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Velissaris S, Davis MC, Fisher F, Gluyas C, Stout JC. A pilot evaluation of an 8-week mindfulness-based stress reduction program for people with pre-symptomatic Huntington's disease. J Community Genet 2023; 14:395-405. [PMID: 37458974 PMCID: PMC10444936 DOI: 10.1007/s12687-023-00651-1] [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: 07/07/2022] [Accepted: 05/02/2023] [Indexed: 08/23/2023] Open
Abstract
People with Huntington's disease (HD) face difficult emotional and practical challenges throughout their illness, including in the pre-symptomatic stage. There are, however, extremely limited psychosocial interventions adapted to or researched for HD. We adapted and piloted an 8-week mindfulness-based stress reduction (MBSR) program in people with pre-symptomatic HD to determine if the program (i) was feasible and acceptable to participants, (ii) resulted in increased mindfulness understanding and skills, and (iii) led to improved psychological adjustment. Quantitative measures of mindfulness, emotion regulation, mood, and quality of life were administered pre and post the MBSR program and at 3-month follow-up. Measures of mindfulness practice and session clarity were administered weekly. Qualitative participant feedback was collected with a post-program interview conducted by independent clinicians. Seven participants completed the 8-week course. The program's feasibility and acceptability was supported by excellent retention and participation rates and acceptable rates of home practice completion. In addition, qualitative feedback indicated participant satisfaction with the program structure and content. Two core mindfulness skills (observing and non-judgment) showed significant improvement from pre- to post-assessment. Participant qualitative feedback indicated increased confidence and capacity to use mindfulness techniques, particularly in emotionally challenging situations. Participant questionnaire data showed good psychological adjustment at baseline, which did not change after treatment. Psychological benefits of the program identified in qualitative data included fewer ruminations about HD, reduced isolation and stigma, and being seen by others as calmer. These findings justify expansion of the program to determine its efficacy in a larger, controlled study.
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Affiliation(s)
- Sarah Velissaris
- Statewide Progressive Neurological Disease Service, Calvary Health Care Bethlehem, 476 Kooyong Rd., South Caulfield, 3162, VIC, Australia.
| | - Marie-Claire Davis
- Statewide Progressive Neurological Disease Service, Calvary Health Care Bethlehem, 476 Kooyong Rd., South Caulfield, 3162, VIC, Australia
| | - Fiona Fisher
- Statewide Progressive Neurological Disease Service, Calvary Health Care Bethlehem, 476 Kooyong Rd., South Caulfield, 3162, VIC, Australia
| | - Cathy Gluyas
- Statewide Progressive Neurological Disease Service, Calvary Health Care Bethlehem, 476 Kooyong Rd., South Caulfield, 3162, VIC, Australia
| | - Julie C Stout
- The Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
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Boersema-Wijma DJ, van Duijn E, Heemskerk AW, van der Steen JT, Achterberg WP. Palliative care in advanced Huntington's disease: a scoping review. BMC Palliat Care 2023; 22:54. [PMID: 37138329 PMCID: PMC10155365 DOI: 10.1186/s12904-023-01171-y] [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: 08/19/2022] [Accepted: 04/12/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND As Huntington's disease (HD) is a progressive disease for which there is no cure yet, patients in the advanced stage of HD may benefit from palliative care. OBJECTIVE To review the literature focusing on palliative care in advanced stage HD, and the level of evidence. METHODS Publications between 1993 and October 29th, 2021 from 8 databases (Embase, Web of Science, Cochrane, Emcare, PsycINFO, Academic Search Premier, PMC PubMed Central and Pubmed) were included. The literature was deductively classified based on topics that are part of the definition of palliative care, or as care-related topics that emerged from the literature. Levels of evidence I (high) - V (low) were determined as defined by the Joanna Briggs Institute. RESULTS Our search resulted in 333 articles, 38 of which were included. The literature covered four domains of palliative care: physical care, psychological care, spiritual care, and social care. Four other topics in the literature were: advance care planning, end-of-life needs assessments, pediatric HD care, and need for health care services. Most literature was underpinned by a low level of evidence, except for the topics on social care (Level III-V), advance care planning (Level II-V) and end-of-life needs assessments (Level II-III). CONCLUSIONS To deliver adequate palliative care in advanced HD, both general and HD-specific symptoms and problems need to be addressed. As the level of evidence in existing literature is low, further research is essential to improve palliative care and to meet patient's wishes and needs.
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Affiliation(s)
- Dorine J Boersema-Wijma
- Department of Public Health and Primary care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2333 ZD, the Netherlands.
- Huntington Center of Expertise Topaz Overduin, Nachtegaallaan 5, Katwijk, 2225 SX, the Netherlands.
| | - Erik van Duijn
- Huntington Center of Expertise Topaz Overduin, Nachtegaallaan 5, Katwijk, 2225 SX, the Netherlands
| | - Anne-Wil Heemskerk
- Department of Public Health and Primary care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2333 ZD, the Netherlands
- Huntington Center of Expertise Topaz Overduin, Nachtegaallaan 5, Katwijk, 2225 SX, the Netherlands
| | - Jenny T van der Steen
- Department of Public Health and Primary care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2333 ZD, the Netherlands
- Radboudumc Alzheimer center and Department of Primary and Community Care, Radboud university medical center, Geert Grooteplein Noord 21, Nijmegen, 6500 HB, the Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2333 ZD, the Netherlands
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Clark ML, Abimanyi-Ochom J, Le H, Long B, Orr C, Khanh-Dao Le L. A systematic review and meta-analysis of depression and apathy frequency in adult-onset Huntington's disease. Neurosci Biobehav Rev 2023; 149:105166. [PMID: 37054804 DOI: 10.1016/j.neubiorev.2023.105166] [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: 11/18/2022] [Revised: 04/07/2023] [Accepted: 04/09/2023] [Indexed: 04/15/2023]
Abstract
Depression and apathy are associated with decreased functional capacity in Huntington's disease (HD) but frequency of depression and apathy in HD is largely unknown. Systematic literature searching was conducted across 21 databases until 30 June 2021. Inclusion criteria was limited to clinician-rated assessments of depression and apathy and adult-onset HD. Inverse-variance heterogeneity meta-analyses were conducted exploring depression and apathy frequency within individuals from families affected by HD, and within individuals with confirmed HD gene-positive status. Screening identified 289 articles for full-text review; nine remained for meta-analysis. Depression frequency in the lifetime in adults affected by or at-risk for HD was 38%, I2 = 99%. Apathy frequency in the lifetime in adults affected by or at-risk for HD was 40%, I2 = 96%. The robustness of the findings improved when limiting the analysis to gene-positive individuals only where apathy was found to be slightly more common than depression, 48% and 43% respectively. Future studies may consider reporting results from juvenile-onset HD and adult-onset HD cohorts separately to further explore phenotypic profiles.
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Affiliation(s)
- Melanie L Clark
- Deakin University, Deakin Health Economics, School of Health and Social Development, Geelong, Victoria, 3220, Australia; Neurosciences Unit, North Metropolitan Health Services Mental Health Public Health Dental Services, Perth, Western Australia; Perron Institute for Neurological and Translational Science, Perth, Western Australia.
| | - Julie Abimanyi-Ochom
- Deakin University, Deakin Health Economics, School of Health and Social Development, Geelong, Victoria, 3220, Australia; Deakin University, Institute for Health Transformation, Faculty of Health, Geelong, Victoria, 3220, Australia
| | - Ha Le
- Deakin University, Deakin Health Economics, School of Health and Social Development, Geelong, Victoria, 3220, Australia; Deakin University, Institute for Health Transformation, Faculty of Health, Geelong, Victoria, 3220, Australia
| | - Brian Long
- Neurosciences Unit, North Metropolitan Health Services Mental Health Public Health Dental Services, Perth, Western Australia
| | - Carolyn Orr
- Neurosciences Unit, North Metropolitan Health Services Mental Health Public Health Dental Services, Perth, Western Australia; Perron Institute for Neurological and Translational Science, Perth, Western Australia
| | - Long Khanh-Dao Le
- Health Economics Division, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Ruiz-Idiago J, Pomarol-Clotet E, Salvador R. Longitudinal analysis of neuropsychiatric symptoms in a large cohort of early-moderate manifest Huntington's disease patients. Parkinsonism Relat Disord 2023; 106:105228. [PMID: 36470173 DOI: 10.1016/j.parkreldis.2022.11.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 11/16/2022] [Accepted: 11/19/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND The relationship between neuropsychiatric symptoms (NPS) and other clinical dimensions in Huntington's disease (HD) is controversial. This longitudinal study analyzed the association between NPS and motor, cognitive and functional aspects of the disease along with other variables related to its clinical onset and progression. METHODS 639 early-moderate HD patients were assessed longitudinally (mean: 4.95 visits/5 years). Generalized linear mixed models were used to explore associations between NPS and the aforementioned aspects. Other variables previously reported as significant in smaller or cross-sectional studies were included in the models. RESULTS Significant associations found included a negative linear relationship between presence of depressed mood and illness duration (7.2% odds reduction of being depressed per year), a 7.6% increase in the odds of having irritability with increased chorea scores, a negative association (4.3% reduction in odds) between age at onset and aggression (i.e. earlier onset was related to a higher probability of having aggressive behaviors) and a negative association between irritability and the interference component of the Stroop test (3% odds change). Total functional capacity (TFC) was the most frequently associated factor with NPS, with apathy and perseverative behavior having the strongest relations with TFC (22% and 18% increases in odds per unit reduction in TFC respectively). CONCLUSIONS With the exception of irritability, NPS are not related to motor or cognitive variables in early-moderate HD. Total functional capacity (TFC) is the most frequently associated factor with NPS, with apathy and perseverative behavior having the strongest relations with TFC.
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Affiliation(s)
- Jesús Ruiz-Idiago
- Neuropsychiatry Unit, Hospital Mare de Déu de la Mercè, Hermanas Hospitalarias, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autónoma de Barcelona, Spain; European Huntington's Disease Network (EHDN), Ulm, Germany; FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain.
| | - Edith Pomarol-Clotet
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain; Mental Health Research Networking Center (CIBERSAM), Spain
| | - Raymond Salvador
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain; Mental Health Research Networking Center (CIBERSAM), Spain
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Gluyas C, Mottram L, Gibb R, Stout J. Identification of psychoeducation needs and an intervention response for pre-symptomatic Huntington's disease. J Community Genet 2022; 14:175-183. [PMID: 36495385 PMCID: PMC9736709 DOI: 10.1007/s12687-022-00624-w] [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: 07/07/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022] Open
Abstract
People who are aware that they are gene-positive for Huntington's disease (HD) may face an array of personal, relationship, social, financial and employment challenges prior to the onset of the disease. These challenges have been associated with increased psychological problems such as anxiety and depression. Information and support for people with pre-symptomatic HD is indicated, but there is a scarcity of research and service models to inform psychological interventions. We trialled an intervention strategy involving psychoeducation forums designed specifically for pre-symptomatic HD. In phase I of the study, we asked people with pre-symptomatic HD to identify their uppermost needs for information. Phase II involved the delivery of this information via a series of forums. The forums also provided an opportunity for interaction among the participants. Three forums were attended by 88 people with pre-symptomatic HD and significant others. Analysis of post-forum feedback questionnaires indicated high levels of satisfaction with the forums' structure, content and relevance, and notably, the pre-symptomatic specificity of focus. Additional qualitative data from recordings of forum discussion groups revealed that participants greatly valued the opportunity to meet similar others, and share their concerns and strategies for addressing these concerns. There was an abundance of requests for more forums on a wide range of relevant topics. It is recommended that this model of intervention may be of value for implementation in other HD services or community groups.
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Affiliation(s)
- Cathy Gluyas
- Statewide Progressive Neurological Disease Service, Calvary Health Care Bethlehem, 152 Como Parade West, Parkdale, Victoria 3195 Australia
| | - Lisa Mottram
- Statewide Progressive Neurological Disease Service, Calvary Health Care Bethlehem, 152 Como Parade West, Parkdale, Victoria 3195 Australia
| | - Rosanne Gibb
- Statewide Progressive Neurological Disease Service, Calvary Health Care Bethlehem, 152 Como Parade West, Parkdale, Victoria 3195 Australia
| | - Julie Stout
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, Victoria 3168 Australia
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Sarafudheen S, Shoka A, Kathirgamachelvam J. Pathological gambling and impulsivity related to Huntington's disease. PROGRESS IN NEUROLOGY AND PSYCHIATRY 2022. [DOI: 10.1002/pnp.754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Sheeba Sarafudheen
- Dr Sarafudheen is ST4, Psychiatry Trainee; Dr Shoka is Consultant Psychiatrist, and Dr Kathirgamachelvam is FY2 Doctor, all at Peter Bruff Ward, King's Wood Centre, Essex
| | - Ahmed Shoka
- Dr Sarafudheen is ST4, Psychiatry Trainee; Dr Shoka is Consultant Psychiatrist, and Dr Kathirgamachelvam is FY2 Doctor, all at Peter Bruff Ward, King's Wood Centre, Essex
| | - Janarth Kathirgamachelvam
- Dr Sarafudheen is ST4, Psychiatry Trainee; Dr Shoka is Consultant Psychiatrist, and Dr Kathirgamachelvam is FY2 Doctor, all at Peter Bruff Ward, King's Wood Centre, Essex
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Clinical Correlates of Depression and Suicidality in Huntington Disease: An Analysis of the Enroll-HD Observational Study. Cogn Behav Neurol 2022; 35:85-94. [PMID: 35486527 DOI: 10.1097/wnn.0000000000000301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 07/08/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Depression and suicidality are commonly experienced by Huntington disease (HD) gene carriers. Research on these behavioral symptoms is imperative, not only to increase our understanding of the symptoms and how they relate to HD, but also to contribute to improving patients' care and quality of life. OBJECTIVE To identify clinical variables associated with a history of depression and suicidality in HD gene carriers. METHOD We conducted a cross-sectional study of HD gene carriers from the Enroll-HD database PDS4 (periodic data set 4; N = 11,582). Data from baseline visits were obtained, and binary logistic regression models were used to ascertain the effects of clinical variables on the likelihood that HD gene carriers would have previous depression and suicidal ideation/attempts. RESULTS Approximately 65% (n = 7526) of the HD gene carriers had a history of depression, and ~27% (n = 3152) had previous suicidal ideation/attempts. Female sex; diagnosis of manifest HD; history of perseverative/obsessive behavior, apathy, and psychosis; and previous suicidal ideation/attempts were significantly associated with a history of depression in the HD gene carriers. Medical history of apathy, psychosis, and depression, as well as worse scores on the Total Functional Capacity and Irritability Scales, were significantly associated with previous suicidal ideation/attempts in the HD gene carriers. CONCLUSION The prevalence of depression and suicidality is high among HD gene carriers. An improved understanding of the risk factors for depression and suicide in HD gene carriers can assist providers in recognizing at-risk individuals and allow providers to implement therapeutic strategies.
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8
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van Duijn E, Fernandes AR, Abreu D, Ware JJ, Neacy E, Sampaio C. Incidence of completed suicide and suicide attempts in a global prospective study of Huntington's disease. BJPsych Open 2021; 7:e158. [PMID: 34462049 PMCID: PMC8444051 DOI: 10.1192/bjo.2021.969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Risk of death from suicide in Huntington's disease is notably elevated relative to that in the general population, although the incidence within HD populations has not been precisely defined. Robust incidence estimates of suicidal behavior can serve as references for HD therapeutic research and post-marketing surveillance to help evaluate the suicidality risk of novel therapeutics. AIMS To estimate the incidence rate of completed suicide and suicide attempt in the global, prospective HD cohort study Enroll-HD that records these events per protocol. METHOD A total of 20 912 participants were available for analysis (HD gene-expansion carriers (HDGECs) n = 15 924; non-HDGECs n = 4988) representing a collective observation period of 53 390 participant-years. Each observed event was subject to clinical review and evaluation. We generated incidence rates (events per 100 000 person-years) for suicides and suicide attempts using all available data, as well as by year of study and geographical region. Proportionate mortality statistics for suicide and respective 95% confidence intervals were also generated. RESULTS The overall incidence rate of suicide in HDGECs was 72 per 100 000 person-years, and 8 per 100 000 person-years in non-HDGECs. Proportionate mortality attributable to suicide in HDGECs was 4.6%. For suicide attempts, the global overall incidence rate observed in HDGECs was 306-375 per 100 000 person-years, and 23-38 per 100 000 person-years in non-HDGECs. CONCLUSIONS The incidence estimates calculated here can be used as a reference to help evaluate drug safety and may also be useful in assessing progress in clinical care for HDGECs once therapeutic interventions become widely available.
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Affiliation(s)
- Erik van Duijn
- Department of Psychiatry, Leiden University Medical Center, The Netherlands and Huntington Center Topaz Overduin, The Netherlands
| | - A Raquel Fernandes
- Association for Research and Development of the Faculty of Medicine, University of Lisbon, Portugal
| | - Daisy Abreu
- Association for Research and Development of the Faculty of Medicine, University of Lisbon, Portugal
| | | | - Eileen Neacy
- CHDI Management/CHDI Foundation, New Jersey, USA
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Stoker TB, Mason SL, Greenland JC, Holden ST, Santini H, Barker RA. Huntington's disease: diagnosis and management. Pract Neurol 2021; 22:32-41. [PMID: 34413240 DOI: 10.1136/practneurol-2021-003074] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 11/03/2022]
Abstract
Huntington's disease (HD) is an inherited neurodegenerative disease characterised by neuropsychiatric symptoms, a movement disorder (most commonly choreiform) and progressive cognitive impairment. The diagnosis is usually confirmed through identification of an increased CAG repeat length in the huntingtin gene in a patient with clinical features of the condition. Though diagnosis is usually straightforward, unusual presentations can occur, and it can be difficult to know when someone has transitioned from being an asymptomatic carrier into the disease state. This has become increasingly important recently, with several putative disease-modifying therapies entering trials. A growing number of conditions can mimic HD, including rare genetic causes, which must be considered in the event of a negative HD genetic test. Patients are best managed in specialist multidisciplinary clinics, including when considering genetic testing. Current treatments are symptomatic, and largely directed at the chorea and neurobehavioural problems, although supporting trial evidence for these is often limited.
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Affiliation(s)
- Thomas B Stoker
- John van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Sarah L Mason
- John van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Julia C Greenland
- John van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Simon T Holden
- Department of Clinical Genetics, Addenbrooke's Hospital, Cambridge, UK
| | | | - Roger A Barker
- John van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,Wellcome Trust Medical Research Council - Cambridge Stem Cell Institute, Cambridge, UK
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10
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Gasenko KA, Arslanova AV. [Huntington's disease in psychiatric practice]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:81-86. [PMID: 34283535 DOI: 10.17116/202112106181] [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: 11/17/2022]
Abstract
Huntington's disease, or Huntington's chorea, is considered as an orphan disease. However, chorea is not the single, and in many cases, not the most severe sign of this disease. Along with motor symptoms, psychiatric symptoms make a significant contribution to patient disability and desocialization. In addition, in many patients, mental and cognitive manifestations can significantly precede motor symptoms. This article considers the most common comorbid mental disorders in this disease, their characteristics and features of the course are given based on literature and own observations.
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Affiliation(s)
- K A Gasenko
- Solodnickov Clinical Psychiatric Hospital, Omsk, Russia
| | - A V Arslanova
- Solodnickov Clinical Psychiatric Hospital, Omsk, Russia
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11
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Crowell V, Houghton R, Tomar A, Fernandes T, Squitieri F. Modeling Manifest Huntington's Disease Prevalence Using Diagnosed Incidence and Survival Time. Neuroepidemiology 2021; 55:361-368. [PMID: 34350853 DOI: 10.1159/000516767] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/20/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Understanding the epidemiology of Huntington's disease (HD) is key to assessing disease burden and the healthcare resources required to meet patients' needs. We aimed to develop and validate a model to estimate the diagnosed prevalence of manifest HD by the Shoulson-Fahn stage. METHODS A literature review identified epidemiological data from Brazil, Canada, France, Germany, Italy, Spain, the UK, and the USA. Data on staging distribution at diagnosis, progression, and mortality were derived from Enroll-HD. Newly diagnosed patients with manifest HD were simulated by applying annual diagnosed incidence rates to the total population in each country, each year from 1950 onwards. The number of diagnosed prevalent patients from the previous year who remained in each stage was estimated in line with the probability of death or progression. Diagnosed prevalence in 2020 was estimated as the sum of simulated patients, from all the incident cohorts, still alive. RESULTS The model estimates that in 2020, there were 66,787 individuals diagnosed with HD in the 8 included countries, of whom 62-63% were in Shoulson-Fahn stages 1 and 2 (with less severely limited functional capacity than those in stages 3-5). Diagnosed prevalence is estimated to be 8.2-9.0 per 100,000 in the USA, Canada, and the 5 included European countries and 3.5 per 100,000 in Brazil. CONCLUSION The modeled estimates generally accord with the previously published data. This analysis contributes to better understanding of the epidemiology of HD and highlights areas of uncertainty.
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Affiliation(s)
- Valerie Crowell
- Access Insights & Metrics, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Richard Houghton
- Product Development Personalized Healthcare, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | | | | | - Ferdinando Squitieri
- Huntington and Rare Diseases Unit, Fondazione IRCCS Casa Sollievo della Sofferenza Research Hospital, San Giovanni Rotondo, Italy
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12
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Sexton A, West K, Gill G, Wiseman A, Taylor J, Purvis R, Fahey M, Storey E, Walsh M, James P. Suicide in frontotemporal dementia and Huntington disease: analysis of family-reported pedigree data and implications for genetic healthcare for asymptomatic relatives. Psychol Health 2020; 36:1397-1402. [PMID: 33232178 DOI: 10.1080/08870446.2020.1849700] [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] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Genomic testing for early-onset dementia is becoming more accessible, along with predictive testing for at-risk relatives; however, complex counselling issues are important to address. The topic of suicide often has stigma associated, and thoughts or experiences may not be volunteered without prompting. Little has been published with consideration to suicide rates in the context of family experiences and their significance in genetic counselling for relatives of people with Huntington disease and frontotemporal dementia. DESIGN This study included pedigree information for 267 symptomatic individuals with frontotemporal dementia or Huntington disease, provided via genetic counselling clinics. MAIN OUTCOME MEASURES Descriptive statistics and suicide rate calculations based on family reported pedigree data. RESULTS The suicide rate was 2996 per 100,000 compared with the population rate of 10 per 100,000. Approximately one in 15 families reported suicide of an affected family member, and file notes indicated that one in five families had experienced suicide, suicidal thoughts or suicide attempts in one or more affected, unaffected or pre-symptomatic relative. CONCLUSION Health professional awareness of family experiences, including suicide of a relative, is vital in facilitating client decisions about genetic testing, and in providing adequate psychosocial support during the process of genetic testing and adaption to results.
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Affiliation(s)
- Adrienne Sexton
- Genomic Medicine, The Royal Melbourne Hospital, Parkville, Australia.,Department of Medicine, The University of Melbourne, Parkville, Australia
| | - Kirsty West
- Genomic Medicine, The Royal Melbourne Hospital, Parkville, Australia
| | - Gulvir Gill
- Genomic Medicine, The Royal Melbourne Hospital, Parkville, Australia
| | - Allan Wiseman
- Genomic Medicine, The Royal Melbourne Hospital, Parkville, Australia
| | - Jessica Taylor
- Genomic Medicine, The Royal Melbourne Hospital, Parkville, Australia
| | - Rebecca Purvis
- Genomic Medicine, The Royal Melbourne Hospital, Parkville, Australia
| | - Michael Fahey
- Genomic Medicine, The Royal Melbourne Hospital, Parkville, Australia.,Department of Paediatrics, Monash University, Clayton, Australia
| | - Elsdon Storey
- Genomic Medicine, The Royal Melbourne Hospital, Parkville, Australia.,Central Clinical School, Monash University, Clayton, Australia
| | - Maie Walsh
- Genomic Medicine, The Royal Melbourne Hospital, Parkville, Australia
| | - Paul James
- Genomic Medicine, The Royal Melbourne Hospital, Parkville, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
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13
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Ranganathan M, Kostyk SK, Allain DC, Race JA, Daley AM. Age of onset and behavioral manifestations in Huntington's disease: An Enroll-HD cohort analysis. Clin Genet 2020; 99:133-142. [PMID: 33020896 DOI: 10.1111/cge.13857] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/01/2020] [Accepted: 10/03/2020] [Indexed: 11/28/2022]
Abstract
Huntington's disease is associated with motor, cognitive and behavioral dysfunction. Behavioral symptoms may present before, after, or simultaneously with clinical disease manifestation. The relationship between age of onset and behavioral symptom presentation and severity was explored using the Enroll-HD database. Manifest individuals (n = 4469) were initially divided into three groups for preliminary analysis: early onset (<30 years; n = 479); mid-adult onset (30-59 years; n = 3478); and late onset (>59 years; n = 512). Incidence of behavioral symptoms reported at onset was highest in those with early onset symptoms at 26% (n = 126), compared with 19% (n = 678) for mid-adult onset and 11% (n = 56) for late onset (P < 0.0001). Refined analysis, looking across the continuum of ages rather than between categorical subgroups found that a one-year increase in age of onset was associated with a 5.6% decrease in the odds of behavioral symptoms being retrospectively reported as the presenting symptom (P < 0.0001). By the time of study enrollment, the odds of reporting severe behavioral symptoms decreased by 5.5% for each one-year increase in reported age of onset. Exploring environmental, genetic and epigenetic factors that affect age of onset and further characterizing types and severity of behavioral symptoms may improve treatment and understanding of Huntington's disease's impact on affected individuals.
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Affiliation(s)
- Megha Ranganathan
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sandra K Kostyk
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Dawn C Allain
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Jonathan A Race
- Division of Biostatistics, The Ohio State University, Columbus, Ohio, USA.,Eli Lilly and Company, Design Hub-Immunology Division, Indianapolis, Indiana, USA
| | - Allison M Daley
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Kayson E, Eberly S, Anderson KE, Marder K, Shoulson I, Oakes D, Young AB, Biglan K, Hersch S. The Prospective Huntington At-Risk Observational Study (PHAROS): The Emotional Well-Being, Safety and Feasibility of Long-Term Research Participation. J Huntingtons Dis 2020; 8:435-441. [PMID: 31381523 DOI: 10.3233/jhd-190365] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is limited understanding of the feasibility of conducting long-term research among undiagnosed (pre-symptomatic) adults at risk to develop Huntington disease (HD), while protecting their emotional well-being and safety. OBJECTIVE To assess pre-specified events pertaining to emotional well-being, safety, and feasibility among healthy consenting adults at risk for developing HD who have chosen not to undergo genetic testing. METHODS PHAROS research participants prospectively reported the occurrence of events pertaining to psychological distress (psychiatric evaluations, depression, suicidality) and feasibility (maintaining confidentiality, study attrition). PHAROS enrolled 1001 participants. RESULTS Events pertaining to psychological distress were reported by 35% of participants. The most common events included heightened suicide risk (26%), new onset depression (12%), and new mental health evaluation (9%); all occurred significantly more frequently among participants with expanded trinucleotide CAG repeats (≥37). Five deaths occurred, none related to suicide. Forty-one percent of participants reported self-disclosure of their HD at-risk status, and 15% reported that someone else (usually a family member) had done so. Confidentiality of CAG test results was maintained by investigators. The withdrawal rate was largely uniform over the study period and did not differ significantly by gender or CAG status. CONCLUSIONS The potentially vulnerable research participants in PHAROS showed good emotional tolerability and safety. Individual CAG data were not disclosed, and confidentiality about disclosure of at-risk HD status was well maintained by others (family, friends, etc.). Long-term research participation of adults at risk for HD who choose not to undergo pre-symptomatic DNA testing is well tolerated, safe and feasible.
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Affiliation(s)
- Elise Kayson
- Center for Health + Technology/Clinical Trials Coordination Center, University of Rochester, Rochester, NY, USA.,Department of Neurology, University of Rochester, Rochester, NY, USA
| | - Shirley Eberly
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
| | - Karen E Anderson
- Department of Psychiatry, Research Division and Department of Neurology, Georgetown University, Washington, DC, USA
| | - Karen Marder
- Columbia University Medical Center, New York, NY, USA
| | - Ira Shoulson
- Department of Neurology, University of Rochester, Rochester, NY, USA
| | - David Oakes
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
| | - Anne B Young
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kevin Biglan
- Department of Neurology, University of Rochester, Rochester, NY, USA.,Eli Lilly and Company, Indianapolis, IN, USA
| | - Steven Hersch
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Voyager Therapeutics, Cambridge, MA, USA
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15
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Carlozzi NE, Goodnight S, Kratz AL, Stout JC, McCormack MK, Paulsen JS, Boileau NR, Cella D, Ready RE. Validation of Neuro-QoL and PROMIS Mental Health Patient Reported Outcome Measures in Persons with Huntington Disease. J Huntingtons Dis 2020; 8:467-482. [PMID: 31424415 DOI: 10.3233/jhd-190364] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Patient-reported outcomes (PROs) for mental health are important for persons with Huntington disease (HD) who commonly experience symptoms of depression, anxiety, irritability, anger, aggression, and apathy. Given this, there is a need for reliable and valid patient-reported outcomes measures of mental health for use as patient-centered outcomes in clinical trials. OBJECTIVE Thus, the purpose of this study was to establish the psychometric properties (i.e., reliability and validity) of six Neuro-QoL and PROMIS mental health measures to support their clinical utility in persons with HD. METHODS 294 individuals with premanifest (n = 102) or manifest HD (n = 131 early HD; n = 61 late HD) completed Neuro-QoL/PROMIS measures of Emotional and Behavioral Dyscontrol, Positive Affect and Well-Being, Stigma, Anger, Anxiety, and Depression, legacy measures of self-reported mental health, and clinician-rated assessments of functioning. RESULTS Convergent validity and discriminant validity for the Neuro-QoL and PROMIS measures of Emotional and Behavioral Dyscontrol, Positive Affect and Well-Being, Stigma, Anger, Anxiety, and Depression, were supported in persons with HD. Neuro-QoL measures of Anxiety and Depression also demonstrated moderate sensitivity and specificity (i.e., they were able to distinguish between individuals with and without clinically significant anxiety and depression). CONCLUSIONS Findings provide psychometric support for the clinical utility of the Neuro-QoL/PROMIS measures of mental health measures in persons with HD. As such, these measures should be considered for the standardized assessment of health-related quality of life in persons with HD.
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Affiliation(s)
- Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Siera Goodnight
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Anna L Kratz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Julie C Stout
- Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Michael K McCormack
- Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, Piscataway, NJ, USA.,Department of Pathology, Rowan-School of Medicine, Stratford, NJ, USA
| | - Jane S Paulsen
- Departments of Psychiatry, Neurology, and Psychology, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA
| | - Nicholas R Boileau
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - David Cella
- Departments of Medical Social Sciences and Preventative Medicine, Northwestern University, Chicago, IL, USA
| | - Rebecca E Ready
- Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, MA, USA
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16
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Leal Rato M, Ferreira JJ. Reader response: Risk factors for suicidality in Huntington disease: An analysis of the 2CARE clinical trial. Neurology 2020; 94:637. [DOI: 10.1212/wnl.0000000000009229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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17
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Ratna N, Kamble NL, Venkatesh SD, Purushottam M, Pal PK, Jain S. Psychiatric morbidity and poor follow-up underlie suboptimal functional and survival outcomes in Huntington's disease. BMC Neurol 2020; 20:87. [PMID: 32164608 PMCID: PMC7068943 DOI: 10.1186/s12883-020-01671-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 03/02/2020] [Indexed: 01/25/2023] Open
Abstract
Background Huntington’s disease (HD), an inherited, often late-onset, neurodegenerative disorder, is considered to be a rare, orphan disease. Research into its genetic correlates and services for those affected are inadequate in most low-middle income countries, including India. The apparent ‘incurability’ often deters symptomatic and rehabilitative care, resulting in poor quality of life and sub-optimal outcomes. There are no studies assessing disease burden and outcomes from India. Methods We attempted to evaluate individuals diagnosed to have HD at our tertiary-care center between 2013 and 2016 for clinical symptoms, functionality, mortality, follow up status through a structured interview, clinical data from medical records and UHDRS-TFC scoring. Results Of the 144 patients, 25% were untraceable, and another 17 (11.8%) had already died. Mean age at death and duration of illness at the time of death, were 53 years and 7 years respectively, perhaps due to suicides and other comorbidities at an early age. The patients who could be contacted (n = 81) were assessed for morbidity and total functional capacity (TFC). Mean CAG repeat length and TFC score were 44.2 and 7.5 respectively. Most individuals (66%) were in TFC stage I and II and could perhaps benefit from several interventions. The TFC score correlated inversely with duration of illness (p < 0.0001). The majority were being taken care of at home, irrespective of the physical and mental disability. There was a high prevalence of psychiatric morbidity (91%) including suicidal tendency (22%). Three of the 17 who died had committed suicide, and several other families reported suicidal history in other family members. Only about half the patients (57%) maintained a regular clinical follow-up. Conclusions This study demonstrates the poor follow-up rates, significant suicidality and other psychiatric symptoms, sub-optimal survival durations and functional outcomes highlighting the need for holistic care for the majority who appear to be amenable to interventions.
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Affiliation(s)
- Nikhil Ratna
- Department of Clinical Neuro Sciences, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India.
| | - Nitish L Kamble
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Sowmya D Venkatesh
- Molecular Genetics Laboratory, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Meera Purushottam
- Molecular Genetics Laboratory, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Pramod K Pal
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Sanjeev Jain
- Molecular Genetics Laboratory, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
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18
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Simpson J, Dale M, Theed R, Gunn S, Zarotti N, Eccles FJR. Validity of irritability in Huntington's disease: A scoping review. Cortex 2019; 120:353-374. [PMID: 31401402 DOI: 10.1016/j.cortex.2019.06.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/18/2019] [Accepted: 06/29/2019] [Indexed: 01/01/2023]
Abstract
PURPOSE To scope the literature concerning irritability in Huntington's disease to determine whether or not irritability is a valid and meaningful construct within this population. METHOD A scoping literature review was conducted based on findings from a search of five databases (Academic Search Ultimate, PsycINFO, CINAHL, Scopus and Web of Science) in November 2018. From an initial return of 453 papers, 40 were found suitable for review. RESULTS Review of the 40 studies highlighted several aspects of irritability in people with HD which influence its validity as an independent construct in context of the disease. While various measures are used to assess irritability, a gold standard has yet to be identified and consequently irritability is assessed inconsistently across the literature. In addition, the results suggest that irritability may not reflect pathological disease processes in HD, but rather comprises a multidimensional construct which appears to be strongly associated with other psychological difficulties such as depression and anxiety. CONCLUSIONS The current concept of irritability in people with HD continues to lack a general consensus in the clinical literature, in terms of both operationalisation and assessment. Consequently, further research is warranted in order to determine the extent to which irritability is a valid construct within the context of HD, including its associated behavioural, cognitive and affective dimensions.
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Affiliation(s)
- Jane Simpson
- Division of Health Research, Lancaster University, Lancaster, UK.
| | - Maria Dale
- Adult Mental Health Psychology, Leicestershire Partnership NHS Trust, Leicester, UK
| | - Rachael Theed
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Sarah Gunn
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Nicolò Zarotti
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Fiona J R Eccles
- Division of Health Research, Lancaster University, Lancaster, UK
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19
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Kachian ZR, Cohen-Zimerman S, Bega D, Gordon B, Grafman J. Suicidal ideation and behavior in Huntington's disease: Systematic review and recommendations. J Affect Disord 2019; 250:319-329. [PMID: 30875675 DOI: 10.1016/j.jad.2019.03.043] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/21/2019] [Accepted: 03/04/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND An increased risk of suicide in Huntington's disease (HD) patients is well documented, with rates significantly higher than those of the general population as well as other neurodegenerative diseases. However, despite its prevalence, the magnitude of this phenomenon as well as its predictors and etiology are still poorly understood. METHODS We performed the first systematic review of all the studies published between March 1993 and December 2018 which investigated HD patients and gene carriers that reported suicidal ideation, suicide attempt, or suicide as an outcome. RESULTS This review reveals that some aspects of suicidality in HD are more clearly understood than others. We confirm an increased risk of suicidal ideation, suicide attempt, and suicide for HD patients. We found that suicidal ideation is elevated throughout the course of the disease, and that psychiatric comorbidities are common risk factors with depression being the most prominent. LIMITATIONS Important data are still largely missing, specifically regarding cognitive and neuroanatomical mechanisms and potential effective interventions. Moreover, inconsistencies in terminology, assessment tools, and outcome measures limit the comparability of the research and the conclusions that can be drawn. CONCLUSIONS Incidence of suicidal ideation, suicide attempt, and suicide are higher among those with HD relative to the non-HD population. It is therefore important that suicidal thoughts and behaviors are closely monitored in HD clinics and that clinical trials use standardized scales. Future research should focus on better understanding the etiology of this high suicide risk and on testing the efficacy of potential interventions.
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Affiliation(s)
- Zachary R Kachian
- Cognitive Neuroscience Laboratory, Think+Speak lab, Shirley Ryan AbilityLab, 355 E Erie St., Chicago, IL 60611, USA
| | - Shira Cohen-Zimerman
- Cognitive Neuroscience Laboratory, Think+Speak lab, Shirley Ryan AbilityLab, 355 E Erie St., Chicago, IL 60611, USA.
| | - Danny Bega
- Department of Neurology, Division of Movement Disorders, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Barry Gordon
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Cognitive Science Department, Johns Hopkins University, Baltimore, MD, USA
| | - Jordan Grafman
- Cognitive Neuroscience Laboratory, Think+Speak lab, Shirley Ryan AbilityLab, 355 E Erie St., Chicago, IL 60611, USA; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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20
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McGarry A, McDermott MP, Kieburtz K, Fung WLA, McCusker E, Peng J, de Blieck EA, Cudkowicz M. Risk factors for suicidality in Huntington disease: An analysis of the 2CARE clinical trial. Neurology 2019; 92:e1643-e1651. [PMID: 30850442 DOI: 10.1212/wnl.0000000000007244] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 12/05/2018] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Most suicidality literature in Huntington disease (HD) is based on natural history studies or retrospective reviews, but reports on risk factors from clinical trials are limited. METHODS We analyzed 609 participants from 2CARE, a randomized, double-blind, placebo-controlled clinical trial with up to 5 years of follow-up, for risk factors related to suicidality. The primary outcome variable was the time from randomization until the first occurrence of either suicidal ideation or attempt. We also considered time from randomization until the first suicide attempt as a secondary outcome variable. RESULTS Depression, anxiety, bipolar disorder, antidepressant or anxiolytic use, and prior suicide attempt at baseline were associated with time to ideation or attempt. Baseline employment status, marital status, CAG repeat length, tetrabenazine use, and treatment assignment (coenzyme Q10 or placebo) were not associated with suicidality. Time-dependent variables from the Unified Huntington's Disease Rating Scale Behavioral Assessment were associated with time to suicidal ideation or attempt, driven mainly by items related to depressed mood, low self-esteem/guilt, anxiety, suicidal thoughts, irritability, and compulsions. Variables associated with time to suicide attempt alone were generally similar. CONCLUSION These data suggest psychiatric comorbidities in HD are predictive of suicidal behavior while participating in clinical trials, reinforcing the importance of clinical surveillance and treatment towards lessening risk during participation and perhaps beyond. Designing a composite algorithm for early prediction of suicide attempts in HD may be of value, particularly given anticipated trials aimed at disease modification are likely to be long-term. CLINICALTRIALSGOV IDENTIFIER NCT00608881.
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Affiliation(s)
- Andrew McGarry
- From Cooper University Healthcare at Rowan University (A.M.), Camden, NJ; University of Rochester (M.P.M., K.K., E.A.d.B.), NY; North York General Hospital (W.L.A.F.), University of Toronto, Canada; Westmead Hospital (E.M.), Australia; The Ohio State University (J.P.), Columbus; and Harvard Medical School (M.C.), Boston, MA.
| | - Michael P McDermott
- From Cooper University Healthcare at Rowan University (A.M.), Camden, NJ; University of Rochester (M.P.M., K.K., E.A.d.B.), NY; North York General Hospital (W.L.A.F.), University of Toronto, Canada; Westmead Hospital (E.M.), Australia; The Ohio State University (J.P.), Columbus; and Harvard Medical School (M.C.), Boston, MA
| | - Karl Kieburtz
- From Cooper University Healthcare at Rowan University (A.M.), Camden, NJ; University of Rochester (M.P.M., K.K., E.A.d.B.), NY; North York General Hospital (W.L.A.F.), University of Toronto, Canada; Westmead Hospital (E.M.), Australia; The Ohio State University (J.P.), Columbus; and Harvard Medical School (M.C.), Boston, MA
| | - Wai Lun Alan Fung
- From Cooper University Healthcare at Rowan University (A.M.), Camden, NJ; University of Rochester (M.P.M., K.K., E.A.d.B.), NY; North York General Hospital (W.L.A.F.), University of Toronto, Canada; Westmead Hospital (E.M.), Australia; The Ohio State University (J.P.), Columbus; and Harvard Medical School (M.C.), Boston, MA
| | - Elizabeth McCusker
- From Cooper University Healthcare at Rowan University (A.M.), Camden, NJ; University of Rochester (M.P.M., K.K., E.A.d.B.), NY; North York General Hospital (W.L.A.F.), University of Toronto, Canada; Westmead Hospital (E.M.), Australia; The Ohio State University (J.P.), Columbus; and Harvard Medical School (M.C.), Boston, MA
| | - Jing Peng
- From Cooper University Healthcare at Rowan University (A.M.), Camden, NJ; University of Rochester (M.P.M., K.K., E.A.d.B.), NY; North York General Hospital (W.L.A.F.), University of Toronto, Canada; Westmead Hospital (E.M.), Australia; The Ohio State University (J.P.), Columbus; and Harvard Medical School (M.C.), Boston, MA
| | - Elisabeth A de Blieck
- From Cooper University Healthcare at Rowan University (A.M.), Camden, NJ; University of Rochester (M.P.M., K.K., E.A.d.B.), NY; North York General Hospital (W.L.A.F.), University of Toronto, Canada; Westmead Hospital (E.M.), Australia; The Ohio State University (J.P.), Columbus; and Harvard Medical School (M.C.), Boston, MA
| | - Merit Cudkowicz
- From Cooper University Healthcare at Rowan University (A.M.), Camden, NJ; University of Rochester (M.P.M., K.K., E.A.d.B.), NY; North York General Hospital (W.L.A.F.), University of Toronto, Canada; Westmead Hospital (E.M.), Australia; The Ohio State University (J.P.), Columbus; and Harvard Medical School (M.C.), Boston, MA
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Loss-of-Huntingtin in Medial and Lateral Ganglionic Lineages Differentially Disrupts Regional Interneuron and Projection Neuron Subtypes and Promotes Huntington's Disease-Associated Behavioral, Cellular, and Pathological Hallmarks. J Neurosci 2019; 39:1892-1909. [PMID: 30626701 DOI: 10.1523/jneurosci.2443-18.2018] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/21/2018] [Accepted: 12/29/2018] [Indexed: 12/23/2022] Open
Abstract
Emerging studies are providing compelling evidence that the pathogenesis of Huntington's disease (HD), a neurodegenerative disorder with frequent midlife onset, encompasses developmental components. Moreover, our previous studies using a hypomorphic model targeting huntingtin during the neurodevelopmental period indicated that loss-of-function mechanisms account for this pathogenic developmental component (Arteaga-Bracho et al., 2016). In the present study, we specifically ascertained the roles of subpallial lineage species in eliciting the previously observed HD-like phenotypes. Accordingly, we used the Cre-loxP system to conditionally ablate the murine huntingtin gene (Httflx) in cells expressing the subpallial patterning markers Gsx2 (Gsx2-Cre) or Nkx2.1 (Nkx2.1-Cre) in Httflx mice of both sexes. These genetic manipulations elicited anxiety-like behaviors, hyperkinetic locomotion, age-dependent motor deficits, and weight loss in both Httflx;Gsx2-Cre and Httflx;Nkx2.1-Cre mice. In addition, these strains displayed unique but complementary spatial patterns of basal ganglia degeneration that are strikingly reminiscent of those seen in human cases of HD. Furthermore, we observed early deficits of somatostatin-positive and Reelin-positive interneurons in both Htt subpallial null strains, as well as early increases of cholinergic interneurons, Foxp2+ arkypallidal neurons, and incipient deficits with age-dependent loss of parvalbumin-positive neurons in Httflx;Nkx2.1-Cre mice. Overall, our findings indicate that selective loss-of-huntingtin function in subpallial lineages differentially disrupts the number, complement, and survival of forebrain interneurons and globus pallidus GABAergic neurons, thereby leading to the development of key neurological hallmarks of HD during adult life. Our findings have important implications for the establishment and deployment of neural circuitries and the integrity of network reserve in health and disease.SIGNIFICANCE STATEMENT Huntington's disease (HD) is a progressive degenerative disorder caused by aberrant trinucleotide expansion in the huntingtin gene. Mechanistically, this mutation involves both loss- and gain-of-function mechanisms affecting a broad array of cellular and molecular processes. Although huntingtin is widely expressed during adult life, the mutant protein only causes the demise of selective neuronal subtypes. The mechanisms accounting for this differential vulnerability remain elusive. In this study, we have demonstrated that loss-of-huntingtin function in subpallial lineages not only differentially disrupts distinct interneuron species early in life, but also leads to a pattern of neurological deficits that are reminiscent of HD. This work suggests that early disruption of selective neuronal subtypes may account for the profiles of enhanced regional cellular vulnerability to death in HD.
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