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Ashner MC, Garcia TP. Understanding the implications of a complete case analysis for regression models with a right-censored covariate. AM STAT 2023; 78:335-344. [PMID: 39070115 PMCID: PMC11281394 DOI: 10.1080/00031305.2023.2282629] [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: 12/18/2022] [Accepted: 10/28/2023] [Indexed: 07/30/2024]
Abstract
Despite its drawbacks, the complete case analysis is commonly used in regression models with incomplete covariates. Understanding when the complete case analysis will lead to consistent parameter estimation is vital before use. Our aim here is to demonstrate when a complete case analysis is consistent for randomly right-censored covariates and to discuss the implications of its use even when consistent. Across the censored covariate literature, different assumptions are made to ensure a complete case analysis produces a consistent estimator, which leads to confusion in practice. We make several contributions to dispel this confusion. First, we summarize the language surrounding the assumptions that lead to a consistent complete case estimator. Then, we show a unidirectional hierarchical relationship between these assumptions, which leads us to one sufficient assumption to consider before using a complete case analysis. Lastly, we conduct a simulation study to illustrate the performance of a complete case analysis with a right-censored covariate under different censoring mechanism assumptions, and we demonstrate its use with a Huntington disease data example.
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Affiliation(s)
| | - Tanya P. Garcia
- Department of Biostatistics, University of North Carolina at Chapel Hill
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2
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Iñesta C, Oltra-Cucarella J, Bonete-López B, Calderón-Rubio E, Sitges-Maciá E. Regression-Based Normative Data for Independent and Cognitively Active Spanish Older Adults: Digit Span, Letters and Numbers, Trail Making Test and Symbol Digit Modalities Test. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9958. [PMID: 34639265 PMCID: PMC8507906 DOI: 10.3390/ijerph18199958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/16/2021] [Accepted: 09/18/2021] [Indexed: 12/31/2022]
Abstract
In this work, we developed normative data for the neuropsychological assessment of independent and cognitively active Spanish older adults over 55 years of age. METHOD Regression-based normative data were calculated from a sample of 103 non-depressed independent community-dwelling adults aged 55 or older (67% women). Raw data for Digit Span (DS), Letters and Numbers (LN), the Trail Making Test (TMT), and the Symbol Digit Modalities Test (SDMT) were regressed on age, sex, and education. The model predicting TMT-B scores also included TMT-A scores. Z-scores for the discrepancy between observed and predicted scores were used to identify low scores. The base rate of low scores for SABIEX normative data was compared to the base rate of low scores using published normative data obtained from the general population. RESULTS The effects of age, sex, and education varied across neuropsychological measures. Although the proportion of low scores was similar between normative datasets, there was no agreement in the identification of cognitively impaired individuals. CONCLUSIONS Normative data obtained from the general population might not be sensitive to identify low scores in cognitively active older adults, incorrectly classifying them as cognitively normal compared to the less-active population. We provide a friendly calculator for use in neuropsychological assessment in cognitively active Spanish people aged 55 or older.
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Affiliation(s)
- Clara Iñesta
- SABIEX, Universidad Miguel Hernández de Elche, Av. de la Universidad, 03207 Elche, Spain; (C.I.); (B.B.-L.); (E.C.-R.); (E.S.-M.)
| | - Javier Oltra-Cucarella
- SABIEX, Universidad Miguel Hernández de Elche, Av. de la Universidad, 03207 Elche, Spain; (C.I.); (B.B.-L.); (E.C.-R.); (E.S.-M.)
- Department of Health Psychology, Miguel Hernandez University of Elche, 03202 Elche, Spain
| | - Beatriz Bonete-López
- SABIEX, Universidad Miguel Hernández de Elche, Av. de la Universidad, 03207 Elche, Spain; (C.I.); (B.B.-L.); (E.C.-R.); (E.S.-M.)
- Department of Health Psychology, Miguel Hernandez University of Elche, 03202 Elche, Spain
| | - Eva Calderón-Rubio
- SABIEX, Universidad Miguel Hernández de Elche, Av. de la Universidad, 03207 Elche, Spain; (C.I.); (B.B.-L.); (E.C.-R.); (E.S.-M.)
| | - Esther Sitges-Maciá
- SABIEX, Universidad Miguel Hernández de Elche, Av. de la Universidad, 03207 Elche, Spain; (C.I.); (B.B.-L.); (E.C.-R.); (E.S.-M.)
- Department of Health Psychology, Miguel Hernandez University of Elche, 03202 Elche, Spain
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3
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Carlozzi NE, Boileau NR, Hahn EA, Barton SK, Cella D, McCormack MK, Ready RE. Responsiveness to Change Over Time: An Examination of the Neuro-QoL Social Function Measures in Persons with Huntington's Disease. J Huntingtons Dis 2021; 9:83-97. [PMID: 31744014 DOI: 10.3233/jhd-190385] [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: 11/15/2022]
Abstract
BACKGROUND Social health is an important concern in persons with Huntington's disease (HD); however, there is little literature examining this construct in this population. OBJECTIVE While cross-sectional data supports the clinical utility of two Neuro-QoL social health measures in persons with HD, data is still needed to establish their longitudinal validity. METHODS Participants (N = 358) completed baseline and at least one follow-up (12- and 24-month) assessment that included the completion of Neuro-QoL Social Health computer adaptive tests (CATs) and short forms (for Ability to Participate in Social Roles and Activities [SRA] and Satisfaction with SRA). Test-retest reliability was examined using intra class correlations, and one-way ANOVAs with Bonferroni post-hoc contrasts were used to determine whether there were group differences among premanifest, early- and late-stage HD participants on the Social health measures. In addition, standardized response means were used to examine longitudinal responsiveness, and mixed or general linear models were used to examine change over time (relative to self-reported change on an associated anchor item about social health and clinician-rated change based on Total Functional Capacity scores from the UHDRS). RESULTS Test-retest reliability of the measures was excellent (ICCs ranged from 0.82 to 0.87 across the different measures) and persons with greater disease burden reported more problems with social health than those at earlier stages in the disease process (all p < 0.0001). Responsiveness was supported for all measures except the Ability to Participate in SRA CAT; participants who had self-reported or clinician-rated declines in health generally had 12- and 24-month declines on the Neuro-QoL measures. CONCLUSIONS Findings indicate that these measures may be useful for studies attempting to assess change in social health over time.
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Affiliation(s)
- Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Nicholas R Boileau
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Elizabeth A Hahn
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Stacey K Barton
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - 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
| | - Rebecca E Ready
- Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, MA, USA
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4
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Carlozzi NE, Boileau NR, Roché MW, Ready RE, Perlmutter JS, Chou KL, Barton SK, McCormack MK, Stout JC, Cella D, Miner JA, Paulsen JS. Responsiveness to change over time and test-retest reliability of the PROMIS and Neuro-QoL mental health measures in persons with Huntington disease (HD). Qual Life Res 2020; 29:3419-3439. [PMID: 32813263 PMCID: PMC7686156 DOI: 10.1007/s11136-020-02596-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND The majority of persons with Huntington disease (HD) experience mental health symptoms. Patient-reported outcome (PRO) measures are capable of capturing unobservable behaviors and feelings relating to mental health. The current study aimed to test the reliability and responsiveness to self-reported and clinician-rated change over time of Neuro-QoL and PROMIS mental health PROs over the course of a 24-month period. METHODS At baseline, 12-months, and 24-months, 362 participants with premanifest or manifest HD completed the Neuro-QoL Depression computer adaptive test (CAT), PROMIS Depression short form (SF), Neuro-QoL Anxiety CAT, PROMIS Anxiety SF, PROMIS Anger CAT and SF, Neuro-QoL Emotional/Behavioral Dyscontrol CAT and SF, Neuro-QoL Positive Affect and Well-Being CAT and SF, and Neuro-QoL Stigma CAT and SF. Participants completed several clinician-administered measures at each time point, as well as several global ratings of change at 12- and 24-months. Reliability (test-retest reliability and measurement error) and responsiveness (using standardized response means and general linear models) were assessed. RESULTS Test-retest reliability and measurement error were excellent for all PROs (all ICC ≥ .90 for test-retest reliability and all SEM percentages ≤ 6.82%). In addition, 12- and 24-month responsiveness were generally supported for the Neuro-QoL and PROMIS mental health PROs; findings relative to clinician-rated anchors of change (e.g., SRMs for the group with declines ranged from .38 to .91 for 24-month change and .09 to .45, with the majority above .25 for 12-month change) were generally more robust than those relative to self-reported anchors of change (e.g., SRMs for the group with declines ranged from .02 to .75, with the majority above .39 for 24-month change and .09 to .45, with the majority above .16 for 12-month change). CONCLUSIONS The Neuro-QoL and PROMIS mental health PROs demonstrated strong psychometric reliability, as well as responsiveness to self-reported and clinician-rated change over time in people with HD.
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Affiliation(s)
- Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA.
- Department of Physical Medicine & Rehabilitation, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Building NCRC B14, Room G213, Ann Arbor, MI, 48109-2800, USA.
| | - Nicholas R Boileau
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Matthew W Roché
- CHDI Management/CHDI Foundation, Princeton, NJ, USA
- Department of Psychology, New Jersey City University, Jersey City, NJ, USA
| | - Rebecca E Ready
- Psychological and Brain Sciences, University of Massachusetts, Amherst, MA, USA
| | - Joel S Perlmutter
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
- Department of Radiology, Neuroscience, Physical Therapy, and Occupational Therapy, Washington University in St. Louis, St. Louis, MO, USA
| | - Kelvin L Chou
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Stacey K Barton
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Michael K McCormack
- Department of Pathology, Rowan University - SOM, Stratford, NJ, USA
- Department of Psychiatry, Rutgers University, RWJMS, Piscataway, NJ, USA
| | - Julie C Stout
- Department of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - David Cella
- Departments of Medical Social Sciences and Preventative Medicine, Northwestern University, Chicago, IL, USA
| | - Jennifer A Miner
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Jane S Paulsen
- Department of Psychiatry and Department of Neurology, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA
- Department of Psychological and Brain Sciences, The University of Iowa, Iowa City, IA, USA
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5
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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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Ryan J, Woods RL, Britt CJ, Murray AM, Shah RC, Reid CM, Wolfe R, Nelson MR, Orchard SG, Lockery JE, Trevaks RE, Storey E. Normative Data for the Symbol Digit Modalities Test in Older White Australians and Americans, African-Americans, and Hispanic/Latinos. J Alzheimers Dis Rep 2020; 4:313-323. [PMID: 33024939 PMCID: PMC7504980 DOI: 10.3233/adr-200194] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Processing speed, which can be assessed using the Symbol Digit Modalities Test (SDMT), is central to many brain functions. Processing speed declines with advanced age but substantial impairments are indicative of brain injury or disease. Objective The purpose of this study was to provide SDMT normative data for older community-dwelling individuals in the U.S. and Australia. Methods The ASPREE trial recruited 19,114 relatively healthy older men and women in Australia and the U.S. from the general community. All participants were without a diagnosis of dementia and with a Modified Mini-Mental State examination score of 78 or more at enrolment. The SDMT was administered at baseline as part of a neuropsychological test battery. Results The median age of participants was 74 years (range 65-99), and 56% were women. The median years of education was 12. Ethno-racial differences in SDMT performance were observed and normative data were thus presented separately for 16,289 white Australians, 1,082 white Americans, 891 African-Americans, and 316 Hispanic/Latinos. There were consistent positive associations found between SDMT and education level, and negative associations between SDMT and age. Mean scores for women were consistently higher than men with the exception of Hispanic/Latinos aged ≥70 years. Conclusion This study provides comprehensive SDMT normative data for whites (Australian and U.S.), Hispanic/Latinos, and African-Americans, according to gender, age, and education level. These norms can be used clinically as reference standards to screen for cognitive impairments in older individuals.
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Affiliation(s)
- Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Carlene J Britt
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anne M Murray
- Berman Center for Outcomes and Clinical Research, Hennepin Health Research Institute and Division of Geriatrics, Department of Medicine, Hennepin HealthCare and University of Minnesota, MN, USA
| | - Raj C Shah
- Department of Family Medicine and Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark R Nelson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jessica E Lockery
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ruth E Trevaks
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Elsdon Storey
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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7
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Carlozzi NE, Boileau NR, Chou KL, Ready RE, Cella D, McCormack MK, Miner JA, Dayalu P. HDQLIFE and neuro-QoL physical function measures: Responsiveness in persons with huntington's disease. Mov Disord 2019; 35:326-336. [PMID: 31724237 DOI: 10.1002/mds.27908] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 09/26/2019] [Accepted: 10/04/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Huntington's disease (HD) is a neurological disorder that causes severe motor symptoms that adversely impact health-related quality of life. Patient-reported physical function outcome measures in HD have shown cross-sectional evidence of validity, but responsiveness has not yet been assessed. OBJECTIVES This study evaluates the responsiveness of the Huntington Disease Health-Related Quality of Life (HDQLIFE) and the Quality of Life in Neurological Disorders (Neuro-QoL) physical function measures in persons with HD. METHODS A total of 347 participants completed baseline and at least 1 follow-up (12-month and 24-month) measure (HDQLIFE Chorea, HDQLIFE Swallowing Difficulties, HDQLIFE Speech Difficulties, Neuro-QoL Upper Extremity Function, and/or Neuro-QoL Lower Extremity Function). Of the participants that completed the baseline assessment, 338 (90.9%) completed the 12-month assessment, and 293 (78.8%) completed the 24-month assessment. Standardized response means and general linear models evaluated whether the physical function measures were responsive to self-reported and clinician-rated change over time. RESULTS Small to moderate effect sizes for the standardized response means supported 12-month and 24-month responsiveness of the HDQLIFE and Neuro-QoL measures for those with either self-reported or clinician-rated declines in function. General linear models supported 12-month and 24-month responsiveness for all HRQOL measures relative to self-reported declines in health, but generally only 24-month responsiveness was supported relative to clinician-rated declines in function. CONCLUSIONS Longitudinal analyses indicate that the HDQLIFE and the Neuro-QoL physical function measures are sensitive to change over time in individuals with HD. Thus, these scales exhibit evidence of responsiveness and may be useful outcome measures in future clinical trials. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicholas R Boileau
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Kelvin L Chou
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Rebecca E Ready
- Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, Massachusetts, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael K McCormack
- Department of Psychiatry, Rutgers University-Robert Wood Johnson Medical School, Piscataway, New Jersey, USA.,Department of Pathology, Rowan University-SOM (School of Medicine), Stratford, New Jersey, USA
| | - Jennifer A Miner
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Praveen Dayalu
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
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8
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Spatial memory in Huntington’s disease: A comparative review of human and animal data. Neurosci Biobehav Rev 2019; 98:194-207. [DOI: 10.1016/j.neubiorev.2019.01.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 11/26/2018] [Accepted: 01/14/2019] [Indexed: 12/24/2022]
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9
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Snowden JS. The Neuropsychology of Huntington's Disease. Arch Clin Neuropsychol 2018; 32:876-887. [PMID: 28961886 DOI: 10.1093/arclin/acx086] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 09/04/2017] [Indexed: 01/24/2023] Open
Abstract
Huntington's disease is an inherited, degenerative brain disease, characterized by involuntary movements, cognitive disorder and neuropsychiatric change. Men and women are affected equally. Symptoms emerge at around 40 years, although there is wide variation. A rare juvenile form has onset in childhood or adolescence. The evolution of disease is insidious and structural and functional brain changes may be present more than a decade before symptoms and signs become manifest. The earliest site of pathology is the striatum and neuroimaging measures of striatal change correlate with neurological and cognitive markers of disease. Chorea and other aspects of the movement disorder are the most visible aspect of the disease. However, non-motor features have greatest affect on functional independence and quality of life, so require recognition and management. The evidence-base for non-pharmacological treatments in Huntington's disease is currently limited, but recent intervention studies are encouraging.
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Affiliation(s)
- Julie S Snowden
- Greater Manchester Neuroscience Centre, Salford Royal NHS Trust, Salford, UK.,Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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10
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Baake V, Reijntjes RH, Dumas EM, Thompson JC, Roos RA. Cognitive decline in Huntington's disease expansion gene carriers. Cortex 2017; 95:51-62. [DOI: 10.1016/j.cortex.2017.07.017] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 03/21/2017] [Accepted: 07/13/2017] [Indexed: 11/30/2022]
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Stout JC, Andrews SC, Glikmann-Johnston Y. Cognitive assessment in Huntington disease clinical drug trials. HANDBOOK OF CLINICAL NEUROLOGY 2017; 144:227-244. [PMID: 28947120 DOI: 10.1016/b978-0-12-801893-4.00019-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Several Huntington disease (HD) clinical trials are in progress and on the horizon. Potential treatments are increasingly being targeted at ameliorating the cognitive decline in HD. This necessitates a careful consideration of trial designs, including endpoint strategies suitable for testing cognitive function. The aim of this chapter is to evaluate and consider the use of cognitive measures in HD clinical trials. We first consider the role of cognition in clinical trial endpoint models, including a review of previous HD clinical trials that have included cognitive measures. We evaluate strategies for selecting cognitive tools for HD clinical trials, and consider cognitive assessments that have been used in other neuropsychiatric disorders, namely Alzheimer disease and schizophrenia. Next, we describe a general framework for selecting patient-based outcomes in clinical trials, and apply this framework to the selection of cognitive outcomes. Using the HD-Cognitive Assessment Battery (HD-CAB), a new cognitive battery designed for clinical trials, we illustrate the evaluation of cognitive outcomes in terms of their responsivity, reliability, validity, appropriateness, precision, interpretability, feasibility, and acceptability. Finally, we articulate a pathway for continued development of cognitive tools that would pave the way for finding treatments that ameliorate cognitive decline in HD.
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Affiliation(s)
- Julie C Stout
- School of Psychological Sciences, and Monash Institute of Cognitive and Clinical Neuroscience, Monash University, Victoria, Australia.
| | - Sophie C Andrews
- School of Psychological Sciences, and Monash Institute of Cognitive and Clinical Neuroscience, Monash University, Victoria, Australia
| | - Yifat Glikmann-Johnston
- School of Psychological Sciences, and Monash Institute of Cognitive and Clinical Neuroscience, Monash University, Victoria, Australia
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12
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Garcia TP, Marder K. Statistical Approaches to Longitudinal Data Analysis in Neurodegenerative Diseases: Huntington's Disease as a Model. Curr Neurol Neurosci Rep 2017; 17:14. [PMID: 28229396 PMCID: PMC5633048 DOI: 10.1007/s11910-017-0723-4] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Understanding the overall progression of neurodegenerative diseases is critical to the timing of therapeutic interventions and design of effective clinical trials. Disease progression can be assessed with longitudinal study designs in which outcomes are measured repeatedly over time and are assessed with respect to risk factors, either measured repeatedly or at baseline. Longitudinal data allows researchers to assess temporal disease aspects, but the analysis is complicated by complex correlation structures, irregularly spaced visits, missing data, and mixtures of time-varying and static covariate effects. We review modern statistical methods designed for these challenges. Among all methods, the mixed effect model most flexibly accommodates the challenges and is preferred by the FDA for observational and clinical studies. Examples from Huntington's disease studies are used for clarification, but the methods apply to neurodegenerative diseases in general, particularly as the identification of prodromal forms of neurodegenerative disease through sensitive biomarkers is increasing.
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Affiliation(s)
- Tanya P Garcia
- Department of Epidemiology and Biostatistics, Texas A&M University, TAMU 1266, College Station, TX, 77843-1266, USA.
| | - Karen Marder
- Department of Neurology, Columbia University, 630 West 168th Street, New York, NY, 10032, USA
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13
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Paulsen JS, Miller AC, Hayes T, Shaw E. Cognitive and behavioral changes in Huntington disease before diagnosis. HANDBOOK OF CLINICAL NEUROLOGY 2017; 144:69-91. [PMID: 28947127 DOI: 10.1016/b978-0-12-801893-4.00006-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Phenotypic manifestations of Huntington disease (HD) can be detected at least 15 years prior to the time when a motor diagnosis is given. Advances in clinical care and future research will require consistent use of HD definitions and HD premanifest (prodromal) stages being used across clinics, sites, and countries. Cognitive and behavioral (psychiatric) changes in HD are summarized and implications for ongoing advancement in our knowledge of prodromal HD are suggested. The earliest detected cognitive changes are observed in the Symbol Digit Modalities Test, Stroop Interference, Stroop Color and Word Test-interference condition, and Trail Making Test. Cognitive changes in the middle and near motor diagnostic stages of prodromal HD involve nearly every cognitive test administered and the greatest changes over time (i.e., slopes) are found in those prodromal HD participants who are nearest to motor diagnosis. Psychiatric changes demonstrate significant worsening over time and remain elevated compared with healthy controls throughout the prodromal disease course. Psychiatric and behavior changes in prodromal HD are much lower than that obtained using cognitive assessment, although the psychiatric and behavioral changes represent symptoms most debilitating to independent capacity and wellness.
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Affiliation(s)
- Jane S Paulsen
- Departments of Psychiatry, Neurology and Psychology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, United States.
| | - Amanda C Miller
- Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | - Terry Hayes
- Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | - Emily Shaw
- Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, United States
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14
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Baake V, Hart EP, Bos R, Roos RAC. Participants at the Leiden Site of the REGISTRY Study: A Demographic Approach. J Huntingtons Dis 2016; 5:83-90. [PMID: 27003663 DOI: 10.3233/jhd-150157] [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: 11/15/2022]
Abstract
BACKGROUND REGISTRY is the largest European observational study of Huntington's disease (HD). The Leiden University Medical Center (LUMC) in The Netherlands is the largest recruiting site. OBJECTIVE The aim of this paper is to give an overview of the baseline characteristics of all Leiden participants from the start of the study in 2005 until the close of REGISTRY at the LUMC in September 2014. METHODS The Leiden cohort is described in two different ways: CAG repeat length and presence of motor signs. RESULTS Division into groups based on prolonged CAG length revealed that the cohort consists of 4 intermediate - (27-35 CAG), 22 reduced penetrance - (36-39 CAG), 465 full penetrance - (>39 CAG) and 60 control participants (<27 CAG). The second way of dividing the participants based on present or absent of motor signs, showed that 170 pre-motormanifest - and 317 motormanifest participants were enrolled. CONCLUSION The Leiden REGISTRY cohort at baseline is mainly characterized by full penetrance gene expansion carriers who have been clinically diagnosed with HD but who remain relatively functionally independent. For the majority of these participants, disease onset was based on motor signs followed by psychiatric and cognitive signs.
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Affiliation(s)
- Verena Baake
- Leiden University Medical Center, Department of Neurology, Leiden, The Netherlands
| | - Ellen P Hart
- Center for Human Drug Research, Leiden, The Netherlands
| | - Reineke Bos
- Leiden University Medical Center, Department of Neurology, Leiden, The Netherlands
| | - Raymund A C Roos
- Leiden University Medical Center, Department of Neurology, Leiden, The Netherlands
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Mitochondrial modulators in experimental Huntington’s disease: reversal of mitochondrial dysfunctions and cognitive deficits. Neurobiol Aging 2015; 36:2186-200. [DOI: 10.1016/j.neurobiolaging.2015.02.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 12/25/2014] [Accepted: 02/05/2015] [Indexed: 01/19/2023]
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16
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GEORGIOU-KARISTIANIS NELLIE, LONG JEFFREYD, LOURENS SPENCERG, STOUT JULIEC, MILLS JAMESA, PAULSEN JANES. Movement sequencing in Huntington disease. World J Biol Psychiatry 2014; 15:459-71. [PMID: 24678867 PMCID: PMC4389285 DOI: 10.3109/15622975.2014.895042] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To examine longitudinal changes in movement sequencing in prodromal Huntington's disease (HD) participants (795 prodromal HD; 225 controls) from the PREDICT-HD study. METHODS Prodromal HD participants were tested over seven annual visits and were stratified into three groups (low, medium, high) based on their CAG-Age Product (CAP) score, which indicates likely increasing proximity to diagnosis. A cued movement sequence task assessed the impact of advance cueing on response initiation and execution via three levels of advance information. RESULTS Compared to controls, all CAP groups showed longer initiation and movement times across all conditions at baseline, demonstrating a disease gradient for the majority of outcomes. Across all conditions, the high CAP group had the highest mean for baseline testing, but also demonstrated an increase in movement time across the study. For initiation time, the high CAP group showed the highest mean baseline time across all conditions, but also faster decreasing rates of change over time. CONCLUSIONS With progress to diagnosis, participants may increasingly use compensatory strategies, as evidenced by faster initiation. However, this occurred in conjunction with slowed execution times, suggesting a decline in effectively accessing control processes required to translate movement into effective execution.
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Affiliation(s)
| | - JEFFREY D. LONG
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA,Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - SPENCER G. LOURENS
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - JULIE C. STOUT
- School of Psychological Sciences, Monash University, Wellington Road, Clayton, Victoria, Australia,Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - JAMES A. MILLS
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - JANE S. PAULSEN
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA,Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA,Department of Psychology, University of Iowa, Iowa City, IA, USA
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17
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Paulsen JS, Long JD, Johnson HJ, Aylward EH, Ross CA, Williams JK, Nance MA, Erwin CJ, Westervelt HJ, Harrington DL, Bockholt HJ, Zhang Y, McCusker EA, Chiu EM, Panegyres PK. Clinical and Biomarker Changes in Premanifest Huntington Disease Show Trial Feasibility: A Decade of the PREDICT-HD Study. Front Aging Neurosci 2014; 6:78. [PMID: 24795630 PMCID: PMC4000999 DOI: 10.3389/fnagi.2014.00078] [Citation(s) in RCA: 145] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 04/05/2014] [Indexed: 11/13/2022] Open
Abstract
There is growing consensus that intervention and treatment of Huntington disease (HD) should occur at the earliest stage possible. Various early-intervention methods for this fatal neurodegenerative disease have been identified, but preventive clinical trials for HD are limited by a lack of knowledge of the natural history of the disease and a dearth of appropriate outcome measures. Objectives of the current study are to document the natural history of premanifest HD progression in the largest cohort ever studied and to develop a battery of imaging and clinical markers of premanifest HD progression that can be used as outcome measures in preventive clinical trials. Neurobiological predictors of Huntington's disease is a 32-site, international, observational study of premanifest HD, with annual examination of 1013 participants with premanifest HD and 301 gene-expansion negative controls between 2001 and 2012. Findings document 39 variables representing imaging, motor, cognitive, functional, and psychiatric domains, showing different rates of decline between premanifest HD and controls. Required sample size and models of premanifest HD are presented to inform future design of clinical and preclinical research. Preventive clinical trials in premanifest HD with participants who have a medium or high probability of motor onset are calculated to be as resource-effective as those conducted in diagnosed HD and could interrupt disease 7-12 years earlier. Methods and measures for preventive clinical trials in premanifest HD more than a dozen years from motor onset are also feasible. These findings represent the most thorough documentation of a clinical battery for experimental therapeutics in stages of premanifest HD, the time period for which effective intervention may provide the most positive possible outcome for patients and their families affected by this devastating disease.
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Affiliation(s)
- Jane S. Paulsen
- Department of Psychiatry, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA
- Department of Neurology, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA
- Department of Psychology, The University of Iowa, Iowa City, IA, USA
| | - Jeffrey D. Long
- Department of Psychiatry, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA
- Department of Biostatistics, College of Public Health, The University of Iowa, Iowa City, IA, USA
| | - Hans J. Johnson
- Department of Psychiatry, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA
- Department of Biomedical Engineering, College of Engineering, The University of Iowa, Iowa City, IA, USA
| | - Elizabeth H. Aylward
- Center for Integrative Brain Research, Seattle Children’s Research Institute, Seattle, WA, USA
| | | | | | - Martha A. Nance
- Department of Neurology, College of Medicine, The University of Minnesota, Minneapolis, MN, USA
| | - Cheryl J. Erwin
- Center of Excellence for Ethics, Humanities and Spirituality, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX, USA
| | - Holly J. Westervelt
- Department of Psychiatry and Human Behavior, Division of Biology and Medicine, Brown University, Providence, RI, USA
| | - Deborah L. Harrington
- Department of Radiology, School of Medicine, University of California, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | | | - Ying Zhang
- Department of Biostatistics, Indiana University Fairbanks School of Public Health and Indiana University School of Medicine, Indianapolis, IN, USA
| | - Elizabeth A. McCusker
- Department of Neurology, Westmead Hospital, The University of Sydney, Sydney, NSW, Australia
| | - Edmond M. Chiu
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
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Collins LM, Lazic SE, Barker RA. A retrospective analysis of hand tapping as a longitudinal marker of disease progression in Huntington's disease. BMC Neurol 2014; 14:35. [PMID: 24564568 PMCID: PMC3937529 DOI: 10.1186/1471-2377-14-35] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 02/21/2014] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Current clinical assessments of motor function in Huntington's Disease (HD) rely on subjective ratings such as the Unified Huntington's Disease Rating scale (UHDRS). The ability to track disease progression using simple, objective, inexpensive, and robust measures would be beneficial. METHODS One objective measure of motor performance is hand-tapping. Over the last 14 years we have routinely collected, using a simple device, the number of taps made by the right and left hand over 30 seconds in HD patients attending our NHS clinics. RESULTS Here we report on a longitudinal cohort of 237 patients, which includes patients at all stages of the disease on a wide range of drug therapies. Hand tapping in these patients declines linearly at a rate of 5.1 taps per year (p < 0.0001; 95% CI = 3.8 to 6.3 taps), and for each additional year of age patients could perform 0.9 fewer taps (main effect of age: p = 0.0007; 95% CI = 0.4 to 1.4). Individual trajectories can vary widely around this average rate of decline, and much of this variation could be attributed to CAG repeat length. Genotype information was available for a subset of 151 patients, and for each additional repeat, patients could perform 5.6 fewer taps (p < 0.0001; 95% CI = 3.3 to 8.0 taps), and progressed at a faster rate of 0.45 fewer taps per year (CAG by time interaction: p = 0.008; 95% CI = 0.12 to 0.78 taps). In addition, for each unit decrease in Total Functional Capacity (TFC) within individuals, the number of taps decreased by 6.3 (95% CI = 5.4 to 7.1, p < 0.0001). CONCLUSIONS Hand tapping is a simple, robust, and reliable marker of disease progression. As such, this simple motor task could be a useful tool by which to assess disease progression as well therapies designed to slow it down.
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Affiliation(s)
| | - Stanley E Lazic
- In Silico Lead Discovery, Novartis Institutes for Biomedical Research, Basel, Switzerland
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Banks SJ, Obuchowski N, Shin W, Lowe M, Phillips M, Modic M, Bernick C. The Protective Effect of Education on Cognition in Professional Fighters. Arch Clin Neuropsychol 2013; 29:54-9. [DOI: 10.1093/arclin/act079] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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20
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Paulsen JS, Smith MM, Long JD. Cognitive decline in prodromal Huntington Disease: implications for clinical trials. J Neurol Neurosurg Psychiatry 2013; 84:1233-9. [PMID: 23911948 PMCID: PMC3795884 DOI: 10.1136/jnnp-2013-305114] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Controversy exists regarding the feasibility of preventive clinical trials in prodromal Huntington disease (HD). A primary limitation is a lack of outcome measures for persons with the gene mutation who have not yet been diagnosed with HD. Many longitudinal studies of cognitive decline in prodromal HD have not stratified samples based on disease progression, thereby obscuring differences between symptomatic and nonsymptomatic individuals. METHODS Prodromal participants from PREDICT-HD were stratified by disease progression into one of three groups: those having a High, Medium, or Low probability of motor manifestation within the next 5 years. Data from a total of N=1299 participants with up to 5950 data points were subjected to linear mixed effects regression on 29 longitudinal cognitive variables, controlling for age, education, depression, and gender. RESULTS Performance of the three prodromal HD groups was characterised by insidious and significant cognitive decline over time. Twenty-one variables from 19 distinct cognitive tasks revealed evidence of a disease progression gradient, meaning that the rate of deterioration varied as a function of progression level, with faster deterioration associated with greater disease progression. Nineteen measures showed significant longitudinal change in the High group, nine showed significant change in the Medium group and four showed significant cognitive decline in the Low group. CONCLUSIONS Results indicate that clinical trials may be conducted in prodromal HD using the outcome measures and methods specified. The findings may help inform interventions in HD as well as other neurodegenerative disorders.
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Affiliation(s)
- Jane S Paulsen
- Department of Neurology, Carver College of Medicine, Univeristy of Iowa, , Iowa City, Iowa, USA
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Hart EP, Dumas EM, van Zwet EW, van der Hiele K, Jurgens CK, Middelkoop HAM, van Dijk JG, Roos RAC. Longitudinal pilot-study of Sustained Attention to Response Task and P300 in manifest and pre-manifest Huntington's disease. J Neuropsychol 2013; 9:10-20. [PMID: 24151858 DOI: 10.1111/jnp.12031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 08/21/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Earlier research has found cross-sectional attentional control deficits in manifest Huntington's disease (HD) using neuropsychological testing combined with simultaneous P300 registration. In the current pilot-study, we investigate attentional control in pre-manifest and manifest HD over a 3-year follow-up period. METHOD Five manifest HD (MHD), 9 pre-manifest HD (PMHD), and 12 control subjects were included. Sustained Attention to Response task (SART) and P300 registration resulted in number of errors, reaction time (RT), and P300 amplitude and latency. RT change patterns surrounding No-go trials were also investigated. Within-subject differences were tested using paired-samples t-tests and between-group results with ANCOVA on delta scores (follow-up--baseline scores). RESULTS Manifest HD made more errors and were slower than controls and PMHD. Longitudinally, MHD showed an overall RT increase and a specific slowing on trials preceding a correct No-go trial (within-group effects). The latter was also seen in PMHD. P300 latency prolongation was found for controls on No-go and for MHD on Go trials. On specific trials surrounding both correct and incorrect No-go trials, MHD became significantly slower over time than controls and PMHD (between-group effects). CONCLUSIONS Over 3-years, MHD subjects became slower on the SART and showed a prolongation of P300 latency on specific SART trials. Specific slowing of performance over time was also seen in PMHD, suggestive of compensatory mechanisms in this group.
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Affiliation(s)
- Ellen P Hart
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
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22
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Sandhir R, Mehrotra A. Quercetin supplementation is effective in improving mitochondrial dysfunctions induced by 3-nitropropionic acid: Implications in Huntington's disease. Biochim Biophys Acta Mol Basis Dis 2013; 1832:421-30. [DOI: 10.1016/j.bbadis.2012.11.018] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Revised: 11/21/2012] [Accepted: 11/27/2012] [Indexed: 11/29/2022]
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