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Goh AMY, You E, Perin S, Lautenschlager NT, Clay FJ, Loi SM, Chong T, Ames D, Chiu E, Ellis KA. Alcohol Use, Mental Health, and Functional Capacity as Predictors of Workplace Disability in a Cohort With Manifest Huntington's Disease. J Neuropsychiatry Clin Neurosci 2021; 32:235-243. [PMID: 32102602 DOI: 10.1176/appi.neuropsych.19090199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Huntington's disease (HD) is an inherited neurodegenerative disease involving motor, cognitive, psychiatric, and behavioral impairments that eventually affect work-role functioning. There is limited research regarding predictors of workplace disability in HD. The authors examined predictors of work impairment and disability in a cross-sectional cohort of employed persons with symptomatic HD participating in the worldwide Enroll-HD study. METHODS The study sample (N=316) comprised individuals with manifest HD and a CAG repeat length range between 39 and 60 and were currently engaged in paid full- or part-time employment. Univariate and multivariate logistic regression analyses identified predictors and the effect of all predictors in a fully adjusted model. RESULTS Of the sample, 20.3% reported missing work due to HD, 60.1% reported experiencing impairment while working due to HD, 79.1% reported having work-related activity impairment due to HD, and 60.8% reported impairment in overall work productivity due to HD. Individuals had 25% higher odds of missing work time if they had a higher level of functional impairment (odds ratio=0.76, 95% CI=0.64, 0.91) and had three times greater odds of missing work if they were current alcohol drinkers, compared with nondrinkers (odds ratio=2.86, 95% CI=1.62, 5.03). Individuals with lower self-perceived mental health were also 5% more likely to experience impairment at work due to HD. Motor impairment was not a strong predictor of workplace disability. CONCLUSIONS These findings provide important new knowledge that can inform the development of strategies or targeted intervention trials to support persons with symptomatic HD to maintain their work roles.
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Affiliation(s)
- Anita M Y Goh
- Department of Psychiatry, Academic Unit for Psychiatry of Old Age, University of Melbourne, Melbourne (Goh, You, Perin, Lautenschlager, Chong, Ames, Chiu, Ellis); Neuropsychiatry Unit, Melbourne Neuropsychiatry Centre, Royal Melbourne Hospital, Melbourne (Goh, Loi); Department of Psychiatry, University of Melbourne, Melbourne (Goh, Lautenschlager, Clay, Ellis); NorthWestern Mental Health, Melbourne Health, Melbourne (Goh, Lautenschlager, Ellis); National Ageing Research Institute, Parkville, Australia (Goh); Department of Psychiatry, St. Vincent's Hospital, University of Melbourne, Melbourne (Chong); School of Psychological Sciences, University of Melbourne, Melbourne (Ellis); Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne (Ellis)
| | - Emily You
- Department of Psychiatry, Academic Unit for Psychiatry of Old Age, University of Melbourne, Melbourne (Goh, You, Perin, Lautenschlager, Chong, Ames, Chiu, Ellis); Neuropsychiatry Unit, Melbourne Neuropsychiatry Centre, Royal Melbourne Hospital, Melbourne (Goh, Loi); Department of Psychiatry, University of Melbourne, Melbourne (Goh, Lautenschlager, Clay, Ellis); NorthWestern Mental Health, Melbourne Health, Melbourne (Goh, Lautenschlager, Ellis); National Ageing Research Institute, Parkville, Australia (Goh); Department of Psychiatry, St. Vincent's Hospital, University of Melbourne, Melbourne (Chong); School of Psychological Sciences, University of Melbourne, Melbourne (Ellis); Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne (Ellis)
| | - Stephanie Perin
- Department of Psychiatry, Academic Unit for Psychiatry of Old Age, University of Melbourne, Melbourne (Goh, You, Perin, Lautenschlager, Chong, Ames, Chiu, Ellis); Neuropsychiatry Unit, Melbourne Neuropsychiatry Centre, Royal Melbourne Hospital, Melbourne (Goh, Loi); Department of Psychiatry, University of Melbourne, Melbourne (Goh, Lautenschlager, Clay, Ellis); NorthWestern Mental Health, Melbourne Health, Melbourne (Goh, Lautenschlager, Ellis); National Ageing Research Institute, Parkville, Australia (Goh); Department of Psychiatry, St. Vincent's Hospital, University of Melbourne, Melbourne (Chong); School of Psychological Sciences, University of Melbourne, Melbourne (Ellis); Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne (Ellis)
| | - Nicola T Lautenschlager
- Department of Psychiatry, Academic Unit for Psychiatry of Old Age, University of Melbourne, Melbourne (Goh, You, Perin, Lautenschlager, Chong, Ames, Chiu, Ellis); Neuropsychiatry Unit, Melbourne Neuropsychiatry Centre, Royal Melbourne Hospital, Melbourne (Goh, Loi); Department of Psychiatry, University of Melbourne, Melbourne (Goh, Lautenschlager, Clay, Ellis); NorthWestern Mental Health, Melbourne Health, Melbourne (Goh, Lautenschlager, Ellis); National Ageing Research Institute, Parkville, Australia (Goh); Department of Psychiatry, St. Vincent's Hospital, University of Melbourne, Melbourne (Chong); School of Psychological Sciences, University of Melbourne, Melbourne (Ellis); Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne (Ellis)
| | - Fiona J Clay
- Department of Psychiatry, Academic Unit for Psychiatry of Old Age, University of Melbourne, Melbourne (Goh, You, Perin, Lautenschlager, Chong, Ames, Chiu, Ellis); Neuropsychiatry Unit, Melbourne Neuropsychiatry Centre, Royal Melbourne Hospital, Melbourne (Goh, Loi); Department of Psychiatry, University of Melbourne, Melbourne (Goh, Lautenschlager, Clay, Ellis); NorthWestern Mental Health, Melbourne Health, Melbourne (Goh, Lautenschlager, Ellis); National Ageing Research Institute, Parkville, Australia (Goh); Department of Psychiatry, St. Vincent's Hospital, University of Melbourne, Melbourne (Chong); School of Psychological Sciences, University of Melbourne, Melbourne (Ellis); Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne (Ellis)
| | - Samantha M Loi
- Department of Psychiatry, Academic Unit for Psychiatry of Old Age, University of Melbourne, Melbourne (Goh, You, Perin, Lautenschlager, Chong, Ames, Chiu, Ellis); Neuropsychiatry Unit, Melbourne Neuropsychiatry Centre, Royal Melbourne Hospital, Melbourne (Goh, Loi); Department of Psychiatry, University of Melbourne, Melbourne (Goh, Lautenschlager, Clay, Ellis); NorthWestern Mental Health, Melbourne Health, Melbourne (Goh, Lautenschlager, Ellis); National Ageing Research Institute, Parkville, Australia (Goh); Department of Psychiatry, St. Vincent's Hospital, University of Melbourne, Melbourne (Chong); School of Psychological Sciences, University of Melbourne, Melbourne (Ellis); Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne (Ellis)
| | - Terence Chong
- Department of Psychiatry, Academic Unit for Psychiatry of Old Age, University of Melbourne, Melbourne (Goh, You, Perin, Lautenschlager, Chong, Ames, Chiu, Ellis); Neuropsychiatry Unit, Melbourne Neuropsychiatry Centre, Royal Melbourne Hospital, Melbourne (Goh, Loi); Department of Psychiatry, University of Melbourne, Melbourne (Goh, Lautenschlager, Clay, Ellis); NorthWestern Mental Health, Melbourne Health, Melbourne (Goh, Lautenschlager, Ellis); National Ageing Research Institute, Parkville, Australia (Goh); Department of Psychiatry, St. Vincent's Hospital, University of Melbourne, Melbourne (Chong); School of Psychological Sciences, University of Melbourne, Melbourne (Ellis); Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne (Ellis)
| | - David Ames
- Department of Psychiatry, Academic Unit for Psychiatry of Old Age, University of Melbourne, Melbourne (Goh, You, Perin, Lautenschlager, Chong, Ames, Chiu, Ellis); Neuropsychiatry Unit, Melbourne Neuropsychiatry Centre, Royal Melbourne Hospital, Melbourne (Goh, Loi); Department of Psychiatry, University of Melbourne, Melbourne (Goh, Lautenschlager, Clay, Ellis); NorthWestern Mental Health, Melbourne Health, Melbourne (Goh, Lautenschlager, Ellis); National Ageing Research Institute, Parkville, Australia (Goh); Department of Psychiatry, St. Vincent's Hospital, University of Melbourne, Melbourne (Chong); School of Psychological Sciences, University of Melbourne, Melbourne (Ellis); Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne (Ellis)
| | - Edmond Chiu
- Department of Psychiatry, Academic Unit for Psychiatry of Old Age, University of Melbourne, Melbourne (Goh, You, Perin, Lautenschlager, Chong, Ames, Chiu, Ellis); Neuropsychiatry Unit, Melbourne Neuropsychiatry Centre, Royal Melbourne Hospital, Melbourne (Goh, Loi); Department of Psychiatry, University of Melbourne, Melbourne (Goh, Lautenschlager, Clay, Ellis); NorthWestern Mental Health, Melbourne Health, Melbourne (Goh, Lautenschlager, Ellis); National Ageing Research Institute, Parkville, Australia (Goh); Department of Psychiatry, St. Vincent's Hospital, University of Melbourne, Melbourne (Chong); School of Psychological Sciences, University of Melbourne, Melbourne (Ellis); Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne (Ellis)
| | - Kathryn A Ellis
- Department of Psychiatry, Academic Unit for Psychiatry of Old Age, University of Melbourne, Melbourne (Goh, You, Perin, Lautenschlager, Chong, Ames, Chiu, Ellis); Neuropsychiatry Unit, Melbourne Neuropsychiatry Centre, Royal Melbourne Hospital, Melbourne (Goh, Loi); Department of Psychiatry, University of Melbourne, Melbourne (Goh, Lautenschlager, Clay, Ellis); NorthWestern Mental Health, Melbourne Health, Melbourne (Goh, Lautenschlager, Ellis); National Ageing Research Institute, Parkville, Australia (Goh); Department of Psychiatry, St. Vincent's Hospital, University of Melbourne, Melbourne (Chong); School of Psychological Sciences, University of Melbourne, Melbourne (Ellis); Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne (Ellis)
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Fritz NE, Boileau NR, Stout JC, Ready R, Perlmutter JS, Paulsen JS, Quaid K, Barton S, McCormack MK, Perlman SL, Carlozzi NE. Relationships Among Apathy, Health-Related Quality of Life, and Function in Huntington's Disease. J Neuropsychiatry Clin Neurosci 2018; 30:194-201. [PMID: 29558861 PMCID: PMC6081241 DOI: 10.1176/appi.neuropsych.17080173] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Up to 90% of individuals with Huntington's disease (HD)-a progressive, inherited neurodegenerative disorder-experience apathy. Apathy is particularly debilitating because it is marked by a reduction in goal-directed behaviors, including self-care, social interactions, and mobility. The objective of this study was to examine relationships between variables of apathy, functional status, physical function, cognitive function, behavioral status/emotional function, and health-related quality of life. Clinician-rated measures of physical, cognitive, and behavioral function, including one clinician-rated item on apathy, and self-reported measures of physical function, health-related quality of life, and emotional, cognitive, and social function were collected in a single session from 487 persons with the HD mutation (prodromal, N=193; early-stage manifest, N=186; late-stage manifest, N=108). Multiple linear regression models were used to examine which outcomes best predicted clinician-rated apathy after controlling for disease stage. Greater apathy related to less independence, increased motor impairment, and more clinician-rated behavioral problems (i.e., anger, irritability, depression). Similarly, poorer self-reported health-related quality of life; greater chorea; greater upper- and lower-extremity dysfunction; greater speech and swallowing dysfunction; worse anxiety, depression, and behavioral dyscontrol; worse cognitive function; and less satisfaction with social roles related to greater apathy. In conclusion, apathy related to physical, cognitive, and behavioral dysfunction across disease stages. Future work should explore whether clinical interventions targeting different functional domains may have the potential to reduce apathy in this patient population.
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Affiliation(s)
- Nora E. Fritz
- Departments of Health Care Sciences and Neurology, Wayne State University, Detroit, MI
| | - Nicholas R. Boileau
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Julie C. Stout
- Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Rebecca Ready
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA
| | - Joel S. Perlmutter
- Neurology, Radiology, Neuroscience, Physical Therapy, Occupational Therapy, Washington University in St. Louis, St. Louis, MO
| | - Jane S. Paulsen
- Department of Neurology, Department of Psychiatry, and Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA
| | - Kimberly Quaid
- Department of Medical and Molecular Genetics, Indiana University, Indianapolis, IN
| | - Stacey Barton
- Neurology, Radiology, Neuroscience, Physical Therapy, Occupational Therapy, Washington University in St. Louis, St. Louis, MO
| | - Michael K. McCormack
- Department of Psychiatry, Rutgers University-RWJMS, Piscataway, NJ and Department of Pathology, Rowan University, School of Medicine, Stratford, NJ
| | - Susan L. Perlman
- Department of Neurology, University of California Los Angeles, Los Angeles, CA
| | - Noelle E. Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
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