1
|
Atkins KJ, Andrews SC, Stout JC, Chong TTJ. The effect of Huntington's disease on cognitive and physical motivation. Brain 2024; 147:2449-2458. [PMID: 38266149 PMCID: PMC11224606 DOI: 10.1093/brain/awae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/09/2023] [Accepted: 01/04/2024] [Indexed: 01/26/2024] Open
Abstract
Apathy is one of the most common neuropsychiatric features of Huntington's disease. A hallmark of apathy is diminished goal-directed behaviour, which is characterized by a lower motivation to engage in cognitively or physically effortful actions. However, it remains unclear whether this reduction in goal-directed behaviour is driven primarily by a motivational deficit and/or is secondary to the progressive cognitive and physical deficits that accompany more advanced disease. We addressed this question by testing 17 individuals with manifest Huntington's disease and 22 age-matched controls on an effort-based decision-making paradigm. Participants were first trained on separate cognitively and physically effortful tasks and provided explicit feedback about their performance. Next, they chose on separate trials how much effort they were willing to exert in each domain in return for varying reward. At the conclusion of the experiment, participants were asked to rate their subjective perception of task load. In the cognitive task, the Huntington's disease group were more averse to cognitive effort than controls. Although the Huntington's disease group were more impaired than controls on the task itself, their greater aversion to cognitive effort persisted even after controlling for task performance. This suggests that the lower levels of cognitive motivation in the Huntington's disease group relative to controls was most likely driven by a primary motivational deficit. In contrast, both groups expressed a similar preference for physical effort. Importantly, the similar levels of physical motivation across both groups occurred even though participants with Huntington's disease performed objectively worse than controls on the physical effort task, and were aware of their performance through explicit feedback on each trial. This indicates that the seemingly preserved level of physical motivation in Huntington's disease was driven by a willingness to engage in physically effortful actions despite a reduced capacity to do so. Finally, the Huntington's disease group provided higher ratings of subjective task demand than controls for the cognitive (but not physical) effort task and when assessing the mental (but not the physical) load of each task. Together, these results revealed a dissociation in cognitive and physical motivation deficits between Huntington's disease and controls, which were accompanied by differences in how effort was subjectively perceived by the two groups. This highlights that motivation is the final manifestation of a complex set of mechanisms involved in effort processing, which are separable across different domains of behaviour. These findings have important clinical implications for the day-to-day management of apathy in Huntington's disease.
Collapse
Affiliation(s)
- Kelly J Atkins
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria 3800, Australia
| | - Sophie C Andrews
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria 3800, Australia
- Thompson Institute, University of the Sunshine Coast, Queensland 4575, Australia
| | - Julie C Stout
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria 3800, Australia
| | - Trevor T J Chong
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria 3800, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria 3004, Australia
- Department of Clinical Neurosciences, St Vincent’s Hospital, Melbourne, Victoria 3065, Australia
| |
Collapse
|
2
|
Isaacs DA, Hay KR, Hoadley J, McDonell KE, Brown AE, Wynn A, Claassen DO, Gibson J. Influence of anosognosia on patient-reported outcomes for psychiatric symptoms and quality of life in Huntington's disease. Parkinsonism Relat Disord 2024; 123:106969. [PMID: 38614044 PMCID: PMC11169743 DOI: 10.1016/j.parkreldis.2024.106969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/16/2024] [Accepted: 04/07/2024] [Indexed: 04/15/2024]
Abstract
INTRODUCTION Anosognosia, defined as reduced awareness of one's deficit or symptom, is common in Huntington's disease (HD) and detectable at each disease stage. The impact of anosognosia on self-reporting in HD populations is critical to understand given growing use of patient-reported outcomes in HD clinical care and research. We aimed to determine the influence of anosognosia on patient-reported outcome measures assessing psychiatric symptoms and quality of life in HD. METHODS We enrolled HD patients to complete a battery of patient-reported and rater-administered measures, including the Anosognosia Scale, at baseline and 6 months later. Patient-reported outcome measures included NeuroQoL short forms for depression, anxiety, satisfaction with social roles and activities, and positive affect and well-being and Patient-Reported Outcomes Measurement Information System short forms for emotional distress-anger and sleep-related impairment. Anosognosia Scale-Difference Score indexed patient-clinician agreement on patient motor, cognitive, and behavioral abilities. We conducted multivariable linear regression analyses to quantify the association of baseline anosognosia with 6-month patient-reported outcomes. RESULTS Of 79 patients with complete Anosognosia Scale data at baseline, 25 (31.6 %) met the scale's criterion for anosognosia. In the regression analyses, baseline Difference Score improved prediction of 6-month patient-reported outcomes for depression, anxiety, anger, and positive affect and well-being (χ2(1) value range for likelihood ratio tests contrasting models with and without Difference Score: 13.1-20.9, p-values <0.001). Patients with more anosognosia self-reported less severe psychiatric symptoms and more positive affect and well-being. CONCLUSION Study results suggest that anosognosia influences patient-reported outcomes for psychiatric symptoms and quality of life in HD populations.
Collapse
Affiliation(s)
- David A Isaacs
- Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, 37232, USA; Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, Nashville, TN, 37232, USA.
| | - Kaitlyn R Hay
- Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, 37232, USA.
| | - Jennifer Hoadley
- Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, 37232, USA.
| | - Katherine E McDonell
- Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, 37232, USA.
| | - Amy E Brown
- Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, 37232, USA.
| | - Amy Wynn
- Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, 37232, USA.
| | - Daniel O Claassen
- Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, 37232, USA.
| | - Jessie Gibson
- University of Virginia School of Nursing, 202 Jeanette Lancaster Way, Charlottesville, VA, 22903, USA.
| |
Collapse
|
3
|
Na D, Lim DH, Hong JS, Lee HM, Cho D, Yu MS, Shaker B, Ren J, Lee B, Song JG, Oh Y, Lee K, Oh KS, Lee MY, Choi MS, Choi HS, Kim YH, Bui JM, Lee K, Kim HW, Lee YS, Gsponer J. A multi-layered network model identifies Akt1 as a common modulator of neurodegeneration. Mol Syst Biol 2023; 19:e11801. [PMID: 37984409 DOI: 10.15252/msb.202311801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 10/25/2023] [Accepted: 10/27/2023] [Indexed: 11/22/2023] Open
Abstract
The accumulation of misfolded and aggregated proteins is a hallmark of neurodegenerative proteinopathies. Although multiple genetic loci have been associated with specific neurodegenerative diseases (NDs), molecular mechanisms that may have a broader relevance for most or all proteinopathies remain poorly resolved. In this study, we developed a multi-layered network expansion (MLnet) model to predict protein modifiers that are common to a group of diseases and, therefore, may have broader pathophysiological relevance for that group. When applied to the four NDs Alzheimer's disease (AD), Huntington's disease, and spinocerebellar ataxia types 1 and 3, we predicted multiple members of the insulin pathway, including PDK1, Akt1, InR, and sgg (GSK-3β), as common modifiers. We validated these modifiers with the help of four Drosophila ND models. Further evaluation of Akt1 in human cell-based ND models revealed that activation of Akt1 signaling by the small molecule SC79 increased cell viability in all models. Moreover, treatment of AD model mice with SC79 enhanced their long-term memory and ameliorated dysregulated anxiety levels, which are commonly affected in AD patients. These findings validate MLnet as a valuable tool to uncover molecular pathways and proteins involved in the pathophysiology of entire disease groups and identify potential therapeutic targets that have relevance across disease boundaries. MLnet can be used for any group of diseases and is available as a web tool at http://ssbio.cau.ac.kr/software/mlnet.
Collapse
Affiliation(s)
- Dokyun Na
- Department of Biomedical Engineering, Chung-Ang University, Seoul, Republic of Korea
| | - Do-Hwan Lim
- College of Life Sciences and Biotechnology, Korea University, Seoul, Republic of Korea
- School of Systems Biomedical Science, Soongsil University, Seoul, Republic of Korea
| | - Jae-Sang Hong
- College of Life Sciences and Biotechnology, Korea University, Seoul, Republic of Korea
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA
| | - Hyang-Mi Lee
- Department of Biomedical Engineering, Chung-Ang University, Seoul, Republic of Korea
| | - Daeahn Cho
- Department of Biomedical Engineering, Chung-Ang University, Seoul, Republic of Korea
| | - Myeong-Sang Yu
- Department of Biomedical Engineering, Chung-Ang University, Seoul, Republic of Korea
| | - Bilal Shaker
- Department of Biomedical Engineering, Chung-Ang University, Seoul, Republic of Korea
| | - Jun Ren
- Department of Biomedical Engineering, Chung-Ang University, Seoul, Republic of Korea
| | - Bomi Lee
- College of Life Sciences, Sejong University, Seoul, Republic of Korea
| | - Jae Gwang Song
- College of Life Sciences, Sejong University, Seoul, Republic of Korea
| | - Yuna Oh
- Korea Institute of Science and Technology, Seoul, Republic of Korea
| | - Kyungeun Lee
- Korea Institute of Science and Technology, Seoul, Republic of Korea
| | - Kwang-Seok Oh
- Information-based Drug Research Center, Korea Research Institute of Chemical Technology, Deajeon, Republic of Korea
| | - Mi Young Lee
- Information-based Drug Research Center, Korea Research Institute of Chemical Technology, Deajeon, Republic of Korea
| | - Min-Seok Choi
- College of Life Sciences and Biotechnology, Korea University, Seoul, Republic of Korea
| | - Han Saem Choi
- College of Life Sciences, Sejong University, Seoul, Republic of Korea
| | - Yang-Hee Kim
- College of Life Sciences, Sejong University, Seoul, Republic of Korea
| | - Jennifer M Bui
- Department of Biochemistry and Molecular Biology, Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada
| | - Kangseok Lee
- Department of Life Science, Chung-Ang University, Seoul, Republic of Korea
| | - Hyung Wook Kim
- College of Life Sciences, Sejong University, Seoul, Republic of Korea
| | - Young Sik Lee
- College of Life Sciences and Biotechnology, Korea University, Seoul, Republic of Korea
| | - Jörg Gsponer
- Department of Biochemistry and Molecular Biology, Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
4
|
Neal JW, Greenwald M. Self-Awareness and therapeutic alliance in speech-language treatment of traumatic brain injury. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 25:757-767. [PMID: 36178155 DOI: 10.1080/17549507.2022.2123041] [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: 06/16/2023]
Abstract
Purpose: To investigate the relationships among client self-awareness, client perception of the therapeutic alliance, and speech-language pathologist (SLP) communicative self-awareness in dyads of SLPs and traumatic brain injury (TBI) clients.Method: Nineteen SLP-TBI client dyads (N = 38) engaged in the same collaborative therapy task. At baseline, client self-awareness and client perception of the therapeutic alliance was assessed. SLP communicative self-awareness was measured by 1) a prediction/reflection questionnaire about their own communicative behaviour, administered pre- and post-treatment sessions, and 2) self-evaluation during a novel procedure using video review within three hours after the session.Result: Client self-awareness was not associated with client perceptions of the therapeutic alliance. Client perceptions of the therapeutic alliance were related to specific communicative intentions of the SLP. Regarding SLP communicative self-awareness, SLPs predicted their primary communication modality with 66% accuracy. The video review procedure yielded more detailed SLP communicative self-awareness ratings and was completed within real-world clinical settings.Conclusion: TBI client self-awareness may not impact the establishment of a strong therapeutic alliance between SLP and client. The finding that specific communicative intentions of the SLP were related to client perception of the therapeutic alliance should prompt further efforts to measure SLP communicative intentions and behaviours during TBI treatment sessions.
Collapse
Affiliation(s)
- J Whitney Neal
- Department of Communication Sciences and Disorders, Wayne State University, Detroit, MI, USA
| | - Margaret Greenwald
- Department of Communication Sciences and Disorders, Wayne State University, Detroit, MI, USA
| |
Collapse
|
5
|
A Simple and Efficient Method for the Substrate Identification of Amino Acid Decarboxylases. Int J Mol Sci 2022; 23:ijms232314551. [PMID: 36498879 PMCID: PMC9737665 DOI: 10.3390/ijms232314551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/12/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022] Open
Abstract
Amino acid decarboxylases convert amino acids into different biogenic amines which regulate diverse biological processes. Therefore, identifying the substrates of amino acid decarboxylases is critical for investigating the function of the decarboxylases, especially for the new genes predicted to be amino acid decarboxylases. In the present work, we have established a simple and efficient method to identify the substrates and enzymatic activity of amino acid decarboxylases based on LC-MS methods. We chose GAD65 and AADC as models to validate our method. GAD65 and AADC were expressed in HEK 293T cells and purified through immunoprecipitation. The purified amino acid decarboxylases were subjected to enzymatic reaction with different substrate mixtures in vitro. LC-MS analysis of the reaction mixture identified depleted or accumulated metabolites, which corresponded to candidate enzyme substrates and products, respectively. Our method successfully identified the substrates and products of known amino acid decarboxylases. In summary, our method can efficiently identify the substrates and products of amino acid decarboxylases, which will facilitate future amino acid decarboxylase studies.
Collapse
|
6
|
Valotassiou V, Sifakis N, Tzavara C, Lykou E, Tsinia N, Kamtsadeli V, Sali D, Angelidis G, Psimadas D, Theodorou E, Tsougos I, Papageorgiou SG, Georgoulias P, Papatriantafyllou J. Anosognosia in Dementia: Evaluation of Perfusion Correlates Using 99mTc-HMPAO SPECT and Automated Brodmann Areas Analysis. Diagnostics (Basel) 2022; 12:diagnostics12051136. [PMID: 35626292 PMCID: PMC9140080 DOI: 10.3390/diagnostics12051136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/28/2022] [Accepted: 05/01/2022] [Indexed: 12/10/2022] Open
Abstract
(1) Background: Considerable inconsistency exists regarding the neural substrates of anosognosia in dementia in previous neuroimaging studies. The purpose of this study was the evaluation of anosognosia perfusion correlates across various types of dementia using automated Brodmann areas (BAs) analysis and comparison with a database of normal subjects. (2) Methods: We studied 72 patients: 32 with Alzheimer’s disease, 26 with frontotemporal dementia—FTD (12 behavioral FTD, 9 semantic FTD, 5 Progressive Non-Fluent Aphasia), 11 with corticobasal syndrome, and 3 with progressive supranuclear palsy. Addenbrook’s Cognitive Examination—Revised (ACE-R) mean(±SD) was 55.6(±22.8). For anosognosia measurement, the Anosognosia Questionnaire—Dementia was used. Total anosognosia score mean(±SD) was 22.1(±17.9), cognitive anosognosia score mean(±SD) was 18.1(±15.1) and behavioral–mood anosognosia score mean(±SD) was 3.3(±4.7). (3) Results: Higher anosognosia total score was associated with hypoperfusion in the inferior temporal, anterior cingulate, and inferior frontal cortices of the right hemisphere (BAs 20R, 24R, 32R, 45R). Higher anosognosia cognitive score was correlated with hypoperfusion in the left middle and anterior temporal cortices, and right dorsal anterior cingulate cortex (BAs 21L, 22L, 32R). No association was found with behavioral–mood anosognosia. (4) Conclusions: Automated analysis of brain perfusion Single Photon Emission Computed Tomography could be useful for the investigation of anosognosia neural correlates in dementia.
Collapse
Affiliation(s)
- Varvara Valotassiou
- Nuclear Medicine Department, University Hospital of Larissa, 41110 Larissa, Greece; (C.T.); (G.A.); (D.P.); (E.T.); (P.G.)
- Nuclear Medicine Department, Faculty of Medicine, University of Thessaly, Viopolis, 41500 Larissa, Greece
- Correspondence: or ; Tel.: +30-2413502916; Fax: +302413501851
| | - Nikolaos Sifakis
- Nuclear Medicine Department, “Alexandra” General Hospital, 11528 Athens, Greece;
| | - Chara Tzavara
- Nuclear Medicine Department, University Hospital of Larissa, 41110 Larissa, Greece; (C.T.); (G.A.); (D.P.); (E.T.); (P.G.)
| | - Evi Lykou
- 3rd Age Day Care Center, IASIS, 16562 Athens, Greece; (E.L.); (V.K.); (J.P.)
| | - Niki Tsinia
- 1st University Psychiatric Department, Aeginition Hospital, 11528 Athens, Greece;
| | - Vasiliki Kamtsadeli
- 3rd Age Day Care Center, IASIS, 16562 Athens, Greece; (E.L.); (V.K.); (J.P.)
| | - Dimitra Sali
- Neurology Department, Evrokliniki, 11521 Athens, Greece;
| | - George Angelidis
- Nuclear Medicine Department, University Hospital of Larissa, 41110 Larissa, Greece; (C.T.); (G.A.); (D.P.); (E.T.); (P.G.)
| | - Dimitrios Psimadas
- Nuclear Medicine Department, University Hospital of Larissa, 41110 Larissa, Greece; (C.T.); (G.A.); (D.P.); (E.T.); (P.G.)
| | - Eudoxia Theodorou
- Nuclear Medicine Department, University Hospital of Larissa, 41110 Larissa, Greece; (C.T.); (G.A.); (D.P.); (E.T.); (P.G.)
| | - Ioannis Tsougos
- Medical Physics Department, Faculty of Medicine, University of Thessaly, Viopolis, 41500 Larissa, Greece;
| | | | - Panagiotis Georgoulias
- Nuclear Medicine Department, University Hospital of Larissa, 41110 Larissa, Greece; (C.T.); (G.A.); (D.P.); (E.T.); (P.G.)
- Nuclear Medicine Department, Faculty of Medicine, University of Thessaly, Viopolis, 41500 Larissa, Greece
| | - John Papatriantafyllou
- 3rd Age Day Care Center, IASIS, 16562 Athens, Greece; (E.L.); (V.K.); (J.P.)
- Memory Disorders Clinic, Medical Center, 15125 Athens, Greece
| |
Collapse
|
7
|
Lee S, Jia Y, Snitz BE, Chang CCH, Ganguli M. Assessing Social Cognition in Older Adults: A Population-Based Study. Alzheimer Dis Assoc Disord 2022; 36:103-110. [PMID: 35288520 PMCID: PMC9149050 DOI: 10.1097/wad.0000000000000497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 01/03/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES In a population-based study of mild cognitive impairment (MCI), to validate the assessment of social cognition in older adults. METHODS Cross-sectional study of 902 adults aged 65+ with mean age 76.6 years (SD 8.06). We created a social cognition composite comprising standardized z scores on the Social Norms Questionnaire and the 10-item Reading the Mind in the Eyes Test. We identified associated factors and compared sensitivity, specificity, and the area under the curve of social cognition, for MCI defined as Clinical Dementia Rating (CDR)=0.5, to those of other cognitive domains. We calculated the impact of including social cognition on the proportion neuropsychologically classified as MCI. RESULTS Better social cognition was associated with younger age, female sex, higher education, better general cognition (mini-mental state examination), fewer depressive symptoms, and lower CDR. Adjusting for demographics, associations with mini-mental state examination, depressive symptoms, anxiety symptoms, and subjective cognitive complaints remained significant. The sensitivity and specificity of social cognition for CDR=0.5 were comparable to those of the traditional 5 cognitive domains. Including social cognition as a sixth domain of cognition resulted in a 5% increase in the proportion classified as MCI. CONCLUSIONS Brief objective assessment of social cognition may enhance cognitive assessment of older adults.
Collapse
Affiliation(s)
- Soyoung Lee
- Department of Psychiatry, School of Medicine, University of Maryland
| | - Yichen Jia
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh
| | - Beth E. Snitz
- Department of Neurology, School of Medicine, University of Pittsburgh
| | - Chung-Chou H. Chang
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh
- Department of Medicine, School of Medicine, University of Pittsburgh
| | - Mary Ganguli
- Department of Neurology, School of Medicine, University of Pittsburgh
- Department of Psychiatry, School of Medicine, University of Pittsburgh
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh
| |
Collapse
|
8
|
Isaacs D, Gibson JS, Stovall J, Claassen DO. The Impact of Anosognosia on Clinical and Patient-Reported Assessments of Psychiatric Symptoms in Huntington's Disease. J Huntingtons Dis 2021; 9:291-302. [PMID: 32925080 DOI: 10.3233/jhd-200410] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Psychiatric symptoms are widely prevalent in Huntington's disease (HD) and exert greater impact on quality of life than motor manifestations. Despite this, psychiatric symptoms are frequently underrecognized and undertreated. Lack of awareness, or anosognosia, has been observed at all stages of HD and may contribute to diminished patient self-reporting of psychiatric symptoms. OBJECTIVE We sought to evaluate the impact of anosognosia on performance of commonly used clinical rating scales for psychiatric manifestations of HD. METHODS We recruited 50 HD patients to undergo a formal psychiatrist evaluation, the Problem Behavior Assessment-Short Form (PBA-s), and validated self-report rating scales for depression, anxiety, and anger. Motor impairment, cognitive function, and total functional capacity were assessed as part of clinical exam. Patient awareness of motor, cognitive, emotional, and functional capacities was quantified using the Anosognosia Rating Scale. Convergent validity, discriminant validity, classification accuracy, and anosognosia effect was determined for each psychiatric symptom rating scale. RESULTS Anosognosia was identified in one-third of patients, and these patients underrated the severity of depression and anxiety when completing self-report instruments. Anosognosia did not clearly influence self-reported anger, but this result may have been confounded by the sub-optimal discriminant validity of anger rating scales. CONCLUSION Anosognosia undermines reliability of self-reported depression and anxiety in HD. Self-report rating scales for depression and anxiety may have a role in screening, but results must be corroborated by provider and caregiver input when anosognosia is present. HD clinical trials utilizing patient-reported outcomes as study endpoints should routinely evaluate participants for anosognosia.
Collapse
Affiliation(s)
- David Isaacs
- Neurology Department, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jessie S Gibson
- Neurology Department, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jeffrey Stovall
- Psychiatry Department, Vanderbilt Psychiatric Hospital, Nashville, TN, USA
| | - Daniel O Claassen
- Neurology Department, Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
9
|
Tanigaki WK, Rossetti MA, Rocha NP, Stimming EF. Sleep Dysfunction in Huntington’s Disease: Perspectives from Patients. J Huntingtons Dis 2020; 9:345-352. [DOI: 10.3233/jhd-200434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Despite the abundance of clinical tools, sleep disorders are still not routinely evaluated in patients with Huntington’s disease (HD). Sleep disturbances can exacerbate cognitive impairment and mood disorders and seriously affect the life of the patients and their families. Objective: The current study was designed to investigate sleep quality and its association with clinical symptoms in HD. As an exploratory aim, we also evaluated sleep quality in caregivers of patients with HD. Methods: Twenty-nine patients with HD and 22 caregivers completed a series of self-reported questionnaires about sleep quality and pattern, cognitive function, and depression and anxiety symptoms. Spearman correlation analyses were performed to ascertain the association between sleep quality and severity of self-perceived clinical symptoms. Results: The primary sleep complaints reported by the patients were related to waking up in the middle of the night or early in the morning; and increased sleep latency. Seventeen of 29 HD patients (59%) and 12 of 22 caregivers (55%) were classified as “poor” sleepers. Worse sleep quality among HD patients was associated with greater severity of anxiety and depression symptoms. Importantly, a decline in sleep quality was associated with decreased self-perceived cognitive function for both HD patients and caregivers. Conclusion: Increasing awareness and improving our understanding of sleep dysfunction in HD is imperative for individuals with HD and indirectly, their caregivers. Regularly incorporating sleep assessments when evaluating HD patients should be considered to address this troublesome nonmotor symptom.
Collapse
Affiliation(s)
- Will K. Tanigaki
- McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Maria A. Rossetti
- Neurocognitive Disorders Center, Department of Neurology, McGovern Medical School, UTHealth, Houston, TX, USA
| | - Natalia P. Rocha
- The Mitchell Center for Alzheimer’s Disease and Related Brain Disorders, Department of Neurology, McGovern Medical School, UTHealth, Houston, TX, USA
| | - Erin Furr Stimming
- Huntington’s Disease Society of America (HDSA) Center of Excellence at UTHealth & Department of Neurology, McGovern Medical School, UTHealth, Houston, TX, USA
| |
Collapse
|
10
|
Hergert DC, Haaland KY, Cimino CR. Evaluation of a performance-rating method to assess awareness of cognitive functioning in Huntington's disease. Clin Neuropsychol 2019; 34:477-497. [PMID: 31322031 DOI: 10.1080/13854046.2019.1640286] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective: Anosognosia, or lack of awareness of symptoms, is commonly observed in Huntington's disease (HD) using patient/informant-report discrepancy methods. The purpose of this study was to examine the utility of a performance-rating method for assessing awareness of cognitive performance in HD.Method: Persons with manifest HD (n = 54) rated their performance on the daily living tests from the Neuropsychological Assessment Battery (NAB) using a bell curve. We also examined patient/informant-report discrepancies of executive functioning (FrSBe) in a subset (n = 47) of patients and their informants.Results: Patients were able to reliably use our method of categorizing their performance as evidenced by significant correlations between verbal descriptions of their performance and the percentile ratings they indicated on the bell curve. Patients across the range of observed Unified HD Rating Scale motor scale scores rated their performance on the NAB tasks significantly higher than actual performance for both pretest prediction and posttest evaluation ratings. Only patients with more severe motor impairment underestimated their problems relative to informant report on the FrSBe.Conclusions: This is the first study to use a performance-rating method for examining awareness in HD. Patients could reliably use this performance-based bell curve method to provide accurate estimations of their performance and as a group they tended to overestimate performance as has been demonstrated in previous studies. Unlike previous studies using self-report methodology, we also demonstrated decreased awareness in the persons with HD with less severe motor impairment using the performance-rating method, suggesting the two methods may measure different constructs of awareness.
Collapse
Affiliation(s)
| | - Kathleen Y Haaland
- Department of Psychiatry & Behavioral Sciences, University of New Mexico, Albuquerque, NM, USA
| | - Cynthia R Cimino
- Department of Psychology, University of South Florida, Tampa, FL, USA
| |
Collapse
|
11
|
Snowden JS. The Neuropsychology of Huntington's Disease. Arch Clin Neuropsychol 2018; 32:876-887. [PMID: 28961886 DOI: 10.1093/arclin/acx086] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 09/04/2017] [Indexed: 01/24/2023] Open
Abstract
Huntington's disease is an inherited, degenerative brain disease, characterized by involuntary movements, cognitive disorder and neuropsychiatric change. Men and women are affected equally. Symptoms emerge at around 40 years, although there is wide variation. A rare juvenile form has onset in childhood or adolescence. The evolution of disease is insidious and structural and functional brain changes may be present more than a decade before symptoms and signs become manifest. The earliest site of pathology is the striatum and neuroimaging measures of striatal change correlate with neurological and cognitive markers of disease. Chorea and other aspects of the movement disorder are the most visible aspect of the disease. However, non-motor features have greatest affect on functional independence and quality of life, so require recognition and management. The evidence-base for non-pharmacological treatments in Huntington's disease is currently limited, but recent intervention studies are encouraging.
Collapse
Affiliation(s)
- Julie S Snowden
- Greater Manchester Neuroscience Centre, Salford Royal NHS Trust, Salford, UK.,Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| |
Collapse
|
12
|
|
13
|
Sheppard DP, Pirogovsky-Turk E, Woods SP, Holden HM, Nicoll DR, Filoteo JV, Corey-Bloom J, Gilbert PE. Everyday Functioning in Huntington’s Disease: A Laboratory-Based Study of Financial Management Capacity. APPLIED NEUROPSYCHOLOGY-ADULT 2016; 24:176-182. [DOI: 10.1080/23279095.2015.1125904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- David P. Sheppard
- Department of Psychology, University of Houston, Houston, Texas, USA
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Eva Pirogovsky-Turk
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Steven Paul Woods
- Department of Psychology, University of Houston, Houston, Texas, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
- San Diego State University - University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Heather M. Holden
- San Diego State University - University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Diane R. Nicoll
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - J. Vincent Filoteo
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
- Veterans Affairs, San Diego Health Care System, San Diego, California, USA
| | - Jody Corey-Bloom
- Department of Neurosciences, University of California San Diego, La Jolla, California, USA
| | - Paul E. Gilbert
- Department of Psychology, San Diego State University, San Diego, California, USA
- San Diego State University - University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| |
Collapse
|
14
|
McCusker E, Loy CT. The many facets of unawareness in huntington disease. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2014; 4:257. [PMID: 25411649 PMCID: PMC4231168 DOI: 10.7916/d8fj2fd3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 10/14/2014] [Indexed: 12/01/2022]
Abstract
Background Unawareness or diminished awareness is present when a patient's perception of obvious disease manifestations and impact differ from that of observers such as clinicians or family members. Methods We examined studies that specifically investigate unawareness in Huntington disease (HD). Results Unawareness of motor, cognitive, behavioral, and functional aspects of HD has been documented throughout the disease course. This can occur at motor and cognitive onset but is more pronounced as the disease progresses. Discussion We discuss the implications for diagnosis, symptom report at presentation, timing of diagnosis, acceptance of symptomatic care strategies, and reporting in clinical trials. Assessments of work place competency, discrimination, driving, and the particular challenges of isolated patients without caregivers are described. Engaging with a person who is unaware of their disease or its impact presents a number of conflicts, including maintaining the right to autonomy, privacy, confidentiality, and independence while recognizing concerns for the wellbeing of the vulnerable person with HD and their caregiver when the unaware person refuses assistance. Unawareness is seen increasingly as neurologically based due to the impairment of functional networks, predominantly in nondominant frontostriatal pathways.
Collapse
Affiliation(s)
- Elizabeth McCusker
- Huntington Disease Service, Westmead Hospital, Westmead, Australia ; The University of Sydney, Sydney, Australia
| | - Clement T Loy
- Huntington Disease Service, Westmead Hospital, Westmead, Australia ; The University of Sydney, Sydney, Australia
| |
Collapse
|
15
|
Zukiewicz-Sobczak W, Król R, Wróblewska P, Piątek J, Gibas-Dorna M. Huntington Disease - principles and practice of nutritional management. Neurol Neurochir Pol 2014; 48:442-8. [PMID: 25482256 DOI: 10.1016/j.pjnns.2014.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 10/23/2014] [Accepted: 10/27/2014] [Indexed: 10/24/2022]
Abstract
Huntington disease (HD) is a degenerative brain disease clinically manifested by the characteristic triad: physical symptoms including involuntary movements and poor coordination, cognitive changes with less ability to organize routine tasks, and some emotional and behavioral disturbances. For patients with HD, feeding is one of the problems they have to face. People with HD often have lower than average body weight and struggle with malnutrition. As a part of therapy, good nutrition is an intervention maintaining health and functional ability for maximally prolonged time. In the early stages of HD, small amounts of blenderized foods given orally are recommended. In more advanced stages, enteral nutrition is essential using gastric, or jejunal tubes for short term. Most severe cases require gastrostomy or gastrojejunostomy. Although enteral feeding is well tolerated by most of the patients, a number of complications may occur, including damage to the nose, pharynx, or esophagus, aspiration pneumonia, sinusitis, metabolic imbalances due to improper nutrient and fluid supply, adverse effects affecting gastrointestinal system, and refeeding syndrome.
Collapse
Affiliation(s)
| | - Renata Król
- Higher School of Social Sciences in Lublin, Lublin, Poland
| | | | - Jacek Piątek
- Department of Physiology, Poznan University of Medical Sciences, Poznań, Poland
| | | |
Collapse
|
16
|
Abstract
Although Alzheimer's disease (AD) is a common cause of memory impairment and dementia in the elderly disturbed memory function is a widespread subjective and/or objective symptom in a variety of medical conditions. The early detection and correct distinction of AD from non-AD memory impairment is critically important to detect possibly treatable and reversible underlying causes. In the context of clinical research, it is crucial to correctly distinguish between AD or non-AD memory impairment in order to build homogenous study populations for the assessment of new therapeutic possibilities. The distinction of AD from non-AD memory impairment may be difficult, especially in mildly affected patients, due to an overlap of clinical symptoms and biomarker alterations between AD and certain non-AD conditions. This review aims to describe recent aspects of the differential diagnosis of AD and non-AD related memory impairment and how these may be considered in the presence of memory deficits.
Collapse
Affiliation(s)
- Sönke Arlt
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
17
|
Victorson D, Carlozzi NE, Frank S, Beaumont JL, Cheng W, Gorin B, Duh MS, Samuelson D, Tulsky D, Gutierrez S, Nowinski CJ, Mueller A, Shen V, Sung V. Identifying Motor, Emotional-Behavioral, and Cognitive Deficits that Comprise the Triad of HD Symptoms from Patient, Caregiver, and Provider Perspectives. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2014; 4:224. [PMID: 24757585 PMCID: PMC3986490 DOI: 10.7916/d8jw8bws] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 02/26/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND The objective of this study was to identify important attributes associated with the triad of symptoms (cognition, emotional-behavioral, and motor) of Huntington's disease (HD) from patient, caregiver, and medical provider perspectives to facilitate development of a new disease-specific, health-related quality of life (HRQOL) instrument. METHODS We conducted a targeted literature review of HD and HRQOL instruments, expert surveys, and patient and caregiver phone-based interviews to extract information on the symptoms and issues most relevant to the HD symptom triad (HD triad). The data collected from these sources were used to generate themes and subdomains and to develop an integrated schema that highlights the key dimensions of the triad. RESULTS THE SEARCH IDENTIFIED THE FOLLOWING AREAS: emotional functioning/behavioral changes (e.g., positive emotions, sadness/depression); cognitive functioning (e.g., memory/learning, attention/comprehension); physical functioning (e.g., motor functioning, medication); social functioning (e.g., leisure, interpersonal relationships); end-of-life concerns/planning; and gene testing. Fifteen individuals diagnosed with HD and 16 HD caregivers, recruited from several Huntington's Disease Society of America support group networks, completed phone interviews. Nineteen US medical providers who specialize in HD completed the online survey. Twenty-six subdomains of the HD symptom triad (seven cognition, 12 emotional-behavioral, and seven motor) emerged relatively consistently across patient, caregiver, and provider samples. These included movements/chorea, memory impairment, depression, and anxiety. DISCUSSION Based on an integrated, mixed-methods approach, important HD triad symptom were identified and organized into a guiding schema. These patient-, caregiver-, and provider-triangulated data served as the basis for development of a HD-specific HRQOL instrument, the HD-PRO-TRIAD™.
Collapse
Affiliation(s)
- David Victorson
- Northwestern University, Evanston, Illinois, United States of America
| | - Noelle E Carlozzi
- University of Michigan, Ann Arbor, Michigan, United States of America
| | - Samuel Frank
- Boston University School of Medicine, Boston, Massachusetts, United States of America
| | | | - Wendy Cheng
- Analysis Group, Inc., Boston, Massachusetts, United States of America
| | - Brian Gorin
- Analysis Group, Inc., Boston, Massachusetts, United States of America
| | - Mei Sheng Duh
- Analysis Group, Inc., Boston, Massachusetts, United States of America
| | - David Samuelson
- Analysis Group, Inc., Boston, Massachusetts, United States of America
| | - David Tulsky
- New York University Langone Medical Center, New York, New York, United States of America ; Kessler Foundation, West Orange, New Jersey, United States of America
| | - Sandra Gutierrez
- Northwestern University, Evanston, Illinois, United States of America
| | - Cindy J Nowinski
- Northwestern University, Evanston, Illinois, United States of America
| | - Allison Mueller
- Northwestern University, Evanston, Illinois, United States of America
| | - Vivienne Shen
- Lundbeck LLC, Deerfield, Illinois, United States of America
| | - Victor Sung
- University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| |
Collapse
|
18
|
"Forgetting to remember" in Huntington's disease: a study of laboratory, semi-naturalistic, and self-perceptions of prospective memory. J Int Neuropsychol Soc 2014; 20:192-9. [PMID: 24351166 DOI: 10.1017/s1355617713001355] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Prospective memory (PM) is dependent on executive processes known to be impaired in Huntington's disease (HD); however, no study to the authors' knowledge has investigated PM in this group. We examined performance-based, semi-naturalistic, and self-reported PM in 20 individuals diagnosed with mild-moderate HD and 20 demographically similar controls. Relative to controls, HD participants demonstrated significantly lower scores in time-based PM, event-based PM (at a trend level), and the semi-naturalistic PM trial, all of which were marked by omission errors. HD participants demonstrated comparable recognition memory for the PM intentions relative to controls. HD and control participants also showed comparable scores in self-reported PM complaints. The results suggest that HD is associated with deficits in the strategic aspects of PM. HD-associated PM deficits also are evident in real-world situations, which may relate to an apparent meta-memory deficit for PM functioning as indicated by HD participants' overestimation of their PM performance on self-report.
Collapse
|