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Zadegan SA, Kupcha L, Patino J, Rocha NP, Teixeira AL, Furr Stimming E. Obsessive-compulsive and perseverative behaviors in Huntington's disease. Behav Brain Res 2024; 458:114767. [PMID: 37984520 DOI: 10.1016/j.bbr.2023.114767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/02/2023] [Accepted: 11/16/2023] [Indexed: 11/22/2023]
Abstract
Obsessive-compulsive and perseverative behaviors (OCBs/PBs) are characteristic features of Huntington's Disease (HD). Although a few recent research have attempted to discriminate between OCBs and PBs, most of the available evidence on OCBs does not consistently make this distinction. In this article, we aimed to explore the current inconsistencies in assessing and reporting OCBs/PBs and map the body of existing evidence. Up to half of the patients with motor manifest HD can experience OCBs. Separate reporting of PBs in HD patients has been uncommon among the studies and was frequently reported as a part of obsessive-compulsive symptoms. The structural limitation of the currently used rating scales and the overlaps in neuropathology and definition of OCBs and PBs are among the main reasons for the mixed reporting of OCBs/PBs. Perseverative thinking or behavior as a separate item is found in a few assessment tools, such as the Problem Behaviors Assessment - Short form (PBA-s). Even when the item exists, it is commonly reported as a composite score in combination with the obsessive-compulsive item. In addition to the significant psychological burden in individuals with HD, PBs are associated with somatic effects (e.g., cardiovascular symptoms) and high-risk behaviors (e.g., suicide). Recognition and monitoring of PBs in HD can aid in early detection of concerning symptoms and differentiating overlapping illnesses.
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Affiliation(s)
- Shayan Abdollah Zadegan
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA; Huntington's Disease Society of America (HDSA) Center of Excellence at the University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Luke Kupcha
- McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Jorge Patino
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA; Huntington's Disease Society of America (HDSA) Center of Excellence at the University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Natalia Pessoa Rocha
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA; Huntington's Disease Society of America (HDSA) Center of Excellence at the University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.
| | - Antonio L Teixeira
- Huntington's Disease Society of America (HDSA) Center of Excellence at the University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA; Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Erin Furr Stimming
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA; Huntington's Disease Society of America (HDSA) Center of Excellence at the University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
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Daemen MMJ, Boots LMM, Oosterloo M, de Vugt ME, Duits AA. Facilitators and barriers in caring for a person with Huntington's disease: input for a remote support program. Aging Ment Health 2024; 28:178-187. [PMID: 37409463 DOI: 10.1080/13607863.2023.2230949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/12/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVES This study aims to provide more insight into possible barriers and facilitators caregivers of people with Huntington's disease (HD) encounter, and what their needs and wishes are regarding a remote support program. METHODS In total, 27 persons participated in four focus group interviews. Eligible participants were caregivers (n = 19) of a person with HD, and healthcare professionals (n = 8) involved in HD care. Qualitative data were analyzed by two researchers who independently performed an inductive content analysis. RESULTS Four major themes emerged from the data, including (1) a paradox between taking care of yourself and caring for others; (2) challenges HD caregivers face in daily life, including lack of HD awareness, taboo and shame, feelings of loneliness, concerns about heredity and children, and coping with HD symptoms; (3) facilitators in the caregiving process, including a social network, professional support, openness, talking in early phases, and daily structure; (4) needs regarding a support program. CONCLUSION These insights will be used to develop a remote support program for HD caregivers, using a blended and self-management approach. Newly developed and tailored support should be aimed at empowering caregivers in their role and help them cope with their situation, taking into account barriers and facilitators.
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Affiliation(s)
- Maud M J Daemen
- Department of Psychiatry and Neuropsychology/Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Lizzy M M Boots
- Department of Psychiatry and Neuropsychology/Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Mayke Oosterloo
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marjolein E de Vugt
- Department of Psychiatry and Neuropsychology/Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Annelien A Duits
- Department of Psychiatry and Neuropsychology/Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
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Lee CY, Shin C, Hwang YS, Oh E, Kim M, Kim HS, Chung SJ, Sung YH, Yoon WT, Cho JW, Lee JH, Kim HJ, Chang HJ, Jeon B, Woo KA, Koh SB, Kwon KY, Moon J, Kim YE, Lee JY. Caregiver Burden of Patients With Huntington's Disease in South Korea. J Mov Disord 2024; 17:30-37. [PMID: 37691330 PMCID: PMC10846961 DOI: 10.14802/jmd.23134] [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: 07/19/2023] [Revised: 08/26/2023] [Accepted: 09/08/2023] [Indexed: 09/12/2023] Open
Abstract
OBJECTIVE This is the first prospective cohort study of Huntington's disease (HD) in Korea. This study aimed to investigate the caregiver burden in relation to the characteristics of patients and caregivers. METHODS From August 2020 to February 2022, we enrolled patients with HD from 13 university hospitals in Korea. We used the 12-item Zarit Burden Interview (ZBI-12) to evaluate the caregiver burden. We evaluated the clinical associations of the ZBI-12 scores by linear regression analysis and investigated the differences between the low- and high-burden groups. RESULTS Sixty-five patients with HD and 45 caregivers were enrolled in this cohort study. The average age at onset of motor symptoms was 49.3 ± 12.3 years, with an average cytosine-adenine-guanine (CAG)n of 42.9 ± 4.0 (38-65). The median ZBI-12 score among our caregivers was 17.6 ± 14.2. A higher caregiver burden was associated with a more severe Shoulson-Fahn stage (p = 0.038) of the patients. A higher ZBI-12 score was also associated with lower independence scale (B = -0.154, p = 0.006) and functional capacity (B = -1.082, p = 0.002) scores of patients. The caregiving duration was longer in the high- than in the low-burden group. Caregivers' demographics, blood relation, and marital and social status did not affect the burden significantly. CONCLUSION HD patients' neurological status exerts an enormous impact on the caregiver burden regardless of the demographic or social status of the caregiver. This study emphasizes the need to establish an optimal support system for families dealing with HD in Korea. A future longitudinal analysis could help us understand how disease progression aggravates the caregiver burden throughout the entire disease course.
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Affiliation(s)
- Chan Young Lee
- Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Chaewon Shin
- Department of Neurology, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, Korea
| | - Yun Su Hwang
- Department of Neurology, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine and Biomedical Research Institute, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea
| | - Eungseok Oh
- Department of Neurology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Manho Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Sook Kim
- Department of Neurology, Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Sun Ju Chung
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Hee Sung
- Department of Neurology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Won Tae Yoon
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Whan Cho
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Hyeok Lee
- Department of Neurology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Han-Joon Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Jin Chang
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Beomseok Jeon
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Ah Woo
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seong-Beom Koh
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kyum-Yil Kwon
- Department of Neurology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jangsup Moon
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Genomic Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young Eun Kim
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Jee-Young Lee
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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Bayen E, de Langavant LC, Youssov K, Bachoud-Lévi AC. Informal care in Huntington's disease: Assessment of objective-subjective burden and its associated risk and protective factors. Ann Phys Rehabil Med 2022; 66:101703. [PMID: 36055643 DOI: 10.1016/j.rehab.2022.101703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 08/09/2022] [Accepted: 08/09/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Because of the genetic transmission of Huntington's disease (HD), informal caregivers (ICs, i.e., non-professional caregivers) might experience consecutive and/or concurrent caregiving roles to support several symptomatic relatives with HD over their life. Additionally, some ICs might be HD carriers. However, whether family burden of care is associated with specific factors in HD remains poorly studied. OBJECTIVE To provide a quantitative view of the IC burden and identify associated factors. METHODS This was a cross-sectional assessment of home-dwelling symptomatic HD individuals (from REGISTRY and Bio-HD studies) and their primary adult ICs, including the HD individual's motor, cognitive, behavioral, functional Unified Huntington's Disease Rating Scale score; IC objective burden (quantification of IC time in activities of daily living, instrumental activities of daily living and supervision, using the Resource Utilization in Dementia instrument), IC subjective burden (Zarit Burden Inventory), and ICs' social economic functioning and use of professional home care. RESULTS We included 80 ICs (mean [SD] age 57 [12.9] years, 60% women) in charge of 80 individuals with early to advanced stage HD (mean age 56 [12.6] years, 51% men). The mean hours of informal care time was high: 7.3 (7.9) h/day (range 0-24); the mean professional home care was 2.8 (2.8) h/day (range 0.1-12.3). This objective burden increased with higher functional loss of the HD individual and with more severe cognitive-behavioral disorders. The mean subjective burden (35.4 [17.8], range 4-73) showed a high level since the earliest stage of HD; it was associated with HD duration (mean 9.2 [4.7] years) and with aggressive symptoms in individuals (44% of cases). The burden was partially related to the multiplex caregiving status (19%). Protective factors lowering the IC burden included the absence of financial hardship (57%), a strong social network (16%) and keeping active on the job market outside home (46%). CONCLUSIONS The objective-subjective burden of ICs related to changing patterns of neuro-psychiatric symptoms and mitigating environmental characteristics around the HD individual-caregiver dyads.
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Affiliation(s)
- Eléonore Bayen
- Service de Médecine Physique et de Réadaptation, hôpital Pitié-Salpêtrière, APHP, Paris, France et Faculté de Médecine, Sorbonne Université, Paris, France; Laboratoire d'Imagerie Biomédicale (LIB), Sorbonne Université, Paris, France; Global Brain Health Institute, University of California San Francisco, San Francisco, USA.
| | - Laurent Cleret de Langavant
- Global Brain Health Institute, University of California San Francisco, San Francisco, USA; National Reference Center for Huntington's Disease, Département de Neurologie, hôpital Henri Mondor-Albert Chenevier, APHP, Créteil, France; Equipe Neuropsychologie Interventionnelle, Département d'Etudes Cognitives, Ecole normale supérieure, PSL Research University, Institut Mondor de Recherche Biomédicale, Université Paris-Est Créteil, INSERM U955 E01, Paris et Créteil, France; Faculté de Médecine, Université Paris-Est Créteil, Créteil, France
| | - Katia Youssov
- National Reference Center for Huntington's Disease, Département de Neurologie, hôpital Henri Mondor-Albert Chenevier, APHP, Créteil, France; Equipe Neuropsychologie Interventionnelle, Département d'Etudes Cognitives, Ecole normale supérieure, PSL Research University, Institut Mondor de Recherche Biomédicale, Université Paris-Est Créteil, INSERM U955 E01, Paris et Créteil, France
| | - Anne-Catherine Bachoud-Lévi
- National Reference Center for Huntington's Disease, Département de Neurologie, hôpital Henri Mondor-Albert Chenevier, APHP, Créteil, France; Equipe Neuropsychologie Interventionnelle, Département d'Etudes Cognitives, Ecole normale supérieure, PSL Research University, Institut Mondor de Recherche Biomédicale, Université Paris-Est Créteil, INSERM U955 E01, Paris et Créteil, France; Faculté de Médecine, Université Paris-Est Créteil, Créteil, France
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Youssov K, Audureau E, Vandendriessche H, Morgado G, Layese R, Goizet C, Verny C, Bourhis ML, Bachoud-Lévi AC. The burden of Huntington's disease: A prospective longitudinal study of patient/caregiver pairs. Parkinsonism Relat Disord 2022; 103:77-84. [DOI: 10.1016/j.parkreldis.2022.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/12/2022] [Accepted: 08/19/2022] [Indexed: 10/15/2022]
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Modrzejewska-Zielonka E, Ren M, Młodak A, Marcinkowski JT, Zielonka D. Huntington's Disease Progression and Caregiver Burden. Eur Neurol 2022; 85:398-403. [PMID: 35483333 DOI: 10.1159/000524146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/11/2022] [Indexed: 11/19/2022]
Abstract
Huntington's disease (HD) is a neurodegenerative, progressive disorder conditioned by a mutation in the HTT gene. Its progression is dependent on the causative mutation extension. Caregivers of individuals affected by HD, most often patients' relatives, are burdened with the care. This study aims to assess the caregivers' burden cross-sectionally and longitudinally and look for biological and clinical patients-related burdening factors. In total, 144 caregiver-patient pairs observed annually for up to 8 years were included in the study. In all of the patients, demographic data were collected, Unified Huntington's Disease Rating Scale (UHDRS) assessments were conducted, and disease burden (DB) was calculated when caregivers were assessed in Caregiver Burden Inventory (CBI). Caregivers' burden measured in CBI at the first visit reached 18.7 ± 18.4 scores. Longitudinal observation showed no evidence for any discrepancy between clinical progression measured in UHDRS, nor biological progression measured in DB and the caregivers' burden progression measured in CBI. Caregivers were burdened mostly by patients' dependence and a discrepancy between reality and life expectations. This study indicates factors to be addressed to reduce caregivers' burden. Strict relation between caregivers' burden and biological and clinical progression denies conception of overloaded with care tasks or adaptation to the burden.
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Affiliation(s)
| | - Michał Ren
- Faculty of Mathematics and Computer Science, Adam Mickiewicz University, Poznan, Poland
| | - Andrzej Młodak
- Inter-Faculty Department of Mathematics and Statistics, Calisia University, Kalisz, Poland.,Statistical Office in Poznan, Branch in Kalisz, Kalisz, Poland
| | - Jerzy Tadeusz Marcinkowski
- Department of Hygiene and Epidemiology, Collegium Medicum, Zielona Gora University, Zielona Góra, Poland
| | - Daniel Zielonka
- Department of Public Health, Poznan University of Medical Sciences, Poznan, Poland
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Another Perspective on Huntington's Disease: Disease Burden in Family Members and Pre-Manifest HD When Compared to Genotype-Negative Participants from ENROLL-HD. Brain Sci 2021; 11:brainsci11121621. [PMID: 34942923 PMCID: PMC8699274 DOI: 10.3390/brainsci11121621] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/02/2021] [Accepted: 12/07/2021] [Indexed: 11/17/2022] Open
Abstract
Background: In addition to the effects on patients suffering from motor-manifest Huntington’s disease (HD), this fatal disease is devasting to people who are at risk, premanifest mutation-carriers, and especially to whole families. There is a huge burden on people in the environment of affected HD patients, and a need for further research to identify at-risk caregivers. The aim of our research was to investigate a large cohort of family members, in comparison with genotype negative and premanifest HD in order to evaluate particular cohorts more closely. Methods: We used the ENROLL-HD global registry study to compare motoric, cognitive, functional, and psychiatric manifestation in family members, premanifest HD, and genotype negative participant as controls. Cross-sectional data were analyzed using ANCOVA-analyses in IBM SPSS Statistics V.28. Results: Of N = 21,116 participants from the global registry study, n = 5174 participants had a premanifest motor-phenotype, n = 2358 were identified as family controls, and n = 2640 with a negative HD genotype. Analysis of variance revealed more motoric, cognitive, and psychiatric impairments in premanifest HD (all p < 0.001). Self-reported psychiatric assessments revealed a significantly higher score for depression in family controls (p < 0.001) when compared to genotype negative (p < 0.001) and premanifest HD patients (p < 0.05). Family controls had significantly less cognitive capacities within the cognitive test battery when compared to genotype negative participants. Conclusions: Within the largest cohort of HD patients and families, several impairments of motoric, functional, cognitive, and psychiatric components can be confirmed in a large cohort of premanifest HD, potentially due to prodromal HD pathology. HD family controls suffered from higher self-reported depression and less cognitive capacities, which were potentially due to loaded or stressful situations. This research aims to sensitize investigators to be aware of caregiver burdens caused by HD and encourage support with socio-medical care and targeted psychological interventions. In particular, further surveys and variables are necessary in order to implement them within the database so as to identify at-risk caregivers.
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