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Hendel RK, Hellem MNN, Larsen IU, Vinther-Jensen T, Hjermind LE, Nielsen JE, Vogel A. Impairments of social cognition significantly predict the progression of functional decline in Huntington's disease: A 6-year follow-up study. APPLIED NEUROPSYCHOLOGY. ADULT 2024; 31:777-786. [PMID: 35549503 DOI: 10.1080/23279095.2022.2073824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This study sought to investigate if there was a significant difference between the Huntington's Disease gene expansion carriers who were impaired on the cognitive domains, social cognition and executive functions. Also, it was investigated which of the cognitive domains could predict the decrease in total functional capacity over a 6-year follow-up period. Premanifest and motor-manifest Huntington's Disease gene expansion carriers (N = 98), were examined with a neurological and neuropsychological examination at Time 1 (year 2012-2013). Regression-based normative data was used to classify impairments on the two cognitive domains. Follow-up participants (N = 80) had their functional capacity reexamined at Time 2 (year 2018-2020), to examine which cognitive domain could predict the decrease in functional capacity over the 6-year follow-up. More than 50% of the participants were impaired on the domain of social cognition. These participants were significantly different from the participants who were impaired on executive functions. The motor function and impairments on social cognition significantly predicted the decline in functional capacity. The Emotion Hexagon test was the only significant social cognitive task, that predicted the decline in functional capacity. Social cognition includes unique and separate functions in Huntington's Disease, unaffected by executive functions. This study emphasizes the importance of regular assessment of social cognition in Huntington's Disease and the clinical relevance of impaired social cognitive function.
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Affiliation(s)
- Rebecca K Hendel
- Department of Neurology, Danish Dementia Research Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Marie N N Hellem
- Department of Neurology, Danish Dementia Research Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Ida U Larsen
- Department of Neurology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Tua Vinther-Jensen
- Department of Neurology, Danish Dementia Research Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Neurology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Lena E Hjermind
- Department of Neurology, Danish Dementia Research Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Jørgen E Nielsen
- Department of Neurology, Danish Dementia Research Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Asmus Vogel
- Department of Neurology, Danish Dementia Research Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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Hendel RK, Hellem MNN, Hjermind LE, Nielsen JE, Vogel A. An Exploratory Study Investigating Autonomy in Huntington's Disease Gene Expansion Carriers. J Huntingtons Dis 2022; 11:373-381. [PMID: 35964199 DOI: 10.3233/jhd-220540] [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: 12/31/2022]
Abstract
BACKGROUND Autonomy describes a psychological state of self-regulation of motivation and action, which is a central characteristic of healthy functioning. In neurodegenerative diseases measures of self-perception have been found to be affected by the disease. However, it has never been investigated whether measures of self-perception, like autonomy, is affected in Huntington's disease. OBJECTIVE We investigated whether autonomy is affected in Huntington's disease and if the degree of autonomy is associated with motor function, neuropsychiatric symptoms, cognitive impairments, and apathy. METHODS We included 44 premanifest and motor-manifest Huntington's disease gene expansion carriers and 19 controls. Autonomy was examined using two self-report questionnaires, the Autonomy-Connectedness Scale-30 and the Index of Autonomous Functioning. All participants were examined according to motor function, cognitive impairments, and neuropsychiatric symptoms, including apathy. RESULTS Statistically significant differences were found between motor-manifest Huntington's disease gene expansion carriers and premanifest Huntington's disease gene expansion carriers or controls on two measures of autonomy. Between 25-38% of motor-manifest Huntington's disease gene expansion carriers scored significantly below the normal level on subscales of autonomy as compared to controls. One autonomy subscale was associated with apathy (r = -0.65), but not with other symptoms of Huntington's disease. CONCLUSION This study provides evidence for impaired autonomy in individuals with Huntington's disease and an association between autonomy and apathy. The results underline the importance of maintaining patient autonomy and involvement in care throughout the disease.
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Affiliation(s)
- Rebecca K Hendel
- Department of Neurology, Danish Dementia Research Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Marie N N Hellem
- Department of Neurology, Danish Dementia Research Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Lena E Hjermind
- Department of Neurology, Danish Dementia Research Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Jørgen E Nielsen
- Department of Neurology, Danish Dementia Research Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Asmus Vogel
- Department of Neurology, Danish Dementia Research Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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Hellem MNN, Cheong RY, Tonetto S, Vinther-Jensen T, Hendel RK, Larsen IU, Nielsen TT, Hjermind LE, Vogel A, Budtz-Jørgensen E, Petersén Å, Nielsen JE. Decreased CSF oxytocin relates to measures of social cognitive impairment in Huntington's disease patients. Parkinsonism Relat Disord 2022; 99:23-29. [PMID: 35580426 DOI: 10.1016/j.parkreldis.2022.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/21/2022] [Accepted: 05/08/2022] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Huntington's disease (HD) is an inherited neurodegenerative disease with motor, cognitive and psychiatric symptoms. Non-motor symptoms like depression and altered social cognition are proposed to be caused by dysfunction of the hypothalamus. We measured the hypothalamic neuropeptide oxytocin in plasma and cerebrospinal fluid (CSF) in a cohort of HD gene expansion carriers (HDGECs), compared the levels to healthy HD family controls and correlated oxytocin levels to disease progression and social cognition. METHODS We recruited 113 HDGECs and 33 controls. Psychiatric and cognitive symptoms were evaluated, and social cognition was assessed with the Emotion Hexagon test, Reading the Mind in the Eyes and The Awareness of Social Inference Test. The levels of oxytocin in CSF and blood were analyzed by radioimmunoassay. RESULTS We found the level of oxytocin in CSF to be significantly lower by 33.5% in HDGECs compared to controls (p = 0.016). When dividing the HDGECs into groups with or without cognitive impairment, we found the oxytocin level to be significantly lower by 30.3% in the HDGECs with cognitive symptoms (p = 0.046). We found a statistically significant correlation between the level of oxytocin and scores on social cognition (Reading the Mind in the Eyes p = 0.0019; Emotion Hexagon test: p = 0.0062; The Awareness of Social Inference Test: p = 0.002). CONCLUSIONS This is the first study to measure oxytocin in the CSF of HDGECs. We find that HDGECs have a significantly lower level of oxytocin compared to controls, and that the level of oxytocin may represent an objective and comparable measure that could be used as a state biomarker for impairment of social cognition. We suggest treatment trials to evaluate a potential effect of oxytocin on social cognition in HD.
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Affiliation(s)
- Marie N N Hellem
- The Neurogenetics Clinic and Research Lab, Danish Dementia Research Centre, Copenhagen University Hospital, Rigshospitalet, Inge Lehmanns Vej, Section 8008, 2100, Copenhagen, Denmark.
| | - Rachel Y Cheong
- Translational Neuroendocrine Research Unit, Department of Experimental Medical Science, Lund University, 22184, Lund, Sweden
| | - Simone Tonetto
- Translational Neuroendocrine Research Unit, Department of Experimental Medical Science, Lund University, 22184, Lund, Sweden
| | - Tua Vinther-Jensen
- The Neurogenetics Clinic and Research Lab, Danish Dementia Research Centre, Copenhagen University Hospital, Rigshospitalet, Inge Lehmanns Vej, Section 8008, 2100, Copenhagen, Denmark; Department of Neurology, Bispebjerg-Frederiksberg Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
| | - Rebecca K Hendel
- The Neurogenetics Clinic and Research Lab, Danish Dementia Research Centre, Copenhagen University Hospital, Rigshospitalet, Inge Lehmanns Vej, Section 8008, 2100, Copenhagen, Denmark; Department of Psychology, University of Copenhagen, Øster Farimagsgade 2, 1014, Copenhagen, Denmark
| | - Ida U Larsen
- Department of Neurology, Bispebjerg-Frederiksberg Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
| | - Troels T Nielsen
- The Neurogenetics Clinic and Research Lab, Danish Dementia Research Centre, Copenhagen University Hospital, Rigshospitalet, Inge Lehmanns Vej, Section 8008, 2100, Copenhagen, Denmark
| | - Lena E Hjermind
- The Neurogenetics Clinic and Research Lab, Danish Dementia Research Centre, Copenhagen University Hospital, Rigshospitalet, Inge Lehmanns Vej, Section 8008, 2100, Copenhagen, Denmark
| | - Asmus Vogel
- The Neurogenetics Clinic and Research Lab, Danish Dementia Research Centre, Copenhagen University Hospital, Rigshospitalet, Inge Lehmanns Vej, Section 8008, 2100, Copenhagen, Denmark; Department of Psychology, University of Copenhagen, Øster Farimagsgade 2, 1014, Copenhagen, Denmark
| | - Esben Budtz-Jørgensen
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
| | - Åsa Petersén
- Translational Neuroendocrine Research Unit, Department of Experimental Medical Science, Lund University, 22184, Lund, Sweden
| | - Jørgen E Nielsen
- The Neurogenetics Clinic and Research Lab, Danish Dementia Research Centre, Copenhagen University Hospital, Rigshospitalet, Inge Lehmanns Vej, Section 8008, 2100, Copenhagen, Denmark
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