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Anderson KE, Arbatti L, Hosamath A, Feigin A, Goldstein J, Kayson E, Kinsler BL, Falanga L, Denise L, Carlozzi NE, Frank S, Jackson K, Kostyk S, Purks JL, Serbin KP, Kinel S, Beck CA, Shoulson I. What Huntington's Disease Patients Say About Their Illness: An Online Direct-to-Participant Pilot Study. J Huntingtons Dis 2024:JHD231520. [PMID: 38701155 DOI: 10.3233/jhd-231520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Background Direct-to-participant online reporting facilitates the conduct of clinical research by increasing access and clinically meaningful patient engagement. Objective We assessed feasibility of online data collection from adults with diagnosed Huntington's disease (HD) who directly reported their problems and impact in their own words. Methods Data were collected online from consenting United States residents who self-identified as 1) having been diagnosed with Huntington's disease, 2) able to ambulate independently, and 3) self-sufficient for most daily needs. Data for this pilot study were collected using the Huntington Study Group myHDstory online research platform. The Huntington Disease Patient Report of Problems (HD-PROP), an open-ended questionnaire, was used to capture verbatim bothersome problems and functional impact. Natural language processing, human-in-the-loop curation of verbatim reports involving clinical and experience experts, and machine learning classified verbatim-reports into clinically meaningful symptoms. Results All 8 questionnaires in the online pilot study were completed by 345 participants who were 60.9% men, 34.5±9.9 (mean±SD) years old, and 9.5±8.4 years since HD diagnosis. Racial self-identification was 46.4% Caucasian, 28.7% African American, 15.4% American Indian/Alaska Native, and 9.5% other. Accuracy of verbatim classification was 99%. Non-motor problems were the most frequently reported symptoms; depression and cognitive impairment were the most common. Conclusions Online research participation was feasible for a diverse cohort of adults who self-reported an HD diagnosis and predominantly non-motor symptoms related to mood and cognition. Online research tools can help inform what bothers HD patients, identify clinically meaningful outcomes, and facilitate participation by diverse and under-represented populations.
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Affiliation(s)
| | - Lakshmi Arbatti
- Grey Matter Technologies/Modality.AI, San Francisco, CA, USA
| | | | - Andrew Feigin
- NYU Langone Health, New York, NY, USA
- Huntington Study Group, Rochester, NY, USA
| | | | | | | | | | | | | | - Samuel Frank
- Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | | | | - Ira Shoulson
- Grey Matter Technologies/Modality.AI, San Francisco, CA, USA
- University of Rochester, Rochester, NY, USA
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Hughes S, Aboufadel S, Smirnova A, Snell C, Churchill E, Hall A, Malcarne V, Gilbert PE, Corey‐Bloom J. Development and Psychometric Properties of a New Brief, Yet Comprehensive, Behavioral Questionnaire for Huntington's Disease. Mov Disord Clin Pract 2023; 10:427-433. [PMID: 36949805 PMCID: PMC10026282 DOI: 10.1002/mdc3.13661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 12/08/2022] [Accepted: 12/29/2022] [Indexed: 01/18/2023] Open
Abstract
Background Individuals with Huntington's disease (HD) experience motoric, cognitive, and psychiatric dysfunction. These difficulties can cause maladaptive behaviors that can be very distressing to family and caregivers. Capturing these behaviors in clinical and research settings is crucial. Objectives To develop and evaluate the psychometric properties of an instrument that is brief, yet comprehensive, in assessing a broad range of behaviors in HD. Methods A pool of 30 items encompassing common behaviors in HD was generated. Items were scored on a 4-point Likert scale ranging from completely disagree to completely agree, with higher scores indicating greater dysfunction. The self-report measure was piloted on a small sample of individuals with HD. Reliability (test-retest, internal consistency) and validity (convergent, discriminant, criterion) were evaluated. Results The HD-Behavioral Questionnaire (HD-BQ) demonstrated evidence for reliability with a test-retest correlation coefficient of r = 0.81 and an internal consistency of 0.96. Validity was established with evidence for good convergent, divergent, and criterion validity. A receiver operating characteristic curve showed that the HD-BQ outperformed a similar commonly used measure in diagnostic capability of behaviors in HD. Conclusions The HD-BQ, a patient self-report measure, was created to more fully explore behavioral issues that people with HD experience in response to limitations of commonly used instruments in the field. Psychometric evidence supports that the HD-BQ is a valid and reliable instrument for the brief, yet comprehensive, assessment of problematic behaviors in HD.
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Affiliation(s)
- Shelby Hughes
- Department of NeurosciencesUniversity of California, San DiegoLa JollaCaliforniaUSA
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical PsychologySan DiegoCaliforniaUSA
| | - Sameer Aboufadel
- Department of NeurosciencesUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Anna Smirnova
- Department of NeurosciencesUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Chase Snell
- Department of NeurosciencesUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Emma Churchill
- Department of NeurosciencesUniversity of California, San DiegoLa JollaCaliforniaUSA
- Department of PsychologySan Diego State UniversitySan DiegoCaliforniaUSA
| | - Andrew Hall
- Department of NeurosciencesUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Vanessa Malcarne
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical PsychologySan DiegoCaliforniaUSA
- Department of PsychologySan Diego State UniversitySan DiegoCaliforniaUSA
| | - Paul E. Gilbert
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical PsychologySan DiegoCaliforniaUSA
- Department of PsychologySan Diego State UniversitySan DiegoCaliforniaUSA
| | - Jody Corey‐Bloom
- Department of NeurosciencesUniversity of California, San DiegoLa JollaCaliforniaUSA
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical PsychologySan DiegoCaliforniaUSA
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Hughes SB, Churchill E, Smirnova A, Hall A, Culbert B, Snell C, Wright BA, Gilbert PE, Corey-Bloom J. Anosognosia in HD: Comparison of self-report and caregiver ratings with objective performance measures. Parkinsonism Relat Disord 2023; 107:105272. [PMID: 36610230 PMCID: PMC9933916 DOI: 10.1016/j.parkreldis.2022.105272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/08/2022] [Accepted: 12/29/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Individuals with Huntington's disease (HD) commonly experience anosognosia, a lack of awareness of deficits. Thus, it is important to examine the accuracy of patient vs caregiver ratings on the basis of objective performance-based measures. METHODS The Anosognosia Scale (AS) was given to 33 patients with manifest HD and their caregivers. The AS consists of 8 items in which individuals rate their global abilities relative to same-aged peers. Scores range from very impaired to excellent. Caregiver and patient ratings were then correlated with objective measures. RESULTS Caregivers' evaluations of patients' cognitive and motoric abilities were more highly correlated with objective measures than patients' ratings. Specifically, caregivers' AS item scores were highly correlated with objective measures of walking (Unified Huntington Disease Rating Scale (UHDRS) tandem walking score [r = 0.57, p = .001] vs. patient [r = 0.39, p = .031]); dexterity (UHDRS pronation supination score [r = 0.55, p = .011] vs. patient [r = 0.18, p = .393]); speech (UHDRS dysarthria score [r = 0.55, p = .004] vs. patient [r = 0.03, p = .854]); memory (MoCA score [r = -.45, p = .048] vs. patient [r = -.11, p = .963]); attention (Trails Making Test A score [r = 0.58, p = .004] vs. patient [r = 0.08, p = .686]); and word retrieval (category fluency ([r = -.58, p = .004] vs. patient [r = -.02, p = 1.00]). Moreover, both the UHDRS total motor score (TMS) (F(1,29) = 7.50, p = .010) and the Mini Mental Status Exam (MMSE) (F(1,31) = 5.40, p = .027) were significant predictors of patient levels of anosognosia. CONCLUSIONS Our findings indicate that caregivers may be better able to rate HD patients' cognitive and motor abilities than patients themselves. Both cognitive and motor severity are significant predictors of levels of anosognosia in HD.
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Affiliation(s)
- Shelby B Hughes
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA; San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.
| | - Emma Churchill
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA; Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Anna Smirnova
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Andrew Hall
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Braden Culbert
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Chase Snell
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Brenton A Wright
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Paul E Gilbert
- San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA; Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Jody Corey-Bloom
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA; San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
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Carlozzi NE, Choi SW, Wu Z, Miner JA, Lyden AK, Graves C, Wang J, Sen S. An App-Based Just-in-Time Adaptive Self-management Intervention for Care Partners (CareQOL): Protocol for a Pilot Trial. JMIR Res Protoc 2021; 10:e32842. [PMID: 34889775 PMCID: PMC8704108 DOI: 10.2196/32842] [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: 08/11/2021] [Revised: 10/07/2021] [Accepted: 10/07/2021] [Indexed: 12/02/2022] Open
Abstract
Background Care partners (ie, informal family caregivers) of individuals with health problems face considerable physical and emotional stress, often with a substantial negative impact on the health-related quality of life (HRQOL) of both care partners and care recipients. Given that these individuals are often overwhelmed by their caregiving responsibilities, low-burden self-management interventions are needed to support care partners to ensure better patient outcomes.
Objective The primary objective of this study is to describe an intensive data collection protocol that involves the delivery of a personalized just-in-time adaptive intervention that incorporates passive mobile sensor data feedback (sleep and activity data from a Fitbit [Fitbit LLC]) and real time self-reporting of HRQOL via a study-specific app called CareQOL (University of Michigan) to provide personalized feedback via app alerts.
Methods Participants from 3 diverse care partner groups will be enrolled (care partners of persons with spinal cord injury, care partners of persons with Huntington disease, and care partners of persons with hematopoietic cell transplantation). Participants will be randomized to either a control group, where they will wear the Fitbit and provide daily reports of HRQOL over a 3-month (ie, 90 days) period (without personalized feedback), or the just-in-time adaptive intervention group, where they will wear the Fitbit, provide daily reports of HRQOL, and receive personalized push notifications for 3 months. At the end of the study, participants will complete a feasibility and acceptability questionnaire, and metrics regarding adherence and attrition will be calculated.
Results This trial opened for recruitment in November 2020. Data collection was completed in June 2021, and the primary results are expected to be published in 2022.
Conclusions This trial will determine the feasibility and acceptability of an intensive app-based intervention in 3 distinct care partner groups: care partners for persons with a chronic condition that was caused by a traumatic event (ie, spinal cord injury); care partners for persons with a progressive, fatal neurodegenerative disease (ie, Huntington disease); and care partners for persons with episodic cancer conditions that require intense, prolonged inpatient and outpatient treatment (persons with hematopoietic cell transplantation).
Trial Registration ClinicalTrials.gov NCT04556591; https://clinicaltrials.gov/ct2/show/NCT04556591
International Registered Report Identifier (IRRID) DERR1-10.2196/32842
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Affiliation(s)
- Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
| | - Sung Won Choi
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - Zhenke Wu
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Jennifer A Miner
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
| | - Angela K Lyden
- Clinical Trials Support Office, University of Michigan, Ann Arbor, MI, United States
| | - Christopher Graves
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
| | - Jitao Wang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Srijan Sen
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
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Another Perspective on Huntington's Disease: Disease Burden in Family Members and Pre-Manifest HD When Compared to Genotype-Negative Participants from ENROLL-HD. Brain Sci 2021; 11:brainsci11121621. [PMID: 34942923 PMCID: PMC8699274 DOI: 10.3390/brainsci11121621] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/02/2021] [Accepted: 12/07/2021] [Indexed: 11/17/2022] Open
Abstract
Background: In addition to the effects on patients suffering from motor-manifest Huntington’s disease (HD), this fatal disease is devasting to people who are at risk, premanifest mutation-carriers, and especially to whole families. There is a huge burden on people in the environment of affected HD patients, and a need for further research to identify at-risk caregivers. The aim of our research was to investigate a large cohort of family members, in comparison with genotype negative and premanifest HD in order to evaluate particular cohorts more closely. Methods: We used the ENROLL-HD global registry study to compare motoric, cognitive, functional, and psychiatric manifestation in family members, premanifest HD, and genotype negative participant as controls. Cross-sectional data were analyzed using ANCOVA-analyses in IBM SPSS Statistics V.28. Results: Of N = 21,116 participants from the global registry study, n = 5174 participants had a premanifest motor-phenotype, n = 2358 were identified as family controls, and n = 2640 with a negative HD genotype. Analysis of variance revealed more motoric, cognitive, and psychiatric impairments in premanifest HD (all p < 0.001). Self-reported psychiatric assessments revealed a significantly higher score for depression in family controls (p < 0.001) when compared to genotype negative (p < 0.001) and premanifest HD patients (p < 0.05). Family controls had significantly less cognitive capacities within the cognitive test battery when compared to genotype negative participants. Conclusions: Within the largest cohort of HD patients and families, several impairments of motoric, functional, cognitive, and psychiatric components can be confirmed in a large cohort of premanifest HD, potentially due to prodromal HD pathology. HD family controls suffered from higher self-reported depression and less cognitive capacities, which were potentially due to loaded or stressful situations. This research aims to sensitize investigators to be aware of caregiver burdens caused by HD and encourage support with socio-medical care and targeted psychological interventions. In particular, further surveys and variables are necessary in order to implement them within the database so as to identify at-risk caregivers.
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Feasibility and initial validation of 'HD-Mobile', a smartphone application for remote self-administration of performance-based cognitive measures in Huntington's disease. J Neurol 2020; 268:590-601. [PMID: 32880724 DOI: 10.1007/s00415-020-10169-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/29/2020] [Accepted: 08/13/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Smartphone-based cognitive assessment measures allow efficient, rapid, and convenient collection of cognitive datasets. Establishment of feasibility and validity is essential for the widespread use of this approach. We describe a novel smartphone application (HD-Mobile) that includes three performance-based cognitive tasks with four key outcome measures, for use with Huntington's disease (HD) samples. We describe known groups and concurrent validity, test-retest reliability, sensitivity, and feasibility properties of the tasks. METHODS Forty-two HD CAG-expanded participants (20 manifest, 22 premanifest) and 28 healthy controls completed HD-Mobile cognitive tasks three times across an 8-day period, on days 1, 4, and 8. A subsample of participants had pen-and-paper cognitive task data available from their most recent assessment from their participation in a separate observational longitudinal study, Enroll-HD. RESULTS Manifest-HD participants performed worse than healthy controls for three of four HD-Mobile cognitive measures, and worse than premanifest-HD participants for two of four measures. We found robust test-retest reliability for manifest-HD participants (ICC = 0.71-0.96) and with some exceptions, in premanifest-HD (ICC = 0.52-0.96) and healthy controls (0.54-0.96). Correlations between HD-Mobile and selected Enroll-HD cognitive tasks were mostly medium to strong (r = 0.36-0.68) as were correlations between HD-Mobile cognitive tasks and measures of expected disease progression and motor symptoms for the HD CAG-expanded participants (r = - 0.34 to - 0.54). CONCLUSIONS Results indicated robust known-groups, test-retest, concurrent validity, and sensitivity of HD-Mobile cognitive tasks. The study demonstrates the feasibility and utility of HD-Mobile for conducting convenient, frequent, and potentially ongoing assessment of HD samples without the need for in-person assessment.
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Thorley EM, Iyer RG, Wicks P, Curran C, Gandhi SK, Abler V, Anderson KE, Carlozzi NE. Understanding How Chorea Affects Health-Related Quality of Life in Huntington Disease: An Online Survey of Patients and Caregivers in the United States. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2019; 11:547-559. [PMID: 29750428 PMCID: PMC6132452 DOI: 10.1007/s40271-018-0312-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Chorea is the hallmark motor feature of Huntington disease (HD) and can negatively impact daily functioning and health-related quality of life (HRQoL). OBJECTIVE The objective of this study was to evaluate how chorea impacts HRQoL and overall functioning among HD patients participating on the PatientsLikeMe website ( www.PatientsLikeMe.com ). METHODS A survey was provided to HD participants and/or their caregivers via PatientsLikeMe (9 February 2017-22 March 2017), comprising multiple-choice and open-ended questions designed to assess how chorea impacts HRQoL and overall functioning, and the importance of treating chorea. The HDQLIFE measurement system was used to evaluate patient-reported outcomes of chorea and compare Anxiety and Stigma scores in participants with high chorea versus those with low chorea [HDQLIFE Chorea scores ≥ 60 (n = 45) vs. < 60 (n = 38)]. RESULTS A total of 115 participants (n = 35 caregivers; n = 80 individuals with HD) were included in this study. Among those experiencing chorea (n = 83, 74% of respondents), 66% indicated it was 'Very Important' to manage chorea; however, only 47% agreed that their current medication regimen helped manage their movements. In general, respondents reported that chorea negatively affected HRQoL [HDQLIFE Chorea mean score (standard deviation): 59.3 (6.1)]. Consistent with this, significantly higher Anxiety (P = 0.0423) and stigma (P < 0.0001) scores were observed among respondents with high chorea than in those with low chorea. CONCLUSIONS These results highlight the negative impact of chorea on HRQoL and overall functioning in individuals with HD. Better chorea treatment options are needed to successfully manage symptoms and to help improve HRQoL in these individuals, and patient experiences of anxiety and stigma should be considered in treatment plans.
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Affiliation(s)
| | - Ravi G Iyer
- Teva Pharmaceutical Industries, 41 Moores Rd, Frazer, PA, 19355, USA
| | - Paul Wicks
- PatientsLikeMe, 160 2nd Street, Cambridge, MA, 02142, USA
| | - Chris Curran
- PatientsLikeMe, 160 2nd Street, Cambridge, MA, 02142, USA
| | - Sanjay K Gandhi
- Teva Pharmaceutical Industries, 41 Moores Rd, Frazer, PA, 19355, USA
| | - Victor Abler
- Teva Pharmaceutical Industries, 41 Moores Rd, Frazer, PA, 19355, USA
| | - Karen E Anderson
- Department of Psychiatry, Georgetown University, Washington, DC, USA
| | - Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, 500 S. State Street, Ann Arbor, MI, 48109, USA
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