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Mehanna R, Jankovic J. Systemic Symptoms in Huntington's Disease: A Comprehensive Review. Mov Disord Clin Pract 2024; 11:453-464. [PMID: 38529740 PMCID: PMC11078495 DOI: 10.1002/mdc3.14029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 02/26/2024] [Accepted: 03/12/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Although Huntington's disease (HD) is usually thought of as a triad of motor, cognitive, and psychiatric symptoms, there is growing appreciation of HD as a systemic illness affecting the entire body. OBJECTIVES This review aims to draw attention to these systemic non-motor symptoms in HD. METHODS We identified relevant studies published in English by searching MEDLINE (from 1966 to September 2023), using the following subject headings: Huntington disease, autonomic, systemic, cardiovascular, respiratory, gastrointestinal, urinary, sexual and cutaneous, and additional specific symptoms. RESULTS Data from 123 articles were critically reviewed with focus on systemic features associated with HD, such as cardiovascular, respiratory, gastrointestinal, urinary, sexual and sweating. CONCLUSION This systematic review draws attention to a variety of systemic and autonomic co-morbidities in patients with HD. Not all of them correlate with the severity of the primary HD symptoms or CAG repeats. More research is needed to better understand the pathophysiology and treatment of systemic and autonomic dysfunction in HD.
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Affiliation(s)
- Raja Mehanna
- Department of Neurology, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
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High Frequency of Concomitant Bladder, Bowel, and Sexual Symptoms in Huntington's Disease: A Self-Reported Questionnaire Study. J Pers Med 2021; 11:jpm11080714. [PMID: 34442358 PMCID: PMC8401810 DOI: 10.3390/jpm11080714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/20/2021] [Accepted: 07/23/2021] [Indexed: 11/17/2022] Open
Abstract
Huntington's disease (HD) can be associated with pathologic involvement beyond the striatum including the autonomic nervous system. Bladder, bowel, and sexual dysfunction have been reported independently in HD, but little is known about their concomitant occurrence. To document this concomitant phenomena, forty-eight subjects (54% male, ages 28-74 years, CAG repeat 38-61) with manifest/symptomatic HD completed detailed questionnaires regarding bladder, bowel, and sexual function. In total, 45 subjects (93.8%) reported symptoms in at least one organ system (bladder, bowel, or sexual), 13 (27.1%) reported symptoms in two systems, and 19 (39.6%) reported concomitant symptoms in all three systems. Urinary problems were most frequent in 42 subjects (87.5%) followed by lower bowel (60.4%) and sexual dysfunction (56.2%). Participants reporting concomitant symptoms were more likely to have longer duration of disease and lower Total Functional Capacity (TFC) scores. This study documents the high frequency of bladder, bowel, and sexual dysfunction in HD and the common occurrence of concomitance of these pelvic organ problems.
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Steventon JJ, Rosser AE, Hart E, Murphy K. Hypertension, Antihypertensive Use and the Delayed-Onset of Huntington's Disease. Mov Disord 2020; 35:937-946. [PMID: 32017180 PMCID: PMC7317197 DOI: 10.1002/mds.27976] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/15/2019] [Accepted: 11/26/2019] [Indexed: 12/21/2022] Open
Abstract
Background Hypertension is a modifiable cardiovascular risk factor implicated in neurodegeneration and dementia risk. In Huntington's disease, a monogenic neurodegenerative disease, autonomic and vascular abnormalities have been reported. This study's objective was to examine the relationship between hypertension and disease severity and progression in Huntington's disease. Methods Using longitudinal data from the largest worldwide observational study of Huntington's disease (n = 14,534), we assessed the relationship between hypertension, disease severity, and rate of clinical progression in Huntington's disease mutation carriers. Propensity score matching was used to statistically match normotensive and hypertensive participants for age, sex, body mass index, ethnicity, and CAG length. Results Huntington's disease patients had a lower prevalence of hypertension compared with age‐matched gene‐negative controls. Huntington's disease patients with hypertension had worse cognitive function, a higher depression score, and more marked motor progression over time compared with Huntington's disease patients without hypertension. However, hypertensive patients taking antihypertensive medication had less motor, cognitive, and functional impairment than Huntington's disease patients with untreated hypertension and a later age of clinical onset compared with untreated hypertensive patients and normotensive individuals with Huntington's disease. Conclusions We report the novel finding that hypertension and antihypertensive medication use are associated with altered disease severity, progression, and clinical onset in patients with Huntington's disease. These findings have implications for the management of hypertension in Huntington's disease and suggest that prospective studies of the symptomatic or disease‐modifying potential of antihypertensives in neurodegenerative diseases are warranted. © 2020 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Jessica J Steventon
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Physics and Astronomy, Maindy Road, Cardiff University, Cardiff, Wales, UK
| | - Anne E Rosser
- Neuroscience and Mental Health Research Institute and Brain Research and Intracerebral Neurotherapeutic (BRAIN) unit, School of Medicine, Cardiff University, Cardiff, Wales, UK.,Brain Repair Group, School of Biosciences, Cardiff University, Cardiff, Wales, UK
| | - Emma Hart
- Bristol Heart Institute (BHI), Clinical Research and Imaging Centre, School of Physiology, Pharmacology and Neuroscience, Bristol University, Bristol, UK
| | - Kevin Murphy
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Physics and Astronomy, Maindy Road, Cardiff University, Cardiff, Wales, UK
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Aldaz T, Nigro P, Sánchez-Gómez A, Painous C, Planellas L, Santacruz P, Cámara A, Compta Y, Valldeoriola F, Martí MJ, Muñoz E. Non-motor symptoms in Huntington's disease: a comparative study with Parkinson's disease. J Neurol 2019; 266:1340-1350. [PMID: 30834978 DOI: 10.1007/s00415-019-09263-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/26/2019] [Accepted: 02/26/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND/AIMS The presence of non-motor symptoms in Huntington's disease (HD) has not been systematically assessed so far. Our objective was to know their prevalence and to compare it with a cohort of patients with Parkinson's disease (PD). MATERIALS AND METHODS Participants were consecutively recruited from our outpatient clinic. They were assessed through the motor part of the Unified Huntington's Disease Rating Scale, the motor part of the Unified Parkinson's Disease Rating Scale, the total functional capacity scale and the PD non-motor symptoms questionnaire. RESULTS We enrolled 123 participants: 53 HD, 45 PD and 25 healthy controls (HC). Non-motor symptoms were significantly more prevalent in HD patients than in HC. The most frequent non-motor symptoms in HD, involving more than 50% of patients, were attentional deficits, apathy, dysphagia, memory complaints, depression falls, insomnia and urinary urgency. The total score of non-motor symptoms correlated with disease duration, total functional capacity and disease stage. HD scored significantly higher than PD in 11 items (dysphagia, constipation, bowel incontinence, faecal tenesmus, weight loss, memory, apathy, attention, falls, nightmares, delusions) and in four domains (cognitive, hallucinations and delusions, digestive and cardiovascular). PD did not score significantly higher than HD in any domain. CONCLUSIONS HD patients have a high prevalence of non-motor symptoms, which is even higher than in PD, and correlates with disease progression.
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Affiliation(s)
- Tatiana Aldaz
- Parkinson's Disease and Movement Disorders Unit, Department of Neurology, Hospital Clinic of Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain
| | - Pasquale Nigro
- Parkinson's Disease and Movement Disorders Unit, Department of Neurology, Hospital Clinic of Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain
| | - Almudena Sánchez-Gómez
- Parkinson's Disease and Movement Disorders Unit, Department of Neurology, Hospital Clinic of Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain
| | - Celia Painous
- Parkinson's Disease and Movement Disorders Unit, Department of Neurology, Hospital Clinic of Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain
| | - Lluís Planellas
- Parkinson's Disease and Movement Disorders Unit, Department of Neurology, Hospital Clinic of Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain
| | - Pilar Santacruz
- Parkinson's Disease and Movement Disorders Unit, Department of Neurology, Hospital Clinic of Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain.,European Huntington's Disease Network (EHDN), Barcelona, Spain
| | - Ana Cámara
- Parkinson's Disease and Movement Disorders Unit, Department of Neurology, Hospital Clinic of Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain
| | - Yaroslau Compta
- Parkinson's Disease and Movement Disorders Unit, Department of Neurology, Hospital Clinic of Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain.,Institut de Neurociències, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Francesc Valldeoriola
- Parkinson's Disease and Movement Disorders Unit, Department of Neurology, Hospital Clinic of Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain.,Institut de Neurociències, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Maria J Martí
- Parkinson's Disease and Movement Disorders Unit, Department of Neurology, Hospital Clinic of Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain.,Institut de Neurociències, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Esteban Muñoz
- Parkinson's Disease and Movement Disorders Unit, Department of Neurology, Hospital Clinic of Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain. .,Institut de Neurociències, University of Barcelona, Barcelona, Spain. .,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. .,European Huntington's Disease Network (EHDN), Barcelona, Spain.
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