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Horta-Barba A, Martínez-Horta S, Pérez-Pérez J, Sampedro F, Puig-Davi A, Pagonabarraga J, Kulisevsky J. Measuring the functional impact of cognitive impairment in Huntington’s disease. J Neurol 2022; 269:3541-3549. [PMID: 35061089 PMCID: PMC9217879 DOI: 10.1007/s00415-021-10955-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 11/24/2022]
Abstract
Background Patients with Huntington’s disease (HD) exhibit a variable predominance of cognitive, behavioral and motor symptoms. A specific instrument focusing on the impact of cognitive impairment in HD over functional capacity is lacking. Objective To address the need for a brief and specifically developed HD questionnaire able to capture functional aspects suspected to be sensitive to cognitive impairment. Methods We developed and validated the “Huntington’s Disease-Cognitive Functional Rating Scale” (HD-CFRS) in 78 symptomatic carriers of the Huntington’s disease mutation. We also administered the HD-CFRS to a knowledgeable informant to measure the level of agreement. To explore the association between HD-CFRS scores and participants’ cognitive status, we administered objective measures of cognition. Participants were classified as cognitively preserved (HD-NC), as having mild cognitive impairment (HD-MCI), or as having dementia (HD-Dem). Results The HD-CFRS showed concurrent validity and internal consistency in the three groups. HD carriers and informants in the HD-NC group obtained similar HD-CFRS scores. However, in patients with mild cognitive impairment and dementia, informers reported greater functional impairment than HD participants. The HD-CFRS total score showed strong correlations with measures assessing cognition. Conclusions These findings support the utility of the HD-CFRS as a brief and reliable instrument to measure functional defects associated with cognitive impairment in HD. We believe this questionnaire could be a useful tool both for clinical practice and research.
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Affiliation(s)
- Andrea Horta-Barba
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, 08041, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona (U.A.B.), Barcelona, Spain
- Institut d'Investigacions Biomèdiques-Sant Pau (IIB-Sant Pau), Barcelona, Spain
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- European Huntington's Disease Network (EHDN), Ulm, Germany
| | - Saül Martínez-Horta
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, 08041, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona (U.A.B.), Barcelona, Spain
- Institut d'Investigacions Biomèdiques-Sant Pau (IIB-Sant Pau), Barcelona, Spain
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- European Huntington's Disease Network (EHDN), Ulm, Germany
| | - Jesus Pérez-Pérez
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, 08041, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona (U.A.B.), Barcelona, Spain
- Institut d'Investigacions Biomèdiques-Sant Pau (IIB-Sant Pau), Barcelona, Spain
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- European Huntington's Disease Network (EHDN), Ulm, Germany
| | - Frederic Sampedro
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, 08041, Barcelona, Spain
- Institut d'Investigacions Biomèdiques-Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Arnau Puig-Davi
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, 08041, Barcelona, Spain
- Institut d'Investigacions Biomèdiques-Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Javier Pagonabarraga
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, 08041, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona (U.A.B.), Barcelona, Spain
- Institut d'Investigacions Biomèdiques-Sant Pau (IIB-Sant Pau), Barcelona, Spain
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Jaime Kulisevsky
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, 08041, Barcelona, Spain.
- Department of Medicine, Universitat Autònoma de Barcelona (U.A.B.), Barcelona, Spain.
- Institut d'Investigacions Biomèdiques-Sant Pau (IIB-Sant Pau), Barcelona, Spain.
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.
- European Huntington's Disease Network (EHDN), Ulm, Germany.
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Schobel SA, Palermo G, Auinger P, Long JD, Ma S, Khwaja OS, Trundell D, Cudkowicz M, Hersch S, Sampaio C, Dorsey ER, Leavitt BR, Kieburtz KD, Sevigny JJ, Langbehn DR, Tabrizi SJ. Motor, cognitive, and functional declines contribute to a single progressive factor in early HD. Neurology 2017; 89:2495-2502. [PMID: 29142089 PMCID: PMC5729794 DOI: 10.1212/wnl.0000000000004743] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 09/20/2017] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To identify an improved measure of clinical progression in early Huntington disease (HD) using data from prospective observational cohort studies and placebo group data from randomized double-blind clinical trials. METHODS We studied Unified Huntington Disease Rating Scale (UHDRS) and non-UHDRS clinical measures and brain measures of progressive atrophy in 1,668 individuals with early HD followed up prospectively for up to 30 to 36 months of longitudinal clinical follow-up. RESULTS The results demonstrated that a composite measure of motor, cognitive, and global functional decline best characterized clinical progression and was most strongly associated with brain measures of progressive corticostriatal atrophy. CONCLUSIONS Use of a composite motor, cognitive, and global functional clinical outcome measure in HD provides an improved measure of clinical progression more related to measures of progressive brain atrophy and provides an opportunity for enhanced clinical trial efficiency relative to currently used individual motor, cognitive, and functional outcome measures.
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Affiliation(s)
- Scott A Schobel
- From F. Hoffman-La Roche, Ltd (S.A.S., G.P., O.S.K., D.T., J.J.S.), Roche Innovation Center, Basel, Switzerland; University of Rochester (P.A., S.M., E.R.D., K.D.K.), NY; University of Iowa (J.D.L., D.R.L.), Iowa City; Massachusetts General Hospital and Harvard Medical School (M.C., S.H.), Boston; CHDI Management/Foundation (C.S.), Princeton, NJ; University of British Columbia, Vancouver, Canada (B.R.L.); and University College London (S.J.T.), UK.
| | - Giuseppe Palermo
- From F. Hoffman-La Roche, Ltd (S.A.S., G.P., O.S.K., D.T., J.J.S.), Roche Innovation Center, Basel, Switzerland; University of Rochester (P.A., S.M., E.R.D., K.D.K.), NY; University of Iowa (J.D.L., D.R.L.), Iowa City; Massachusetts General Hospital and Harvard Medical School (M.C., S.H.), Boston; CHDI Management/Foundation (C.S.), Princeton, NJ; University of British Columbia, Vancouver, Canada (B.R.L.); and University College London (S.J.T.), UK
| | - Peggy Auinger
- From F. Hoffman-La Roche, Ltd (S.A.S., G.P., O.S.K., D.T., J.J.S.), Roche Innovation Center, Basel, Switzerland; University of Rochester (P.A., S.M., E.R.D., K.D.K.), NY; University of Iowa (J.D.L., D.R.L.), Iowa City; Massachusetts General Hospital and Harvard Medical School (M.C., S.H.), Boston; CHDI Management/Foundation (C.S.), Princeton, NJ; University of British Columbia, Vancouver, Canada (B.R.L.); and University College London (S.J.T.), UK
| | - Jeffrey D Long
- From F. Hoffman-La Roche, Ltd (S.A.S., G.P., O.S.K., D.T., J.J.S.), Roche Innovation Center, Basel, Switzerland; University of Rochester (P.A., S.M., E.R.D., K.D.K.), NY; University of Iowa (J.D.L., D.R.L.), Iowa City; Massachusetts General Hospital and Harvard Medical School (M.C., S.H.), Boston; CHDI Management/Foundation (C.S.), Princeton, NJ; University of British Columbia, Vancouver, Canada (B.R.L.); and University College London (S.J.T.), UK
| | - Shiyang Ma
- From F. Hoffman-La Roche, Ltd (S.A.S., G.P., O.S.K., D.T., J.J.S.), Roche Innovation Center, Basel, Switzerland; University of Rochester (P.A., S.M., E.R.D., K.D.K.), NY; University of Iowa (J.D.L., D.R.L.), Iowa City; Massachusetts General Hospital and Harvard Medical School (M.C., S.H.), Boston; CHDI Management/Foundation (C.S.), Princeton, NJ; University of British Columbia, Vancouver, Canada (B.R.L.); and University College London (S.J.T.), UK
| | - Omar S Khwaja
- From F. Hoffman-La Roche, Ltd (S.A.S., G.P., O.S.K., D.T., J.J.S.), Roche Innovation Center, Basel, Switzerland; University of Rochester (P.A., S.M., E.R.D., K.D.K.), NY; University of Iowa (J.D.L., D.R.L.), Iowa City; Massachusetts General Hospital and Harvard Medical School (M.C., S.H.), Boston; CHDI Management/Foundation (C.S.), Princeton, NJ; University of British Columbia, Vancouver, Canada (B.R.L.); and University College London (S.J.T.), UK
| | - Dylan Trundell
- From F. Hoffman-La Roche, Ltd (S.A.S., G.P., O.S.K., D.T., J.J.S.), Roche Innovation Center, Basel, Switzerland; University of Rochester (P.A., S.M., E.R.D., K.D.K.), NY; University of Iowa (J.D.L., D.R.L.), Iowa City; Massachusetts General Hospital and Harvard Medical School (M.C., S.H.), Boston; CHDI Management/Foundation (C.S.), Princeton, NJ; University of British Columbia, Vancouver, Canada (B.R.L.); and University College London (S.J.T.), UK
| | - Merit Cudkowicz
- From F. Hoffman-La Roche, Ltd (S.A.S., G.P., O.S.K., D.T., J.J.S.), Roche Innovation Center, Basel, Switzerland; University of Rochester (P.A., S.M., E.R.D., K.D.K.), NY; University of Iowa (J.D.L., D.R.L.), Iowa City; Massachusetts General Hospital and Harvard Medical School (M.C., S.H.), Boston; CHDI Management/Foundation (C.S.), Princeton, NJ; University of British Columbia, Vancouver, Canada (B.R.L.); and University College London (S.J.T.), UK
| | - Steven Hersch
- From F. Hoffman-La Roche, Ltd (S.A.S., G.P., O.S.K., D.T., J.J.S.), Roche Innovation Center, Basel, Switzerland; University of Rochester (P.A., S.M., E.R.D., K.D.K.), NY; University of Iowa (J.D.L., D.R.L.), Iowa City; Massachusetts General Hospital and Harvard Medical School (M.C., S.H.), Boston; CHDI Management/Foundation (C.S.), Princeton, NJ; University of British Columbia, Vancouver, Canada (B.R.L.); and University College London (S.J.T.), UK
| | - Cristina Sampaio
- From F. Hoffman-La Roche, Ltd (S.A.S., G.P., O.S.K., D.T., J.J.S.), Roche Innovation Center, Basel, Switzerland; University of Rochester (P.A., S.M., E.R.D., K.D.K.), NY; University of Iowa (J.D.L., D.R.L.), Iowa City; Massachusetts General Hospital and Harvard Medical School (M.C., S.H.), Boston; CHDI Management/Foundation (C.S.), Princeton, NJ; University of British Columbia, Vancouver, Canada (B.R.L.); and University College London (S.J.T.), UK
| | - E Ray Dorsey
- From F. Hoffman-La Roche, Ltd (S.A.S., G.P., O.S.K., D.T., J.J.S.), Roche Innovation Center, Basel, Switzerland; University of Rochester (P.A., S.M., E.R.D., K.D.K.), NY; University of Iowa (J.D.L., D.R.L.), Iowa City; Massachusetts General Hospital and Harvard Medical School (M.C., S.H.), Boston; CHDI Management/Foundation (C.S.), Princeton, NJ; University of British Columbia, Vancouver, Canada (B.R.L.); and University College London (S.J.T.), UK
| | - Blair R Leavitt
- From F. Hoffman-La Roche, Ltd (S.A.S., G.P., O.S.K., D.T., J.J.S.), Roche Innovation Center, Basel, Switzerland; University of Rochester (P.A., S.M., E.R.D., K.D.K.), NY; University of Iowa (J.D.L., D.R.L.), Iowa City; Massachusetts General Hospital and Harvard Medical School (M.C., S.H.), Boston; CHDI Management/Foundation (C.S.), Princeton, NJ; University of British Columbia, Vancouver, Canada (B.R.L.); and University College London (S.J.T.), UK
| | - Karl D Kieburtz
- From F. Hoffman-La Roche, Ltd (S.A.S., G.P., O.S.K., D.T., J.J.S.), Roche Innovation Center, Basel, Switzerland; University of Rochester (P.A., S.M., E.R.D., K.D.K.), NY; University of Iowa (J.D.L., D.R.L.), Iowa City; Massachusetts General Hospital and Harvard Medical School (M.C., S.H.), Boston; CHDI Management/Foundation (C.S.), Princeton, NJ; University of British Columbia, Vancouver, Canada (B.R.L.); and University College London (S.J.T.), UK
| | - Jeffrey J Sevigny
- From F. Hoffman-La Roche, Ltd (S.A.S., G.P., O.S.K., D.T., J.J.S.), Roche Innovation Center, Basel, Switzerland; University of Rochester (P.A., S.M., E.R.D., K.D.K.), NY; University of Iowa (J.D.L., D.R.L.), Iowa City; Massachusetts General Hospital and Harvard Medical School (M.C., S.H.), Boston; CHDI Management/Foundation (C.S.), Princeton, NJ; University of British Columbia, Vancouver, Canada (B.R.L.); and University College London (S.J.T.), UK
| | - Douglas R Langbehn
- From F. Hoffman-La Roche, Ltd (S.A.S., G.P., O.S.K., D.T., J.J.S.), Roche Innovation Center, Basel, Switzerland; University of Rochester (P.A., S.M., E.R.D., K.D.K.), NY; University of Iowa (J.D.L., D.R.L.), Iowa City; Massachusetts General Hospital and Harvard Medical School (M.C., S.H.), Boston; CHDI Management/Foundation (C.S.), Princeton, NJ; University of British Columbia, Vancouver, Canada (B.R.L.); and University College London (S.J.T.), UK
| | - Sarah J Tabrizi
- From F. Hoffman-La Roche, Ltd (S.A.S., G.P., O.S.K., D.T., J.J.S.), Roche Innovation Center, Basel, Switzerland; University of Rochester (P.A., S.M., E.R.D., K.D.K.), NY; University of Iowa (J.D.L., D.R.L.), Iowa City; Massachusetts General Hospital and Harvard Medical School (M.C., S.H.), Boston; CHDI Management/Foundation (C.S.), Princeton, NJ; University of British Columbia, Vancouver, Canada (B.R.L.); and University College London (S.J.T.), UK
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