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van Lonkhuizen PJC, Frank W, Heemskerk AW, van Duijn E, de Bot ST, Mühlbäck A, Landwehrmeyer GB, Chavannes NH, Meijer E. Quality of life, health-related quality of life, and associated factors in Huntington's disease: a systematic review. J Neurol 2023; 270:2416-2437. [PMID: 36715747 PMCID: PMC10129943 DOI: 10.1007/s00415-022-11551-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/23/2022] [Accepted: 12/24/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Huntington's disease (HD) is a genetic, neurodegenerative disease. Due to the progressive nature of HD and the absence of a cure, (health-related) quality of life ((HR)QoL) is an important topic. Several studies have investigated (HR)QoL in HD, yet a clear synthesis of the existing literature is lacking to date. We performed a systematic review on self-reported (HR)QoL, and factors and intervention effects associated with (HR)QoL in premanifest and manifest HD gene expansion carriers (pHDGECs and mHDGECs, respectively). METHODS PubMed, EMBASE, Web of Science, and PsycINFO were searched systematically from September 17th, 2021, up to August 11th, 2022. Methodological and conceptual quality of the included studies was assessed with two appraisal tools. RESULTS 30 out of 70 eligible articles were included. mHDGECs experienced lower (HR)QoL compared to pHDGECs and controls, whereas mixed findings were reported when compared to other neurological diseases. Several factors were associated with (HR)QoL that might contribute to lower (HR)QoL in mHDGECs, including depressive symptoms, physical and psychological symptoms, lower functional capacity, lower support, and unmet needs. Multidisciplinary rehabilitation programs and a respiratory muscle training were beneficial for (HR)QoL in mHDGECs. DISCUSSION (HR)QoL is experienced differently across the course of the disease. Although (HR)QoL is key for understanding the impact of HD and the effect of symptomatic treatment, there is a need to improve the methodological and conceptual shortcomings that were found in most studies, especially regarding the conceptual clarity when reporting on QoL and HRQoL. Suggestions for strengthening these shortcomings are provided in this review.
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Affiliation(s)
- Pearl J C van Lonkhuizen
- Department of Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands. .,National eHealth Living Lab, Leiden University Medical Center, Leiden, The Netherlands. .,Huntington Center Topaz Overduin, 2225 SX, Katwijk aan Zee, The Netherlands.
| | - Wiebke Frank
- Department of Neurology, University Hospital Ulm, 89081, Ulm, Germany
| | - Anne-Wil Heemskerk
- Department of Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.,Huntington Center Topaz Overduin, 2225 SX, Katwijk aan Zee, The Netherlands
| | - Erik van Duijn
- Huntington Center Topaz Overduin, 2225 SX, Katwijk aan Zee, The Netherlands.,Department of Psychiatry, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands
| | - Susanne T de Bot
- Department of Neurology, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands
| | - Alzbeta Mühlbäck
- Department of Neurology, University Hospital Ulm, 89081, Ulm, Germany.,Department of Neuropsychiatry, kbo-Isar-Amper-Klinikum, 84416, Taufkirchen (Vils), Germany.,Department of Neurology and Center of Clinical Neuroscience, 1st Faculty of Medicine, Charles University and General University Hospital in Prague, 12821, Prague, Czech Republic
| | | | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.,National eHealth Living Lab, Leiden University Medical Center, Leiden, The Netherlands
| | - Eline Meijer
- Department of Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.,National eHealth Living Lab, Leiden University Medical Center, Leiden, The Netherlands
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Grimstvedt TN, Miller JU, van Walsem MR, Feragen KJB. Speech and language difficulties in Huntington's disease: A qualitative study of patients' and professional caregivers' experiences. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2021; 56:330-345. [PMID: 33577706 DOI: 10.1111/1460-6984.12604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/05/2021] [Accepted: 01/11/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Huntington's disease (HD) is a neurodegenerative disease characterized by a triad of motor, cognitive and psychological symptoms, leading to a gradual breakdown of communication skills. Few studies have investigated how people affected by HD and their professional caregivers, for example, medical doctors, physiotherapists and nurses, experience the patients' gradual loss of speech and language. AIMS To examine communication-related experiences of patients and professional caregivers. Experiences with speech therapy and the use of augmentative and alternative communication aids (AAC) were also investigated. METHODS & PROCEDURES Seven individuals with HD and seven professional caregivers were interviewed individually, using a semi-structured interview guide. Transcripts were analysed using a conventional content analysis, and the results presented in three main categories. OUTCOMES & RESULTS Most individuals with HD were aware of having communication difficulties, struggling with understanding others as well as being understood. This was confirmed by professional caregivers, who also raised ethical issues encountered when patients struggled with communication. Both groups talked about external factors (such as noise or crowded social settings) as disrupting communication, and shared recommendations on how people in general, and speech and language therapists (SLTs) in particular, could optimize communication. Very few patients had received information about communication aids, and none was using AACs. Professional caregivers underlined the importance of interdisciplinary collaborations, including SLTs, in order to optimize care. CONCLUSIONS & IMPLICATIONS Findings shed a light on everyday communication challenges faced by people with HD and their professional caregivers, and the lack of implementation of communication aids in this group. The dramatic impact of HD on patients' communication skills underscores the need to include SLTs in the follow-up of this patient group, ideally from the early stages of the disease, while the patient is still capable of voicing his/her own wishes and thoughts. Future research that explores how to optimize communication and implement the use of AACs for individuals with HD is needed. What this paper adds What is already known on this subject Although the ability to communicate gradually deteriorates in individuals affected by Huntington's disease (HD), there is little knowledge about how affected individuals experience the loss of speech and language skills. Interdisciplinary care is recognised as essential for this patient group. However, professional caregivers' thoughts and experiences of communicating with their patients have not been fully explored. Recent years have seen a rapid growth of available communication supporting technologies that could potentially be helpful for individuals with HD, but limited attention has been given to this subject. What this paper adds to existing knowledge What do we now know as a result of this study that we did not know before the results highlight that patients are aware of problems with speech and language even in early phases of the disease, and include patients' personal outlook on problems with communication. Professional caregivers raised ethical issues encountered when patients struggled with communication. Both groups described specific strategies that could facilitate communication. There was a significant lack of experience and knowledge about augmentative and alternative communication aids (AACs). What are the potential or actual clinical implications of this work? Clinical implications of this study. The introduction of communication aids in the follow-up of patients with HD needs to be discussed with the patients in the early phases of the disease, and implemented while the individual still has the capacity to learn and take advantage of alternative communication support. Results underline the importance of including speech and language therapists (SLTs) into multidisciplinary care of patients with HD. SLTs should be available also for professional caregivers who need advice on how to facilitate conversations and social interactions, in order to optimise care of patients with HD.
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Affiliation(s)
- Thea Nygaard Grimstvedt
- Department of Special Needs Education, Faculty of Educational Sciences, University of Oslo, Oslo, Norway
| | | | - Marleen Regina van Walsem
- Department of Neurohabilitation, Oslo University Hospital, Oslo, Norway
- Department of Neurology, Oslo University Hospital, Oslo, Norway
- Centre for Habilitation and Rehabilitation Models and Services, Institute for Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Jamwal R, Jarman HK, Roseingrave E, Douglas J, Winkler D. Smart home and communication technology for people with disability: a scoping review. Disabil Rehabil Assist Technol 2020; 17:624-644. [PMID: 32924660 DOI: 10.1080/17483107.2020.1818138] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE The links between disability, activity limitation and participation restriction are well established. Recent and continued advancement of technology, particularly smart home and communication technologies, presents new ways in which some of the limitations and restrictions experienced by people with disabilities can be overcome. The aim of this scoping review was to explore the impact of smart home and communication technology on the outcomes of people with disabilities and complex needs. METHOD This review involved systematic searching of four databases, hand searches and data extraction. Eligibility criteria included [1] participant outcomes of [2] technology used within the home [3] among adults with a disability and complex needs. RESULTS Of the 2400 studies identified, 21 met our inclusion criteria. Studies were characterized by significant diversity in relation to disability and type of technology. Overall, technology appeared to improve independence, participation and quality of life among people with a disability and complex needs. Despite this, ethical considerations were raised given the vulnerability of this population, including potential risks through social participation and privacy concerns of using monitoring technology. CONCLUSIONS Smart home and communication technology can improve outcomes for people living with disabilities and complex needs. However, a number of factors impact the successful implementation of technology, including personalization, flexibility and ongoing support to the person with a disability and their close others. Future research should utilize high-quality study designs and established measures of important outcomes for this group.IMPLICATIONS FOR REHABILITATIONThere is a broad range of smart home and communication technology devices and systems available that may support the independence and participation of people with disabilities and complex needs; however, high-quality evidence documenting the impact of technology is lacking.Soft-technology supports, including assessment, training and evaluation of technology implementation, may play just as important a role in shaping outcomes as the technology itself.Systematic research is required to ensure there is quality evidence to inform investment in both technologies, and the soft-technology supports that promote its successful use.
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Affiliation(s)
- Rebecca Jamwal
- Summer Foundation, Melbourne, Australia.,Living with Disability Research Centre, La Trobe University, Melbourne, Australia.,Occupational Therapy Department, Austin Health, Melbourne, Australia
| | | | | | - Jacinta Douglas
- Summer Foundation, Melbourne, Australia.,Living with Disability Research Centre, La Trobe University, Melbourne, Australia
| | - Dianne Winkler
- Summer Foundation, Melbourne, Australia.,Living with Disability Research Centre, La Trobe University, Melbourne, Australia
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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: 74] [Impact Index Per Article: 12.3] [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.
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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
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