartile range below the 25th percentile (P25 - 1.5 × IQR) of healthy controls for each variable were established for a profiling method. Dispersion between social cognitive domains was also calculated. RESULTS Compared to healthy controls, individuals with premanifest HD performed worse on all social cognitive domains except empathy. Application of the profiling method revealed a large proportion of people with premanifest HD fell below healthy control median values across ToM (>80%), social perception (>57%), empathy (>54%), and social behaviour (>40%), with a percentage of these individuals displaying more pronounced impairments in empathy (20%) and ToM (22%). Social cognition dispersion did not differ between groups. No significant correlations were found between social cognitive domains and mood, sleep, and neurocognitive outcomes. CONCLUSIONS Significant group-level social cognition deficits were observed in the premanifest HD cohort. However, our profiling method showed that only a small percentage of these individuals experienced marked difficulties in social cognition, indicating the importance of individual-level assessments, particularly regarding future personalised treatments.
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More than Just a Brain Disorder: A Five-Point Manifesto for Psychological Care for People with Huntington’s Disease. J Pers Med 2022; 12:jpm12010064. [PMID: 35055379 PMCID: PMC8780585 DOI: 10.3390/jpm12010064] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 12/18/2022] Open
Abstract
Huntington’s disease (HD) is a rare and complex condition where affected individuals, family members, caregivers, and clinicians face a number of both long-term and fluctuating challenges. The predominant biomedical framework adopted in HD to date has traditionally viewed it as a brain disorder first and foremost. As a consequence, one of the most challenging aspects of the condition—psychological difficulties and their care—is often not given the emphasis it deserves in everyday clinical practice. Here, we propose a manifesto outlining five points to address the quality, effectiveness, availability, and accessibility of psychological care in HD. These include (1) Listening to People with HD, (2) Reformulating Difficulties Psychologically, (3) Exploring New Interventions, (4) Increasing Psychological Provision, and (5) Learning from Other Conditions. As the search for a cure continues, we hope that this manifesto will create a new impetus towards refining the current approach to psychological difficulties in HD and ultimately improve the quality of life of the tens of thousands of families affected by HD worldwide.
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Turner M, Reyes A, Rankin T, Bartlett D, Trajano G, Pulverenti T, Cruickshank T. Torque variability of the plantar flexors in people with Huntington's disease. Am J Transl Res 2021; 13:13862-13869. [PMID: 35035726 PMCID: PMC8748091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/11/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Torque steadiness can be impaired in people with Huntington's disease (HD) and worsen with disease advancement. However, existing studies have several methodological oversights. Studies have used absolute torque targets, which do not account for differences in maximal torque capacity between people. Furthermore, despite its known influence on torque steadiness, previous studies in HD have not controlled for visual feedback. This study evaluated torque variability at relative intensities with and without visual feedback between people with prodromal HD and healthy controls. METHODS Twenty-four people with prodromal HD and twenty-seven age- and sex-matched healthy controls were recruited for this study. Torque variability was evaluated, with and without visual feedback, in the right plantar flexors at 10% and 30% of each participant's maximum voluntary isometric contraction (MVIC). Measures of disease burden included the CAG age product, diagnostic confidence level and Unified Huntington's Disease Rating Scale - Total Motor Score. RESULTS Significant differences in torque variability were observed, though not in overall MVIC, between people with prodromal HD and healthy controls. Significantly higher torque fluctuations were observed for both groups when visual feedback was removed. No associations were observed between torque variability and disease burden in people with prodromal HD. Torque variability measurements showed higher reliability in healthy controls. CONCLUSIONS People with prodromal HD exhibited greater torque variability than healthy controls. Torque variability worsened for both groups when visual feedback was removed. These findings support further investigation into the utilisation of torque variability measurements as markers of disease progression in people with prodromal HD.
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Affiliation(s)
- Mitchell Turner
- School of Medical and Health Sciences, Edith Cowan UniversityPerth, Australia
| | - Alvaro Reyes
- Facultad de Ciencias de la Rehabilitacion, Universidad Andres BelloVina del Mar, Chile
| | - Tim Rankin
- School of Medical and Health Sciences, Edith Cowan UniversityPerth, Australia
- Centre for Sleep Science, School of Human Sciences, Faculty of Science, University of Western AustraliaCrawley, Perth, Australia
| | - Danielle Bartlett
- School of Medical and Health Sciences, Edith Cowan UniversityPerth, Australia
- Centre for Precision Health, Edith Cowan UniversityPerth, Australia
| | - Gabriel Trajano
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology (QUT)Brisbane, Australia
| | - Tim Pulverenti
- School of Medical and Health Sciences, Edith Cowan UniversityPerth, Australia
- Department of Physical Therapy, College of Staten Island, The City University of New YorkStaten Island, NY, USA
| | - Travis Cruickshank
- School of Medical and Health Sciences, Edith Cowan UniversityPerth, Australia
- Centre for Precision Health, Edith Cowan UniversityPerth, Australia
- Perron Institute for Neurological and Translational SciencesPerth, Western Australia
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Tang H, van Eimeren T, Sampaio C, Mestre TA. Validation of biomarkers in Huntington disease to support the development of disease-modifying therapies: A systematic review and critical appraisal scheme. Parkinsonism Relat Disord 2021; 93:89-96. [PMID: 34864305 DOI: 10.1016/j.parkreldis.2021.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 09/22/2021] [Accepted: 10/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND There are promising novel genetic-based therapies under development intended to modify the disease trajectory in Huntington disease (HD). Valid biomarkers that can facilitate the development of such disease-modifying therapies are urgently needed. There are currently no studies that appraise the quality of research for validation of biomarkers in HD. OBJECTIVE To review studies for disease progression biomarkers in HD and evaluate their methodological quality. METHODS A systematic review of all HD biomarker studies up to June 2020 was conducted. Each study was assessed for methodological quality using a 24-item standardized checklist. We completed a subgroup analyses based on year of publication and biomarker type. RESULTS We included 218 HD biomarker studies, 76 (34.9%) were longitudinal and 161 (74%) included premanifest HD. On average, 10 ± 3 items (out of 24) were rated as good quality. The items more commonly rated as poor quality were: reporting of validity and reliability of assessments, sampling method, report of adverse events associated with the biomarker test, power calculation and appropriateness of study enrolment. Publications from 2016 to 2020 (mean score = 11.2 ± 2.3) had a better methodological quality than publications prior to 2016 (mean score = 9.8 ± 3.1; p = 0.018). CONCLUSION Overall, the reported methodological quality of the existing research on biomarkers for disease progression is low, which undermines the confidence of biomarkers use in drug development studies. It will be important to invest in better designed studies to support the use of biomarkers as valid drug development tools.
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Affiliation(s)
- Hanna Tang
- University of Ottawa, Faculty of Medicine, 451 Smyth Rd, Ottawa, ON K1H 8L1, Canada
| | - Thilo van Eimeren
- University of Cologne, Departments of Nuclear Medicine and Neurology, Albertus-Magnus-Platz, 50923, Köln, Germany; German Center for Neurodegenerative Diseases (DZNE), Ludwig-Erhard-Allee 2, 53175, Bonn, Germany
| | - Cristina Sampaio
- CHDI Management/ CHDI Foundation, 350 7th Ave, New York, NY, 10001, United States
| | - Tiago A Mestre
- Parkinson's Disease and Movement Disorders Center, Division of Neurology, Department of Medicine, The Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada.
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Liu H, Zhang C, Xu J, Jin J, Cheng L, Miao X, Wu Q, Wei Z, Liu P, Lu H, van Zijl PCM, Ross CA, Hua J, Duan W. Huntingtin silencing delays onset and slows progression of Huntington's disease: a biomarker study. Brain 2021; 144:3101-3113. [PMID: 34043007 PMCID: PMC8634120 DOI: 10.1093/brain/awab190] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 04/19/2021] [Accepted: 04/29/2021] [Indexed: 01/29/2023] Open
Abstract
Huntington's disease is a dominantly inherited, fatal neurodegenerative disorder caused by a CAG expansion in the huntingtin (HTT) gene, coding for pathological mutant HTT protein (mHTT). Because of its gain-of-function mechanism and monogenic aetiology, strategies to lower HTT are being actively investigated as disease-modifying therapies. Most approaches are currently targeted at the manifest stage, where clinical outcomes are used to evaluate the effectiveness of therapy. However, as almost 50% of striatal volume has been lost at the time of onset of clinical manifest, it would be preferable to begin therapy in the premanifest period. An unmet challenge is how to evaluate therapeutic efficacy before the presence of clinical symptoms as outcome measures. To address this, we aim to develop non-invasive sensitive biomarkers that provide insight into therapeutic efficacy in the premanifest stage of Huntington's disease. In this study, we mapped the temporal trajectories of arteriolar cerebral blood volumes (CBVa) using inflow-based vascular-space-occupancy (iVASO) MRI in the heterozygous zQ175 mice, a full-length mHTT expressing and slowly progressing model with a premanifest period as in human Huntington's disease. Significantly elevated CBVa was evident in premanifest zQ175 mice prior to motor deficits and striatal atrophy, recapitulating altered CBVa in human premanifest Huntington's disease. CRISPR/Cas9-mediated non-allele-specific HTT silencing in striatal neurons restored altered CBVa in premanifest zQ175 mice, delayed onset of striatal atrophy, and slowed the progression of motor phenotype and brain pathology. This study-for the first time-shows that a non-invasive functional MRI measure detects therapeutic efficacy in the premanifest stage and demonstrates long-term benefits of a non-allele-selective HTT silencing treatment introduced in the premanifest Huntington's disease.
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Affiliation(s)
- Hongshuai Liu
- Division of Neurobiology, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chuangchuang Zhang
- Division of Neurobiology, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jiadi Xu
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jing Jin
- Division of Neurobiology, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Liam Cheng
- Division of Neurobiology, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Xinyuan Miao
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Qian Wu
- Division of Neurobiology, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zhiliang Wei
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peiying Liu
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hanzhang Lu
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Peter C M van Zijl
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christopher A Ross
- Division of Neurobiology, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jun Hua
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Wenzhen Duan
- Division of Neurobiology, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Program in Cellular and Molecular Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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van Lonkhuizen PJC, Vegt NJH, Meijer E, van Duijn E, de Bot ST, Klempíř J, Frank W, Landwehrmeyer GB, Mühlbäck A, Hoblyn J, Squitieri F, Foley P, Chavannes NH, Heemskerk AW. Study Protocol for the Development of a European eHealth Platform to Improve Quality of Life in Individuals With Huntington's Disease and Their Partners (HD-eHelp Study): A User-Centered Design Approach. Front Neurol 2021; 12:719460. [PMID: 34589047 PMCID: PMC8476232 DOI: 10.3389/fneur.2021.719460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/26/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Huntington's disease (HD) is an autosomal dominant neurodegenerative disease that affects the quality of life (QoL) of HD gene expansion carriers (HDGECs) and their partners. Although HD expertise centers have been emerging across Europe, there are still some important barriers to care provision for those affected by this rare disease, including transportation costs, geographic distance of centers, and availability/accessibility of these services in general. eHealth seems promising in overcoming these barriers, yet research on eHealth in HD is limited and fails to use telehealth services specifically designed to fit the perspectives and expectations of HDGECs and their families. In the European HD-eHelp study, we aim to capture the needs and wishes of HDGECs, partners of HDGECs, and health care providers (HCPs) in order to develop a multinational eHealth platform targeting QoL of both HDGECs and partners at home. Methods: We will employ a participatory user-centered design (UCD) approach, which focusses on an in-depth understanding of the end-users' needs and their contexts. Premanifest and manifest adult HDGECs (n = 76), partners of HDGECs (n = 76), and HCPs (n = 76) will be involved as end-users in all three phases of the research and design process: (1) Exploration and mapping of the end-users' needs, experiences and wishes; (2) Development of concepts in collaboration with end-users to ensure desirability; (3) Detailing of final prototype with quick review rounds by end-users to create a positive user-experience. This study will be conducted in the Netherlands, Germany, Czech Republic, Italy, and Ireland to develop and test a multilingual platform that is suitable in different healthcare systems and cultural contexts. Discussion: Following the principles of UCD, an innovative European eHealth platform will be developed that addresses the needs and wishes of HDGECs, partners and HCPs. This allows for high-quality, tailored care to be moved partially into the participants' home, thereby circumventing some barriers in current HD care provision. By actively involving end-users in all design decisions, the platform will be tailored to the end-users' unique requirements, which can be considered pivotal in eHealth services for a disease as complex and rare as HD.
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Affiliation(s)
- Pearl J. C. van Lonkhuizen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
- Huntington Center Topaz Overduin, Katwijk, Netherlands
| | - Niko J. H. Vegt
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Eline Meijer
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Erik van Duijn
- Huntington Center Topaz Overduin, Katwijk, Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands
| | - Susanne T. de Bot
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
| | - Jiří Klempíř
- Department of Neurology and Center of Clinical Neuroscience, 1st Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Wiebke Frank
- Department of Neurology, University Hospital Ulm, Ulm, Germany
| | | | | | - Jennifer Hoblyn
- Bloomfield Hospital, Trinity College Dublin, Dublin, Ireland
| | - Ferdinando Squitieri
- Huntington and Rare Diseases Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Casa Sollievo della Sofferenza Research Hospital, San Giovanni Rotondo, Italy
| | - Peter Foley
- Department of Clinical Neurosciences, Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom
| | - Niels H. Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Anne-Wil Heemskerk
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- Huntington Center Topaz Overduin, Katwijk, Netherlands
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Glikmann-Johnston Y, Mercieca EC, Carmichael AM, Alexander B, Harding IH, Stout JC. Hippocampal and striatal volumes correlate with spatial memory impairment in Huntington's disease. J Neurosci Res 2021; 99:2948-2963. [PMID: 34516012 DOI: 10.1002/jnr.24966] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 08/19/2021] [Accepted: 08/28/2021] [Indexed: 02/06/2023]
Abstract
Spatial memory impairments are observed in people with Huntington's disease (HD), however, the domain of spatial memory has received little focus when characterizing the cognitive phenotype of HD. Spatial memory is traditionally thought to be a hippocampal-dependent function, while the neuropathology of HD centers on the striatum. Alongside spatial memory deficits in HD, recent neurocognitive theories suggest that a larger brain network is involved, including the striatum. We examined the relationship between hippocampal and striatal volumes and spatial memory in 36 HD gene expansion carriers, including premanifest (n = 24) and early manifest HD (n = 12), and 32 matched healthy controls. We assessed spatial memory with Paired Associates Learning, Rey-Osterrieth Complex Figure Test, and the Virtual House task, which assesses three components of spatial memory: navigation, object location, and plan drawing. Caudate nucleus, putamen, and hippocampal volumes were manually segmented on T1-weighted MR images. As expected, caudate nucleus and putamen volumes were significantly smaller in the HD group compared to controls, with manifest HD having more severe atrophy than the premanifest HD group. Hippocampal volumes did not differ significantly between HD and control groups. Nonetheless, on average, the HD group performed significantly worse than controls across all spatial memory tasks. The spatial memory components of object location and recall of figural and topographical drawings were associated with striatal and hippocampal volumes in the HD cohort. We provide a case to include spatial memory impairments in the cognitive phenotype of HD, and extend the neurocognitive picture of HD beyond its primary pathology within the striatum.
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Affiliation(s)
- Yifat Glikmann-Johnston
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Emily-Clare Mercieca
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Anna M Carmichael
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Bonnie Alexander
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia.,Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Neurosurgery, Royal Children's Hospital, Parkville, VIC, Australia
| | - Ian H Harding
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Monash Biomedical Imaging, Monash University, Clayton, VIC, Australia
| | - Julie C Stout
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
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46
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Sathe S, Ware J, Levey J, Neacy E, Blumenstein R, Noble S, Mühlbäck A, Rosser A, Landwehrmeyer GB, Sampaio C. Enroll-HD: An Integrated Clinical Research Platform and Worldwide Observational Study for Huntington's Disease. Front Neurol 2021; 12:667420. [PMID: 34484094 PMCID: PMC8416308 DOI: 10.3389/fneur.2021.667420] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 06/21/2021] [Indexed: 12/20/2022] Open
Abstract
Established in July 2012, Enroll-HD is both an integrated clinical research platform and a worldwide observational study designed to meet the clinical research requirements necessary to develop therapeutics for Huntington's disease (HD). The platform offers participants a low-burden entry into HD research, providing a large, well-characterized, research-engaged cohort with associated clinical data and biosamples that facilitates recruitment into interventional trials and other research studies. Additional studies that use Enroll-HD data and/or biosamples are built into the platform to further research on biomarkers and outcome measures. Enroll-HD is now operating worldwide in 21 countries at 159 clinical sites across four continents—Europe, North America, Latin America, and Australasia—and has recruited almost 25,000 participants, generating a large, rich clinical database with associated biosamples to expedite HD research; any researcher at a verifiable research organization can access the clinical datasets and biosamples from Enroll-HD and nested studies. Important operational features of Enroll-HD include a strong emphasis on standardization, data quality, and protecting participant identity, a single worldwide study protocol, a flexible EDC system capable of integrating multiple studies, a comprehensive monitoring infrastructure, an online portal to train and certify site personnel, and standardized study documents including informed consent forms and contractual agreements.
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Affiliation(s)
- Swati Sathe
- CHDI Management/CHDI Foundation, Princeton, NJ, United States
| | - Jen Ware
- CHDI Management/CHDI Foundation, Princeton, NJ, United States
| | - Jamie Levey
- CHDI Management/CHDI Foundation, Princeton, NJ, United States
| | - Eileen Neacy
- CHDI Management/CHDI Foundation, Princeton, NJ, United States
| | | | - Simon Noble
- CHDI Management/CHDI Foundation, Princeton, NJ, United States
| | | | - Anne Rosser
- Brain Repair Group, School of Biosciences, Cardiff University, Cardiff, United Kingdom.,Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, United Kingdom.,Brain Research and Intracranial Neurotherapeutics Unit, Cardiff University, Cardiff, United Kingdom
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47
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Zhang Y, Zhou J, Gehl CR, Long JD, Johnson H, Magnotta VA, Sewell D, Shannon K, Paulsen JS. Mild Cognitive Impairment as an Early Landmark in Huntington's Disease. Front Neurol 2021; 12:678652. [PMID: 34305789 PMCID: PMC8292715 DOI: 10.3389/fneur.2021.678652] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/24/2021] [Indexed: 11/26/2022] Open
Abstract
As one of the clinical triad in Huntington's disease (HD), cognitive impairment has not been widely accepted as a disease stage indicator in HD literature. This work aims to study cognitive impairment thoroughly for prodromal HD individuals with the data from a 12-year observational study to determine whether Mild Cognitive Impairment (MCI) in HD gene-mutation carriers is a defensible indicator of early disease. Prodromal HD gene-mutation carriers evaluated annually at one of 32 worldwide sites from September 2002 to April 2014 were evaluated for MCI in six cognitive domains. Linear mixed-effects models were used to determine age-, education-, and retest-adjusted cut-off values in cognitive assessment for MCI, and then the concurrent and predictive validity of MCI was assessed. Accelerated failure time (AFT) models were used to determine the timing of MCI (single-, two-, and multiple-domain), and dementia, which was defined as MCI plus functional loss. Seven hundred and sixty-eight prodromal HD participants had completed all six cognitive tasks, had MRI, and underwent longitudinal assessments. Over half (i.e., 54%) of the participants had MCI at study entry, and half of these had single-domain MCI. Compared to participants with intact cognitive performances, prodromal HD with MCI had higher genetic burden, worsened motor impairment, greater brain atrophy, and a higher likelihood of estimated HD onset. Prospective longitudinal study of those without MCI at baseline showed that 48% had MCI in subsequent visits and data visualization suggested that single-domain MCI, two-domain MCI, and dementia represent appropriate cognitive impairment staging for HD gene-mutation carriers. Findings suggest that MCI represents an early landmark of HD and may be a sensitive enrichment variable or endpoint for prodromal clinical trials of disease modifying therapeutics.
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Affiliation(s)
- Ying Zhang
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| | - Junyi Zhou
- Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, IN, United States
| | - Carissa R Gehl
- Department of Psychiatry, College of Medicine, University of Iowa, Iowa City, IA, United States
| | - Jeffrey D Long
- Department of Psychiatry, College of Medicine, University of Iowa, Iowa City, IA, United States.,Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, United States
| | - Hans Johnson
- Department of Psychiatry, College of Medicine, University of Iowa, Iowa City, IA, United States.,Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA, United States
| | - Vincent A Magnotta
- Department of Psychiatry, College of Medicine, University of Iowa, Iowa City, IA, United States.,Department of Radiology, College of Medicine, University of Iowa, Iowa, City, IA, United States
| | - Daniel Sewell
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, United States
| | - Kathleen Shannon
- Department of Neurology, University of Wisconsin, Madison, WI, United States
| | - Jane S Paulsen
- Department of Neurology, University of Wisconsin, Madison, WI, United States
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Paz-Rodríguez F, Chávez-Oliveros M, Bernal-Pérez A, Ochoa-Morales A, Martínez-Ruano L, Camacho-Molina A, Rodríguez-Agudelo Y. Neuropsychological performance and disease burden in individuals at risk of developing Huntington disease. Neurologia 2021; 39:S0213-4853(21)00087-6. [PMID: 34090718 DOI: 10.1016/j.nrl.2021.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/31/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Huntington disease (HD) is a hereditary neurodegenerative disorder. Thanks to predictive diagnosis, incipient clinical characteristics have been described in the prodromal phase. OBJECTIVE To compare performance in cognitive tasks of carriers (HDC) and non-carriers (non-HDC) of the huntingtin gene and to analyse the variability in performance as a function of disease burden and proximity to the manifest stage (age of symptom onset). METHOD A sample of 146 participants in a predictive diagnosis of HD programme were divided into the HDC (41.1%) and non-HDC groups (58.9%). Mathematical formulae were used to calculate disease burden and proximity to the manifest stage in the HDC group; these parameters were correlated with neuropsychological performance. RESULTS Significant differences were observed between groups in performance on the Mini-Mental State Examination (MMSE), Stroop-B, Symbol-Digit Modalities Test (SDMT), and phonological fluency. In the HDC group, correlations were observed between disease burden and performance on the MMSE, Stroop-B, and SDMT. The group of patients close to the manifest stage scored lowest on the MMSE, Stroop-B, Stroop-C, SDMT, and semantic verbal fluency. According to the multivariate analysis of covariance, the MMSE effect shows statistically significant differences in disease burden and proximity to onset of symptoms. CONCLUSIONS Members of the HDC group close to the manifest phase performed more poorly on tests assessing information processing speed and attention. Prefrontal cognitive dysfunction appears early, several years before the motor diagnosis of HD.
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Affiliation(s)
- F Paz-Rodríguez
- Laboratorio de Neuropsicología, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, México
| | - M Chávez-Oliveros
- Laboratorio de Neuropsicología, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, México
| | - A Bernal-Pérez
- Laboratorio de Neuropsicología, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, México
| | - A Ochoa-Morales
- Departamento de Genética, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, México
| | - L Martínez-Ruano
- Departamento de Genética, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, México
| | - A Camacho-Molina
- Departamento de Genética, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, México
| | - Y Rodríguez-Agudelo
- Laboratorio de Neuropsicología, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, México.
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49
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Cheong RY, Baldo B, Sajjad MU, Kirik D, Petersén Å. Effects of mutant huntingtin inactivation on Huntington disease-related behaviours in the BACHD mouse model. Neuropathol Appl Neurobiol 2021; 47:564-578. [PMID: 33330988 PMCID: PMC8247873 DOI: 10.1111/nan.12682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/27/2020] [Accepted: 12/14/2020] [Indexed: 01/02/2023]
Abstract
AIMS Huntington disease (HD) is a fatal neurodegenerative disorder with no disease-modifying treatments approved so far. Ongoing clinical trials are attempting to reduce huntingtin (HTT) expression in the central nervous system (CNS) using different strategies. Yet, the distribution and timing of HTT-lowering therapies required for a beneficial clinical effect is less clear. Here, we investigated whether HD-related behaviours could be prevented by inactivating mutant HTT at different disease stages and to varying degrees in an experimental model. METHODS We generated mutant BACHD mice with either a widespread or circuit-specific inactivation of mutant HTT by using Cre recombinase (Cre) under the nestin promoter or the adenosine A2A receptor promoter respectively. We also simulated a clinical gene therapy scenario with allele-specific HTT targeting by injections of recombinant adeno-associated viral (rAAV) vectors expressing Cre into the striatum of adult BACHD mice. All mice were assessed using behavioural tests to investigate motor, metabolic and psychiatric outcome measures at 4-6 months of age. RESULTS While motor deficits, body weight changes, anxiety and depressive-like behaviours are present in BACHD mice, early widespread CNS inactivation during development significantly improves rotarod performance, body weight changes and depressive-like behaviour. However, conditional circuit-wide mutant HTT deletion from the indirect striatal pathway during development and focal striatal-specific deletion in adulthood failed to rescue any of the HD-related behaviours. CONCLUSIONS Our results indicate that widespread targeting and the timing of interventions aimed at reducing mutant HTT are important factors to consider when developing disease-modifying therapies for HD.
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Affiliation(s)
- Rachel Y. Cheong
- Translational Neuroendocrine Research UnitDepartment of Experimental Medical ScienceLund UniversityLundSweden
| | - Barbara Baldo
- Translational Neuroendocrine Research UnitDepartment of Experimental Medical ScienceLund UniversityLundSweden
- Present address:
Evotec SEHD Research and Translational SciencesHamburgGermany
| | - Muhammad U. Sajjad
- Translational Neuroendocrine Research UnitDepartment of Experimental Medical ScienceLund UniversityLundSweden
| | - Deniz Kirik
- Brain Repair and Imaging in Neural Systems UnitDepartment of Experimental Medical ScienceLund UniversityLundSweden
| | - Åsa Petersén
- Translational Neuroendocrine Research UnitDepartment of Experimental Medical ScienceLund UniversityLundSweden
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50
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Reyes A, Bartlett DM, Rankin TJ, Zaenker P, Turner K, Teo WP, Fu SC, Domingos J, Georgiou-Karistianis N, Ziman M, Cruickshank TM. Clinical Determinants of Dual Tasking in People With Premanifest Huntington Disease. Phys Ther 2021; 101:6106263. [PMID: 33482001 DOI: 10.1093/ptj/pzab016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 10/01/2020] [Accepted: 12/13/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Dual-tasking deficiencies are common in people with Huntington disease (HD) and contribute to reduced functional independence. To date, few studies have investigated the determinants of dual-tasking deficiencies in this population. The reliability of dual-tasking measures has also been poorly investigated in HD. The purpose of this study was to investigate the influence of clinical determinants on dual-tasking performance and to determine the association of disease burden outcomes on dual-tasking performance in individuals with premanifest HD. METHODS Thirty-six individuals with premanifest HD and 28 age- and sex-matched healthy controls were recruited for this study. Participants performed 3 single-task (2 cognitive and 1 motor) and 2 dual-task assessments, comprising motor (postural stability) and cognitive (simple or complex mental arithmetic) components. In addition, participants performed a comprehensive clinical battery comprising motor, cognitive, mood, and sleep assessments as well as lifestyle and disease burden measures. RESULTS Poorer sleep quality was associated with greater cognitive dual-task cost in individuals with premanifest HD. Compared with healthy controls, people with premanifest HD demonstrated an impaired capacity to dual task. Dual-task measures exhibited acceptable test-retest reliability in premanifest HD and healthy control groups. CONCLUSION These results show that dual-tasking measures are sensitive and reliable in individuals with premanifest HD. Furthermore, poor sleep quality is associated with worse cognitive performance on dual tasks, which should be considered by rehabilitation specialists when examining and therapeutically managing dual-tasking problems in individuals with HD and other neurodegenerative populations in the future. IMPACT This study adds important knowledge to the sparse literature on dual-tasking deficiencies in people with HD. When examining and therapeutically managing dual-tasking problems in this and other neurodegenerative populations, rehabilitation specialists should consider that people with premanifest HD may have an impaired capacity to dual task. Clinicians also should assess sleep quality, as poorer sleep quality is associated with worse cognitive performance on dual tasks in these individuals. LAY SUMMARY If you have premanifest HD and poor quality of sleep, you may pay more attention to maintaining postural stability rather than performing arithmetic calculations to reduce the risk of falling.
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Affiliation(s)
- Alvaro Reyes
- Facultad de Ciencias de la Rehabilitacion, Universidad Andres Bello, Santiago, Chile
| | - Danielle M Bartlett
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, Western Australia, Australia
| | - Timothy J Rankin
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, Western Australia, Australia
- Centre for Sleep Science, School of Human Sciences, Faculty of Science, University of Western Australia, Crawley, Perth, Western Australia, Australia
| | - Pauline Zaenker
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, Western Australia, Australia
| | - Kate Turner
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, Western Australia, Australia
| | - Wei-Peng Teo
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore
| | - Shih Ching Fu
- School of Electrical Engineering, Computing and Mathematical Sciences, Curtin University, Perth, Western Australia, Australia
| | - Josefa Domingos
- Laboratory of Clinical Pharmacology and Therapeutics and Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Nellie Georgiou-Karistianis
- School of Psychological Sciences and the Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Mel Ziman
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, Western Australia, Australia
- School of Biomedical Science, University of Western Australia, Crawley, Perth, Western Australia, Australia
| | - Travis M Cruickshank
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, Western Australia, Australia
- Exercise Medicine Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
- Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia
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