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Martinez‐Horta S, Perez‐Perez J, Perez‐Gonzalez R, Sampedro F, Horta‐Barba A, Campolongo A, Rivas‐Asensio E, Puig‐Davi A, Pagonabarraga J, Kulisevsky J. Cognitive phenotype and neurodegeneration associated with Tau in Huntington's disease. Ann Clin Transl Neurol 2024; 11:1160-1171. [PMID: 38544341 PMCID: PMC11093246 DOI: 10.1002/acn3.52031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/13/2024] [Indexed: 05/15/2024] Open
Abstract
OBJECTIVE The clinical phenotype of Huntington's disease (HD) can be very heterogeneous between patients, even when they share equivalent CAG repeat length, age, or disease burden. This heterogeneity is especially evident in terms of the cognitive profile and related brain changes. To shed light on the mechanisms participating in this heterogeneity, the present study delves into the association between Tau pathology and more severe cognitive phenotypes and brain damage in HD. METHODS We used a comprehensive neuropsychological examination to characterize the cognitive phenotype of a sample of 30 participants with early-to-middle HD for which we also obtained 3 T structural magnetic resonance image (MRI) and cerebrospinal fluid (CSF). We quantified CSF levels of neurofilament light chain (NfL), total Tau (tTau), and phosphorylated Tau-231 (pTau-231). Thanks to the cognitive characterization carried out, we subsequently explored the relationship between different levels of biomarkers, the cognitive phenotype, and brain integrity. RESULTS The results confirmed that more severe forms of cognitive deterioration in HD extend beyond executive dysfunction and affect processes with clear posterior-cortical dependence. This phenotype was in turn associated with higher CSF levels of tTau and pTau-231 and to a more pronounced pattern of posterior-cortical atrophy in specific brain regions closely linked to the cognitive processes affected by Tau. INTERPRETATION Our findings reinforce the association between Tau pathology, cognition, and neurodegeneration in HD, emphasizing the need to explore the role of Tau in the cognitive heterogeneity of the disease.
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Affiliation(s)
- Saul Martinez‐Horta
- Movement Disorders Unit, Neurology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
- Biomedical Research Institute Sant Pau (IIB‐Sant Pau)BarcelonaSpain
- Centro de Investigación Biomédica en Red‐Enfermedades Neurodegenerativas (CIBERNED)MadridSpain
- Department of MedicineAutonomous University of BarcelonaBarcelonaSpain
- European Huntington's Disease Network (EHDN)
| | - Jesús Perez‐Perez
- Movement Disorders Unit, Neurology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
- Biomedical Research Institute Sant Pau (IIB‐Sant Pau)BarcelonaSpain
- Centro de Investigación Biomédica en Red‐Enfermedades Neurodegenerativas (CIBERNED)MadridSpain
- Department of MedicineAutonomous University of BarcelonaBarcelonaSpain
- European Huntington's Disease Network (EHDN)
| | - Rocío Perez‐Gonzalez
- Centro de Investigación Biomédica en Red‐Enfermedades Neurodegenerativas (CIBERNED)MadridSpain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL) and Instituto de Neurociencias UMH‐CSICAlicanteSpain
| | - Frederic Sampedro
- Biomedical Research Institute Sant Pau (IIB‐Sant Pau)BarcelonaSpain
- Neuroradiology unit, Radiology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
| | - Andrea Horta‐Barba
- Movement Disorders Unit, Neurology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
- Biomedical Research Institute Sant Pau (IIB‐Sant Pau)BarcelonaSpain
- Centro de Investigación Biomédica en Red‐Enfermedades Neurodegenerativas (CIBERNED)MadridSpain
- European Huntington's Disease Network (EHDN)
| | - Antonia Campolongo
- Movement Disorders Unit, Neurology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
- Biomedical Research Institute Sant Pau (IIB‐Sant Pau)BarcelonaSpain
- Department of MedicineAutonomous University of BarcelonaBarcelonaSpain
| | - Elisa Rivas‐Asensio
- Movement Disorders Unit, Neurology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
- Biomedical Research Institute Sant Pau (IIB‐Sant Pau)BarcelonaSpain
- Centro de Investigación Biomédica en Red‐Enfermedades Neurodegenerativas (CIBERNED)MadridSpain
| | - Arnau Puig‐Davi
- Movement Disorders Unit, Neurology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
- Biomedical Research Institute Sant Pau (IIB‐Sant Pau)BarcelonaSpain
- Centro de Investigación Biomédica en Red‐Enfermedades Neurodegenerativas (CIBERNED)MadridSpain
- Department of MedicineAutonomous University of BarcelonaBarcelonaSpain
- European Huntington's Disease Network (EHDN)
| | - Javier Pagonabarraga
- Movement Disorders Unit, Neurology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
- Biomedical Research Institute Sant Pau (IIB‐Sant Pau)BarcelonaSpain
- Centro de Investigación Biomédica en Red‐Enfermedades Neurodegenerativas (CIBERNED)MadridSpain
- Department of MedicineAutonomous University of BarcelonaBarcelonaSpain
- European Huntington's Disease Network (EHDN)
| | - Jaime Kulisevsky
- Movement Disorders Unit, Neurology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
- Biomedical Research Institute Sant Pau (IIB‐Sant Pau)BarcelonaSpain
- Centro de Investigación Biomédica en Red‐Enfermedades Neurodegenerativas (CIBERNED)MadridSpain
- Department of MedicineAutonomous University of BarcelonaBarcelonaSpain
- European Huntington's Disease Network (EHDN)
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Hewitt SRC, White AJ, Mason SL, Barker RA. Metacognitive insight into cognitive performance in Huntington's disease gene carriers. BMJ Neurol Open 2022; 4:e000268. [PMID: 35463389 PMCID: PMC8987702 DOI: 10.1136/bmjno-2022-000268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/10/2022] [Indexed: 11/24/2022] Open
Abstract
Objectives Insight is an important predictor of quality of life in Huntington's disease and other neurodegenerative conditions. However, estimating insight with traditional methods such as questionnaires is challenging and subjected to limitations. This cross-sectional study experimentally quantified metacognitive insight into cognitive performance in Huntington's disease gene carriers. Methods We dissociated perceptual decision-making performance and metacognitive insight into performance in healthy controls (n=29), premanifest (n=19) and early-manifest (n=10) Huntington's disease gene carriers. Insight was operationalised as the degree to which a participant's confidence in their performance was informative of their actual performance (metacognitive efficiency) and estimated using a computational model (HMeta-d'). Results We found that premanifest and early-manifest Huntington's disease gene carriers were impaired in making perceptual decisions compared with controls. Gene carriers required more evidence in favour of the correct choice to achieve similar performance and perceptual impairments were increased in those with manifest disease. Surprisingly, despite marked perceptual impairments, Huntington's disease gene carriers retained metacognitive insight into their perceptual performance. This was the case after controlling for confounding variables and regardless of disease stage. Conclusion We report for the first time a dissociation between impaired cognition and intact metacognition (trial-by-trial insight) in the early stages of a neurodegenerative disease. This unexpected finding contrasts with the prevailing assumption that cognitive deficits are associated with impaired insight. Future studies should investigate how intact metacognitive insight could be used by some early Huntington's disease gene carriers to positively impact their quality of life.
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Affiliation(s)
- Samuel RC Hewitt
- John Van Geest Centre for Brain Repair, Department of Clinical Neuroscience, University of Cambridge, Cambridge, Cambridgeshire, UK
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, London, UK
- Wellcome Centre for Human Neuroimaging, University College London, London, UK
| | - Alice J White
- John Van Geest Centre for Brain Repair, Department of Clinical Neuroscience, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Sarah L Mason
- John Van Geest Centre for Brain Repair, Department of Clinical Neuroscience, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Roger A Barker
- John Van Geest Centre for Brain Repair, Department of Clinical Neuroscience, University of Cambridge, Cambridge, Cambridgeshire, UK
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Cavallo M, Sergi A, Pagani M. Cognitive and social cognition deficits in Huntington's disease differ between the prodromal and the manifest stages of the condition: A scoping review of recent evidence. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 61:214-241. [PMID: 34651307 DOI: 10.1111/bjc.12337] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 10/02/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Huntington's disease (HD) is a dramatic neurodegenerative disorder encompassing severe motor symptoms coupled to significant cognitive and social cognition deficits. However, it is not clear whether and how patients' neuropsychological profile changes between the prodromal and the manifest stages of the condition. The aim of the present in-depth review is to consider cognitive and social cognition impairment in HD patients by differentiating deficits arising before diagnosis from those evident from the manifest phase onwards. METHODS Electronic databases were searched between January 1st , 2010 and December 31st , 2020 by using multiple combinations of keywords related to the investigation of neuropsychological profile in HD for preliminary search, and by defining strict selection criteria for studies to be included. RESULTS Forty-two studies were included. Evidence suggests that the neuropsychological profile in HD reflects a complex pathological spectrum of deficits. It includes impairment in the realms of executive functions, memory, attention, information processing, and social cognition. Interestingly, patients' profiles differ significantly between the manifest and the prodromal stages of their condition, not only in quantitative terms but also from a qualitative point of view. CONCLUSIONS Researchers and clinicians should thus include in clinical routine timely and specific neuropsychological assessments in order to monitor patients' cognitive status as time goes by, with the ultimate goal to implement effective clinical management strategies. PRACTITIONER POINTS The neuropsychological profile in HD encompasses a complex pathological spectrum of deficits. Patients' profiles differ significantly between the manifest and the prodromal stages of their condition. Clinicians should include in everyday practice a timely and specific neuropsychological assessment. Detecting patients' cognitive status during the early stages of the condition already can contribute significantly to implement effective clinical management strategies.
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Affiliation(s)
- Marco Cavallo
- Faculty of Psychology, eCampus University, Novedrate, Italy.,Clinical Psychology Service, Saint George Foundation, Cavallermaggiore, Italy
| | | | - Marco Pagani
- Institute of Cognitive Sciences and Technology, CNR, Rome, Italy.,Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
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Martinez-Horta S, Sampedro F, Horta-Barba A, Perez-Perez J, Pagonabarraga J, Gomez-Anson B, Kulisevsky J. Structural brain correlates of dementia in Huntington's disease. NEUROIMAGE-CLINICAL 2020; 28:102415. [PMID: 32979842 PMCID: PMC7519361 DOI: 10.1016/j.nicl.2020.102415] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 01/18/2023]
Abstract
Dementia may occur in the early stages of HD and with independence of disease burden. More severe posterior-cortical atrophy is associated with dementia in HD. Neuropsychological alterations of dementia in HD extends beyond executive dysfunction. CAG-independent neuropathological mechanisms may contribute to dementia in HD.
Background Huntington’s disease (HD) is a fatal genetic neurodegenerative disorder with no effective treatment currently available. Progressive basal ganglia and whole-brain atrophy and concurrent cognitive deterioration are prototypical aspects of HD. However, the specific patterns of brain atrophy underlying cognitive impairment of different severity in HD are poorly understood. The aim of this study was to investigate the specific structural brain correlates of major cognitive deficits in HD and to explore its association with neuropsychological indicators. Participants Thirty-five symptomatic early-to-mild HD patients and 15 healthy controls (HC) with available T1-MRI imaging were included in this study. Methods In this cross-sectional study, HD patients were classified as patients with (HD-Dem) and without (HD-ND) major cognitive impairment in the range of dementia. This classification was based on previously validated PD-CRS cutoff scores for HD. Differences in brain atrophy across groups were studied by means of grey-matter volume voxel-based morphometry (GMV-VBM) and cortical thickness (Cth). Voxelwise and vertexwise general linear models were used to assess the group comparisons, controlling for the effects of age, sex, education, CAG repeat length and severity of motor symptoms. Clusters surviving p < 0.05 and family-wise error (FWE) correction were considered statistically significant. In order to characterize the impact on cognitive performance of the observed brain differences across groups, GMV and Cth values in the set of significant regions were computed and correlated with specific neuropsychological tests. Results All groups had similar sociodemographic profiles, and the HD groups did not significantly differ in terms of CAG repeat length. Compared to HC, both HD groups exhibited significant atrophy in multiple subcortical and parietal brain regions. However, compared to HC and HD-ND groups, HD-Dem patients showed a more prominent pattern of reduced GMV and cortical thinning. Importantly, this thinning was restricted to regions of the parietal-temporal and occipital cortices. Furthermore, these brain alterations were further associated with poorer cognitive performance in tasks assessing frontal-executive and attention domains as well as memory, language and constructional abilities. Conclusions Major cognitive impairment in the range of dementia in HD is associated with brain and cognitive alterations exceeding the prototypical frontal-executive deficits commonly recognized in HD. The observed posterior-cortical damage identified by MRI and its association with memory, language, and visuoconstructive dysfunction suggest a strong involvement of extra-striatal atrophy in the onset of severe cognitive dysfunction in HD patients. Critically, major cognitive impairment in this sample was not associated with CAG repeat length, age or education. This finding could support a possible involvement of additional neuropathological mechanisms aggravating cognitive deterioration in HD.
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Affiliation(s)
- Saul Martinez-Horta
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación Biomédica en Red-Enfermedades Neurodegenerativas (CIBERNED), Spain; Autonomous University of Barcelona, Department of Medicine, Spain; European Huntington's Disease Network (EHDN), Spain
| | - Frederic Sampedro
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación Biomédica en Red-Enfermedades Neurodegenerativas (CIBERNED), Spain
| | - Andrea Horta-Barba
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación Biomédica en Red-Enfermedades Neurodegenerativas (CIBERNED), Spain; European Huntington's Disease Network (EHDN), Spain
| | - Jesús Perez-Perez
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación Biomédica en Red-Enfermedades Neurodegenerativas (CIBERNED), Spain; Autonomous University of Barcelona, Department of Medicine, Spain; European Huntington's Disease Network (EHDN), Spain
| | - Javier Pagonabarraga
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación Biomédica en Red-Enfermedades Neurodegenerativas (CIBERNED), Spain; Autonomous University of Barcelona, Department of Medicine, Spain; European Huntington's Disease Network (EHDN), Spain
| | - Beatriz Gomez-Anson
- Neuroradiology, Radiology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Jaime Kulisevsky
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación Biomédica en Red-Enfermedades Neurodegenerativas (CIBERNED), Spain; Autonomous University of Barcelona, Department of Medicine, Spain; European Huntington's Disease Network (EHDN), Spain.
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Martínez-Horta S, Horta-Barba A, Perez-Perez J, Antoran M, Pagonabarraga J, Sampedro F, Kulisevsky J. Impaired face-like object recognition in premanifest Huntington's disease. Cortex 2019; 123:162-172. [PMID: 31794910 DOI: 10.1016/j.cortex.2019.10.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 09/02/2019] [Accepted: 10/22/2019] [Indexed: 11/15/2022]
Abstract
Progressive striatal atrophy has long been considered the pathological hallmark of Huntington's disease (HD), but is it now recognized that malfunction and degeneration of posterior-cortical territories are also prominent characteristics of the disease. The limited knowledge about the functional impact of these posterior-cortical changes could be partially attributed to the lack of sensitive measures to capture them. We hypothesized that early malfunction of specific territories of the ventral visual pathway in premanifest HD would lead to difficulties in the recognition of complex stimuli and to differences in their neurophysiological correlates. To test this idea, we used an object, face and face-like object recognition task to be conducted during an electroencephalographic recording. Compared to healthy-matched controls, premanifest participants showed a significantly increased number of recognition errors in the face-like object condition. Moreover, premanifest participants showed a dramatic decrease in the N170 component elicited for the face-like objects. This N170 decrease was significantly associated with the number of recognition errors and with severity of apathy and global cognitive performance. The lack of differences in other clinical and cognitive measures supports a selective deficit in recognition of face-like objects and their neurophysiological correlates in premanifest HD. These deficits occurred in participants up to 15 years before the estimated time to disease onset and correlated strongly with cognitive and behavioral measures known to be sensitive to HD progression. This finding highlights the existence of selective visuoperceptive deficits years before motor-based onset of HD and emphasizes the need to develop sensitive measures to capture early visual system changes in this population. Assessing the integrity of the visual cortex and its related functions in HD could help to identify early markers of disease progression.
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Affiliation(s)
- Saul Martínez-Horta
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Spain; Department of Medicine, Autonomous University of Barcelona, Spain; European Huntington's Disease Network (EHDN), Germany
| | - Andrea Horta-Barba
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Spain; Department of Medicine, Autonomous University of Barcelona, Spain; European Huntington's Disease Network (EHDN), Germany
| | - Jesús Perez-Perez
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Spain; Department of Medicine, Autonomous University of Barcelona, Spain; European Huntington's Disease Network (EHDN), Germany
| | - Mizar Antoran
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
| | - Javier Pagonabarraga
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Spain; Department of Medicine, Autonomous University of Barcelona, Spain
| | - Frederic Sampedro
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Spain; Department of Medicine, Autonomous University of Barcelona, Spain
| | - Jaime Kulisevsky
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Spain; Department of Medicine, Autonomous University of Barcelona, Spain; European Huntington's Disease Network (EHDN), Germany.
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