Task-switching abilities in pre-manifest Huntington's disease subjects

Virtual reality tolerability, sense of presence and usability in Huntington disease: a pilot study

INTRODUCTION

Several studies demonstrated the utility of immersive virtual reality (VR) as a complementary approach to conventional therapy for improving motor, psychological and cognitive impairment in some pathological conditions. Our pilot study aims to evaluate for the first time: 1) sense of presence, tolerability and usability of VR immersive experience in patients with early stages of Huntington disease (eHDp) compared to healthy controls (HC); 2) correlation between the use of technology/cybersickness and the variables of presence/usability; 3) correlation between clinical characteristics (genetic, motor, functional and cognitive) and VR's variables.

METHOD

We recruited 10 eHDp and 10 age, gender and education matched HC. Participants completed questionnaires about sense of presence, usability, tolerability and technology use profile. Subjects were exposed to different VR scenarios from a first-person perspective through a standalone VR headset.

RESULTS

Our results showed no significant statistical difference between eHDp and HC for the sense of presence (p=0.910), usability (p=0.744) and tolerability (p=0.730) during the VR experience. Familiarity with the use of technology was also comparable between groups (p=0.676). Regarding correlations in eHDp group, our results showed no correlations between use of technology/tolerability and the sense of presence/usability. Moreover, clinical characteristics of eHDp (genetic, motor, functional and cognitive scores) did not influence the sense of presence, tolerability and usability.

CONCLUSION

Our research presents preliminary evidence for the applicability of VR in eHDp. These results open up the possibility to explore future applications of this methodology in rehabilitation (i.e., cognitive training, physiotherapy), diagnosis and psychological support in Huntington disease patients.

Prodromal Cognitive Changes as a Prognostic Indicator of Forthcoming Huntington's Disease Severity: A Retrospective Longitudinal Study

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.

The validation of the Italian version of multiple sclerosis neuropsychological screening questionnaire in Huntington's disease

INTRODUCTION

Multiple sclerosis neuropsychological questionnaire (MSNQ) is a brief questionnaire useful for screening patient's and informant's self-perception of cognitive dysfunctions in daily life activities. Our study aims to evaluate the MSNQ validity in Huntington's disease (HD) mutation carriers and to correlate MSNQ scores with neurological, cognitive, and behavioral variables.

METHODS

The study was conducted on a sample of 107 subjects from presymptomatic to the middle stage of HD recruited at LIRH Foundation and C.S.S. Mendel Institute in Rome. Unified Huntington's Disease Rating Scale (UHDRS), an internationally standardized and validated scale, was used to evaluate motor, functional cognitive, and behavioral domains.

RESULTS

Our results showed that in HD subjects, MSNQ has a unidimensional factor structure. Correlational analyses indicated a good correlation between the MSNQ-patient version (MSNQ-p) and clinical variables, specifically with cognitive dysfunction and behavioral alterations. Moreover, higher scores in MSNQ-p were associated with higher motor disease and functional impairment showing that patients in advanced stage of HD perceive a greater cognitive impairment. These results confirm the questionnaire's reliability.

CONCLUSIONS

The present study demonstrates the validity and adaptability of MSNQ in the HD population proposing it as a cognitive tool during routine clinical follow-ups, although further research is needed to determine an optimal cut-off score for this measure.

Effects of Physical Activity on Cognitive Functioning: The Role of Cognitive Reserve and Active Aging

BACKGROUND

The increase in average life expectancy necessitates the identification of possible mechanisms capable of promoting "active aging" to ensure adequate levels of global functioning. Numerous studies show that regular physical activity promotes, even in the elderly, a state of functional psychophysical well-being capable of slowing down age-related cognitive decline. This study aimed to clarify whether, and how, the intensity of physical activity can modulate cognitive and executive skills by influencing specific psychological variables.

METHODS

Our sample consisted of 151 senior subjects divided into hikers (HIK), gentle gymnastics (GYM), and sedentary (SED), who practice intense, moderate, and reduced physical activity, respectively. A battery of psychological questionnaires was administrated to evaluate attentional skills, decision-making, the ability to implement targeted behaviors, perceived self-efficacy, and psychophysical well-being. We included: the Mini-Mental State Examination, Cognitive Reserve Index Questionnaire, General Self-Efficacy Scale, Letter Cancellation Test, Everyday Competence Questionnaire, and Geriatric Depression Scale (GDS).

RESULTS

Comparisons between the scores reported by the three groups showed that the HIK group differs from the others with respect to most of the measurements, presenting better mood and cognitive performance, and a specific psychological profile. On the contrary, the GYM group appeared to have a greater affinity with the SED group than with the HIK group, both cognitively and psychologically.

CONCLUSIONS

Types of physical activity, as well as the intensity and frequency with which they are practiced, are factors that promote an active aging process, protecting the psychophysical well-being and overall cognitive functioning of the elderly.

Huntington disease exacerbates action impulses

Background

Impulsivity is a common clinical feature of Huntington disease (HD), but the underlying cognitive dynamics of impulse control in this population have not been well-studied.

Objective

To investigate the temporal dynamics of action impulse control in HD patients using an inhibitory action control task.

Methods

Sixteen motor manifest HD patients and seventeen age-matched healthy controls (HC) completed the action control task. We applied the activation-suppression theoretical model and distributional analytic techniques to differentiate the strength of fast impulses from their top-down suppression.

Results

Overall, HD patients produced slower and less accurate reactions than HCs. HD patients also exhibited an exacerbated interference effect, as evidenced by a greater slowing of RT on non-corresponding compared to corresponding trials. HD patients made more fast, impulsive errors than HC, evidenced by significantly lower accuracy on their fastest reaction time trials. The slope reduction of interference effects as reactions slowed was similar between HD and controls, indicating preserved impulse suppression.

Conclusion

Our results indicate that patients with HD show a greater susceptibility to act rapidly on incorrect motor impulses but preserved proficiency of top-down suppression. Further research is needed to determine how these findings relate to clinical behavioral symptoms.

The Repeatable Battery for the Assessment of Neuropsychological Status, While Useful for Measuring Cognitive Changes in Manifest Huntington Disease, May Show Limited Utility in Premanifest Disease

BACKGROUND

The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is a brief, standardized neuropsychological test that assesses several areas of cognitive function. Recent studies, although sparse, have examined the use of the RBANS to detect cognitive deficits in individuals with manifest Huntington disease (HD); however, no studies have investigated its utility to detect cognitive deficits in individuals with premanifest HD (PreHD), where cognitive symptoms are thought to be more subtle.

OBJECTIVE

To assess cognitive deficits in individuals with HD, particularly in individuals with PreHD, using an easily administered, brief but comprehensive, neuropsychological test.

METHOD

We administered the RBANS to 31 individuals with HD, 29 individuals with PreHD, and 22 healthy controls (HC) at an academic HD clinical research center and collected RBANS Total, Index, and subtest scores for group comparisons.

RESULTS

The HD group had significantly lower RBANS Total, Index, and subtest scores than the HC. The PreHD group had significantly lower RBANS Total scores and Coding subtest scores than the HC, but no other significant group differences were identified.

CONCLUSION

Our results substantiate previous findings of significant impairment on the RBANS in individuals with HD. In addition, we are the first to demonstrate that, although the RBANS can identify deficits in psychomotor speed and information processing in individuals with PreHD, it does not appear to have the ability to detect impairment in any additional cognitive domains in individuals with PreHD.

Can Stimulus Valence Modulate Task-Switching Ability? A Pilot Study on Primary School Children

Executive functions and emotional processes follow a time-dependent development that reflects the brain’s anatomo-functional maturation. Though the assessment of these cognitive functions is largely examined, in children the role of emotions in the mental set-shifting is still rarely investigated. The aim of this study was to assess how attention shifting can be modulated by the valence of emotional stimuli. To this end, sixty-two primary school children were tested with a new emotional task-switching paradigm obtained by manipulating the emotional valence and physical features of the stimulus pool. Thus, two tasks were alternatively presented: the Valence task and the Color task. Based on executive performance results, we found a lengthening of response times and a lower accuracy in the emotionally connoted task (Valence task), compared to the neutral task (Color task). The data demonstrate that the processing of emotional stimuli modulates the task-switching performance during development. These findings could help in the implementation of teaching strategies that can promote the development of executive functions and, therefore, functionally improve the overall academic performance of children. Finally, a better understanding of the developmental trajectories of executive functions can help neuropsychologists both in the early diagnosis and treatment of potential executive alterations.

Task-switching abilities in episodic and chronic migraine

Migraineurs show impaired cognitive functions interictally, mainly involving information processing speed, basic attention, and executive functions. We aimed to assess executive impairment in migraine patients with different attack frequencies through a task-switching protocol designed to assess different sub-processes of executive functioning. We enrolled 42 migraine patients and divided them into three groups based on the attack frequency: 13 subjects had episodic migraine with a low frequency (LFEM, 4-7 migraine days per month), 14 subjects had high-frequency episodic migraine (HFEM, 8-14 days) and, finally, 15 subjects presented chronic migraine (≥ 15 headache days/month, CM); we compared them to 20 healthy control (HC), matched to both gender and education. Patients with high headache frequencies (CM and HFEM) showed worse performance than LFEM and HC controls, as indicated by poor accuracy, increased switch cost, and reaction times. Our study demonstrated a difference in task-switching abilities in patients with high frequency or chronic migraine compared with low-frequency episodic migraine and healthy controls. These difficulties in executive control processes could be related to altered functioning of the frontal cortex and its cortical and subcortical connections.

More than Just a Brain Disorder: A Five-Point Manifesto for Psychological Care for People with Huntington’s Disease

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.

Cognitive Reserve in Early Manifest Huntington Disease Patients: Leisure Time Is Associated with Lower Cognitive and Functional Impairment

We focused on Cognitive Reserve (CR) in patients with early Huntington Disease (HD) and investigated whether clinical outcomes might be influenced by lifetime intellectual enrichment over time. CR was evaluated by means of the Cognitive Reserve Index questionnaire (CRIq), an internationally validated scale which includes three sections: education, working activity, and leisure time. The clinical HD variables were quantified at three different time points (baseline-t0, 1 year follow up-t1 and 2 years follow up-t2) as per the Unified Huntington’s Disease Rating Scale (UHDRS), an internationally standardized and validated scale including motor, cognitive, functional and behavioral assays. Our sample consisted of 75 early manifest patients, withclinical stage scored according to the Total Functional Capacity (TFC) scale. Our correlational analysis highlighted a significant inverse association between CRIq leisure time (CRIq_LA) and longitudinal functional impairment (namely, the differential TFC score between t2 and t0 or ΔTFC) (p < 0.05), and the multidimensional progression of HD as measured by the composite UHDRS (cUHDRS, p < 0.01). CRIq_LA was significantly and positively associated with better cognitive performances at all time points (p < 0.05). Our results suggest that higher is the CRIq_LA, milder is the progression of HD in terms of functional, multidimensional and cognitive outcome.

Measures of postural control and mobility during dual-tasking as candidate markers of instability in Huntington's disease

BACKGROUND

Individuals with Huntington's disease (HD) have impairments in performing dual-tasks, however, there is limited information about the effects of changing postural and cognitive demands as well as which measures are best suited as markers of underlying motor-cognitive interference.

METHODS

Forty-three individuals with HD and 15 healthy controls (HC) completed single tasks of walking (Timed Up & Go (TUG), 7 m walk), standing (feet together, feet apart and foam surface) and seated cognitive performance (Stroop, Symbol Digit Modalities Test (SDMT), Delis-Kaplan Executive Function System (DKEFS) Sorting test) and dual cognitive-motor tasks while standing (+ Stroop) and walking (+ DKEFS, TUG cognitive). APDM Opal sensors recorded measures of postural sway and time to complete motor tasks.

RESULTS

Individuals with HD had a greater increase in standing postural sway compared to HC from single to dual-tasks and with changes to support surface. Both groups demonstrated a decrease in gait performance during the TUG cognitive, however, this difference was greater in people with HD compared to HC. While those with HD showed a greater dual-task motor cost compared to HC, both groups behaved similarly as condition complexity increased.

CONCLUSIONS

Standing postural sway is a more sensitive marker of instability than change in standard gait speed, particularly under dual-task conditions. The more complex TUG cognitive is a sensitive measure of walking dual-task performance. The results of this study provide insights about the nature of motor-cognitive impairments in HD and provide support for a distinction between static and dynamic postural control mechanisms during performance of dual-tasks.

Cognitive and behavioral associated changes in manifest Huntington disease: A retrospective cross-sectional study

INTRODUCTION

Behavioral and cognitive changes can be observed across all Huntington disease (HD) stages. Our multicenter and retrospective study investigated the association between cognitive and behavioral scale scores in manifest HD, at three different yearly timepoints.

METHODS

We analyzed cognitive and behavioral domains by the Unified Huntington's Disease Rating Scale (UHDRS) and by the Problem Behaviors Assessment Short Form (PBA-s), at three different yearly times of life (t0 or baseline, t1 after one year, t2 after two years), in 97 patients with manifest HD (mean age 48.62 ± 13.1), from three ENROLL-HD Centers. In order to test the disease progression, we also examined patients' motor and functional changes by the UHDRS, overtime.

RESULTS

The severity of apathy and of perseveration/obsession was associated with the severity of the cognitive decline (p < .0001), regardless of the yearly timepoint. The score of irritability significantly and positively correlated with perseveration errors in the verbal fluency test at t0 (r = .34; p = .001), while the psychosis significantly and negatively correlated with the information processing speed at t0 (r = -.21; p = .038) and significantly and positively correlated with perseveration errors in the verbal fluency test at t1 (r = .35; p < .0001). The disease progression was confirmed by the significant worsening of the UHDRS-Total Motor Score (TMS) and of the UHDRS-Total Functional Capacity (TFC) scale score after two-year follow-up (p < .0001).

CONCLUSION

Although the progression of abnormal behavioral manifestations cannot be predicted in HD, the severity of apathy and perseveration/obsessions are significantly associated with the severity of the cognitive function impairment, thus contributing, together, to the disease development and to patients' loss of independence, in addition to the neurological manifestations. This cognitive-behavior pattern determines a common underlying deficit depending on a dysexecutive syndrome.

Time will tell: Decision making in premanifest and manifest Huntington's disease

OBJECTIVE

To investigate cognitive flexibility in premanifest and manifest Huntington's disease (HD).

BACKGROUND

HD is an autosomal dominant neurodegenerative disease characterized by motor, cognitive, and behavioral abnormalities with typical motor symptoms. In this study, we wanted to assess decision making in premanifest (pre-HD) and manifest HD patients.

METHODS

A total of 77 non-demented subjects including 29 pre-HD, 22 manifest HD patients, and 26 healthy controls (HC) were included. We stratified the pre-HD group based on their estimated years to disease onset into a far (FAR, n = 13) and a near (NEAR, n = 16) group. Furthermore, participants performed the Montreal cognitive assessment battery (MoCA), the trail making task part A and B (TMT A, TMT B), the Symbol digit modalities test (SDMT), and the beads task.

RESULTS

In the beads task, HD patients gathered less information than all other groups (all p-values < .001). Furthermore, the NEAR group gathered less information than the FAR group (p < .001) and HC (p = .001). There was no difference between the HC and the FAR group (p = 1.0). In the TMT and the SDMT, HD patients were slower than all other groups (all p-values < .01) but there were no other significant differences.

CONCLUSIONS

Decision making with a higher degree of uncertainty may be an early neuropsychological sign to indicate the disease process prior to reaching criteria for motor diagnosis of HD.

Abnormal visual scanning and impaired mental state recognition in pre-manifest Huntington disease

Huntington's disease (HD) is a genetic neurodegenerative disorder that affects not only the motor but also the cognitive and the neuropsychiatric domain. In particular, deficits in mental state recognition may emerge already at early pre-manifest stages of the disease. The aim of this research was to explore the relation between visual scanning behavior and complex mental state recognition in individuals with pre-manifest HD (preHD). Eighteen preHD and eighteen age- and gender-matched healthy controls took the revised "Reading the Mind in the Eyes" test while their eye-movements were tracked. In addition to the expected deficits in mental state recognition, preHD showed abnormalities concerning all three scanning variables we considered, namely the absolute number of fixations (FC), the average fixation duration (AFD), and the percentage of time spent fixating (FTR). In preHD, FC and FTR but not AFD predicted mental state recognition over and beyond general disease-related declines in cognition and motor functioning. Notably, preHD showed abnormal vertical and horizontal fixation patterns, and these patterns predicted mental state recognition, suggesting the involvement of mechanisms related to the embodied processing of emotional stimuli. Overall, our results suggest that impaired facial mental state recognition in pre-manifest HD is partly due to emotional-motivational factors affecting the visual scanning of facial expressions.

Antidopaminergic treatment is associated with reduced chorea and irritability but impaired cognition in Huntington's disease (Enroll-HD)

OBJECTIVES

Alterations in dopamine neurotransmission underlie some of the clinical features of Huntington's disease (HD) and as such are a target for therapeutic intervention, especially for the treatment of chorea and some behavioural problems. However, justification for such an intervention is mainly based on case reports and small open label studies and the effects these drugs have on cognition in HD remain unclear.

METHODS

In this study, we used the Enroll-HD observational database to assess the effects of antidopaminergic medication on motor, psychiatric and cognitive decline, over a 3-year period. We first looked at the annual rate of decline of a group of HD patients taking antidopaminergic medication (n=466) compared with an untreated matched group (n=466). The groups were matched on specified clinical variables using propensity score matching. Next, we studied a separate group of HD patients who were prescribed such medications part way through the study (n=90) and compared their rate of change before and after the drugs were introduced and compared this to a matched control group.

RESULTS

We found that HD patients taking antidopaminergic medication had a slower progression in chorea and irritability compared with those not taking such medications. However, this same group of patients also displayed significantly greater rate of decline in a range of cognitive tasks.

CONCLUSION

In conclusion we found that antidopaminergic treatment is associated with improvements in the choreic movements and irritability of HD but worsens cognition. However, further research is required to prospectively investigate this and whether these are causally linked, ideally in a double-blind placebo-controlled trial.

Safer Attitude to Risky Decision-Making in Premanifest Huntington's Disease Subjects

Huntington’s disease (HD) is an inherited neurodegenerative disorder characterized by involuntary, jerky movements, incoordination, behavioral changes and subtle executive and cognitive impairment starting before motor symptoms. Our study aimed to assess the risky decision-making process in premanifest (pre) HD subjects, by means Game of Dice Task (GDT). As dependent variables, several GDT outcomes have been taken into consideration. We recruited 30 subjects (15 females) with preHD (i.e., Diagnosis Confidence Level < 4; Total Motor Score < 10), and 21 age, gender and education matched neurologically normal subjects (11 females). GDT is a computer-guided task where subjects are invited to watch the digits on which to bet and to evaluate the related potential risk to win or loss. Our results showed that decision and feedback times were longer in preHD than in neurologically normal group in both disadvantageous and advantageous choices. PreHD subjects provided a greater number of “safe” strategies, taken with longer decision-making time than neurologically normal subjects, showing a reduced propensity to risk. Such behavior, characterized by increased slowness in acting and providing answers, might contribute to delineate a behavioral and cognitive profile in preHD.