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Langbehn DR, Sathe SS, Loy C, Sampaio C, Mccusker EA. A Phenotypic Atlas for Huntington Disease Based on Data From the Enroll-HD Cohort Study. Neurol Genet 2023; 9:e200111. [PMID: 38035176 PMCID: PMC10684052 DOI: 10.1212/nxg.0000000000200111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/04/2023] [Indexed: 12/02/2023]
Abstract
Background and Objectives The variable CAG repeat expansion in the huntingtin gene and its inverse relationship to motor dysfunction onset are fundamental features of Huntington disease (HD). However, the wider phenotype (including non-motor features) at particular CAG lengths, ages, and functional levels is less well-characterized. The large number of participants in the Enroll-HD observational study enables the development of a phenotype atlas that summarizes the range and distribution of HD phenotypes, including outliers and possible clusters, with respect to various CAG repeat lengths, age ranges, and declining functional levels. Methods Enroll-HD is an ongoing prospective longitudinal observational study that collects natural history data, releasing periodic data sets, in people with HD (PwHD) and controls. Core assessments at annual visits focus on behavioral, cognitive, motor, and functional status. Periodic data set 5, used for the development of the first iteration of the Enroll-HD Phenotype Atlas (EHDPA), included all eligible data collected through October 31, 2020. The atlas is based on subsets (cells) of descriptive data for all motor, cognitive, psychiatric, and functional measures that are routinely collected at most Enroll-HD sites, analyzed by single CAG lengths and 5-year age blocks. Results Data from 42,840 visits from 15,982 unique PwHD were available for analysis. At baseline, participants had a mean ± SD age of 48.9 ± 13.9 years and CAG repeat length of 43.4 ± 3.6 and 54.1% were female. The EHDPA includes 223 age-by-CAG subsets for CAG repeats between 36 and 69 with five-year age brackets starting from 20-24 years up to 85-89 years. The atlas can be browsed at enroll-hd.org/for-researchers/atlas-of-hd-phenotype/. Discussion The EHDPA summarizes the spectrum and distribution of HD phenotypes, including outliers and possible clusters, in all domains of disease involvement for the range of CAG repeat lengths, ages, and functional levels. Its availability in an easy-to-use online format will assist clinicians in tracking disease progression in PwHD by identifying phenotypic features most associated with loss of function and enabling conversations related to prognosis. The observable patterns in the EHDPA should also catalyze more formal multidomain characterization of motor, cognitive, and psychiatric progression and their relationships to functional decline and disease modifiers. Trial Registration Information Enroll-HD is registered with clinicaltrials.gov: NCT01574053.
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Affiliation(s)
- Douglas R Langbehn
- From the Departments of Psychiatry (D.R.L.), Biostatistics, University of Iowa, Iowa City; CHDI Management/CHDI Foundation (S.S.S., C.S.), Princeton, NJ; Macquarie Medical School (C.L.), Macquarie University; and Department of Neurology (Huntington disease Service) (E.A.M.), Westmead Hospital, University of Sydney, Australia
| | - Swati S Sathe
- From the Departments of Psychiatry (D.R.L.), Biostatistics, University of Iowa, Iowa City; CHDI Management/CHDI Foundation (S.S.S., C.S.), Princeton, NJ; Macquarie Medical School (C.L.), Macquarie University; and Department of Neurology (Huntington disease Service) (E.A.M.), Westmead Hospital, University of Sydney, Australia
| | - Clement Loy
- From the Departments of Psychiatry (D.R.L.), Biostatistics, University of Iowa, Iowa City; CHDI Management/CHDI Foundation (S.S.S., C.S.), Princeton, NJ; Macquarie Medical School (C.L.), Macquarie University; and Department of Neurology (Huntington disease Service) (E.A.M.), Westmead Hospital, University of Sydney, Australia
| | - Cristina Sampaio
- From the Departments of Psychiatry (D.R.L.), Biostatistics, University of Iowa, Iowa City; CHDI Management/CHDI Foundation (S.S.S., C.S.), Princeton, NJ; Macquarie Medical School (C.L.), Macquarie University; and Department of Neurology (Huntington disease Service) (E.A.M.), Westmead Hospital, University of Sydney, Australia
| | - Elizabeth A Mccusker
- From the Departments of Psychiatry (D.R.L.), Biostatistics, University of Iowa, Iowa City; CHDI Management/CHDI Foundation (S.S.S., C.S.), Princeton, NJ; Macquarie Medical School (C.L.), Macquarie University; and Department of Neurology (Huntington disease Service) (E.A.M.), Westmead Hospital, University of Sydney, Australia
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Garcia-Moreno H, Langbehn DR, Abiona A, Garrood I, Fleszar Z, Manes MA, Morley AMS, Craythorne E, Mohammed S, Henshaw T, Turner S, Naik H, Bodi I, Sarkany RPE, Fassihi H, Lehmann AR, Giunti P. Neurological disease in xeroderma pigmentosum: prospective cohort study of its features and progression. Brain 2023; 146:5044-5059. [PMID: 38040034 PMCID: PMC10690019 DOI: 10.1093/brain/awad266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/22/2023] [Accepted: 07/16/2023] [Indexed: 12/03/2023] Open
Abstract
Xeroderma pigmentosum (XP) results from biallelic mutations in any of eight genes involved in DNA repair systems, thus defining eight different genotypes (XPA, XPB, XPC, XPD, XPE, XPF, XPG and XP variant or XPV). In addition to cutaneous and ophthalmological features, some patients present with XP neurological disease. It is unknown whether the different neurological signs and their progression differ among groups. Therefore, we aim to characterize the XP neurological disease and its evolution in the heterogeneous UK XP cohort. Patients with XP were followed in the UK National XP Service, from 2009 to 2021. Age of onset for different events was recorded. Cerebellar ataxia and additional neurological signs and symptoms were rated with the Scale for the Assessment and Rating of Ataxia (SARA), the Inventory of Non-Ataxia Signs (INAS) and the Activities of Daily Living questionnaire (ADL). Patients' mutations received scores based on their predicted effects. Data from available ancillary tests were collected. Ninety-three XP patients were recruited. Thirty-six (38.7%) reported neurological symptoms, especially in the XPA, XPD and XPG groups, with early-onset and late-onset forms, and typically appearing after cutaneous and ophthalmological symptoms. XPA, XPD and XPG patients showed higher SARA scores compared to XPC, XPE and XPV. SARA total scores significantly increased over time in XPD (0.91 points/year, 95% confidence interval: 0.61, 1.21) and XPA (0.63 points/year, 95% confidence interval: 0.38, 0.89). Hyporeflexia, hypopallesthaesia, upper motor neuron signs, chorea, dystonia, oculomotor signs and cognitive impairment were frequent findings in XPA, XPD and XPG. Cerebellar and global brain atrophy, axonal sensory and sensorimotor neuropathies, and sensorineural hearing loss were common findings in patients. Some XPC, XPE and XPV cases presented with abnormalities on examination and/or ancillary tests, suggesting underlying neurological involvement. More severe mutations were associated with a faster progression in SARA total score in XPA (0.40 points/year per 1-unit increase in severity score) and XPD (0.60 points/year per 1-unit increase), and in ADL total score in XPA (0.35 points/year per 1-unit increase). Symptomatic and asymptomatic forms of neurological disease are frequent in XP patients, and neurological symptoms can be an important cause of disability. Typically, the neurological disease will be preceded by cutaneous and ophthalmological features, and these should be actively searched in patients with idiopathic late-onset neurological syndromes. Scales assessing cerebellar function, especially walking and speech, and disability can show progression in some of the groups. Mutation severity can be used as a prognostic biomarker for stratification purposes in clinical trials.
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Affiliation(s)
- Hector Garcia-Moreno
- Ataxia Centre, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Douglas R Langbehn
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
| | - Adesoji Abiona
- UK National Xeroderma Pigmentosum Service, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
| | - Isabel Garrood
- UK National Xeroderma Pigmentosum Service, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
| | - Zofia Fleszar
- Ataxia Centre, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Marta Antonia Manes
- Ataxia Centre, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Ana M Susana Morley
- UK National Xeroderma Pigmentosum Service, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
- Department of Ophthalmology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
| | - Emma Craythorne
- UK National Xeroderma Pigmentosum Service, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
| | - Shehla Mohammed
- UK National Xeroderma Pigmentosum Service, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
| | - Tanya Henshaw
- UK National Xeroderma Pigmentosum Service, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
| | - Sally Turner
- UK National Xeroderma Pigmentosum Service, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
| | - Harsha Naik
- UK National Xeroderma Pigmentosum Service, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
| | - Istvan Bodi
- Clinical Neuropathology, Academic Neuroscience Building, King’s College Hospital, London SE5 9RS, UK
| | - Robert P E Sarkany
- UK National Xeroderma Pigmentosum Service, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
| | - Hiva Fassihi
- UK National Xeroderma Pigmentosum Service, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
| | - Alan R Lehmann
- UK National Xeroderma Pigmentosum Service, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
- Genome Damage and Stability Centre, School of Life Sciences, University of Sussex, Falmer, Brighton BN1 9RQ, UK
| | - Paola Giunti
- Ataxia Centre, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
- UK National Xeroderma Pigmentosum Service, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
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Estevez-Fraga C, Elmalem MS, Papoutsi M, Durr A, Rees EM, Hobbs NZ, Roos RAC, Landwehrmeyer B, Leavitt BR, Langbehn DR, Scahill RI, Rees G, Tabrizi SJ, Gregory S. Progressive alterations in white matter microstructure across the timecourse of Huntington's disease. Brain Behav 2023; 13:e2940. [PMID: 36917716 PMCID: PMC10097137 DOI: 10.1002/brb3.2940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 02/01/2023] [Accepted: 02/14/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Whole-brain longitudinal diffusion studies are crucial to examine changes in structural connectivity in neurodegeneration. Here, we investigated the longitudinal alterations in white matter (WM) microstructure across the timecourse of Huntington's disease (HD). METHODS We examined changes in WM microstructure from premanifest to early manifest disease, using data from two cohorts with different disease burden. The TrackOn-HD study included 67 controls, 67 premanifest, and 10 early manifest HD (baseline and 24-month data); the PADDINGTON study included 33 controls and 49 early manifest HD (baseline and 15-month data). Longitudinal changes in fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity, and radial diffusivity from baseline to last study visit were investigated for each cohort using tract-based spatial statistics. An optimized pipeline was employed to generate participant-specific templates to which diffusion tensor imaging maps were registered and change maps were calculated. We examined longitudinal differences between HD expansion-carriers and controls, and correlations with clinical scores, including the composite UHDRS (cUHDRS). RESULTS HD expansion-carriers from TrackOn-HD, with lower disease burden, showed a significant longitudinal decline in FA in the left superior longitudinal fasciculus and an increase in MD across subcortical WM tracts compared to controls, while in manifest HD participants from PADDINGTON, there were significant widespread longitudinal increases in diffusivity compared to controls. Baseline scores in clinical scales including the cUHDRS predicted WM microstructural change in HD expansion-carriers. CONCLUSION The present study showed significant longitudinal changes in WM microstructure across the HD timecourse. Changes were evident in larger WM areas and across more metrics as the disease advanced, suggesting a progressive alteration of WM microstructure with disease evolution.
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Affiliation(s)
- Carlos Estevez-Fraga
- Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Michael S Elmalem
- Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Marina Papoutsi
- Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Alexandra Durr
- Sorbonne Université, Paris Brain Institute (ICM), AP-HP, Inserm, CNRS, Pitié-Salpêtrière University Hospital, Paris, France
| | | | - Nicola Z Hobbs
- Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Raymund A C Roos
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Blair R Leavitt
- Centre for Huntington's Disease at UBC Hospital, Department of Medical Genetics and Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Rachael I Scahill
- Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Geraint Rees
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Sarah J Tabrizi
- Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Sarah Gregory
- Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
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Schultz JL, Langbehn DR, Al-Kaylani HM, van der Plas E, Koscik TR, Epping EA, Espe-Pfeifer PB, Martin EP, Moser DJ, Magnotta VA, Nopoulos PC. Longitudinal Clinical and Biological Characteristics in Juvenile-Onset Huntington's Disease. Mov Disord 2023; 38:113-122. [PMID: 36318082 PMCID: PMC9851979 DOI: 10.1002/mds.29251] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/26/2022] [Accepted: 09/29/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Juvenile-onset Huntington's disease (JOHD) is a rare form of Huntington's disease (HD) characterized by symptom onset before the age of 21 years. Observational data in this cohort is lacking. OBJECTIVES Quantify measures of disease progression for use in clinical trials of patients with JOHD. METHODS Participants who received a motor diagnosis of HD before the age of 21 were included in the Kids-JOHD study. The comparator group consisted of children and young adults who were at-risk for inheriting the genetic mutation that causes HD, but who were found to have a CAG repeat in the non-expanded range (gene non-expanded [GNE]). RESULTS Data were obtained between March 17, 2006, and February 13, 2020. There were 26 JOHD participants and 78 GNE participants who were comparable on age (16.03 vs. 14.43, respectively) and sex (53.8% female vs. 57.7% female, respectively). The mean annualized decrease in striatal volume in the JOHD group was -3.99% compared to -0.06% in the GNE (mean difference [MD], -3.93%; 95% confidence intervals [CI], [-4.98 to -2.80], FDR < 0.0001). The mean increase in the Unified Huntington's Disease Rating Scale Total Motor Score per year in the JOHD group was 7.29 points compared to a mean decrease of -0.21 point in the GNE (MD, 7.5; 95% CI, [5.71-9.28], FDR < 0·0001). CONCLUSIONS These findings demonstrate that structural brain imaging and clinical measures in JOHD may be potential biomarkers of disease progression for use in clinical trials. Collaborative efforts are required to validate these results in a larger cohort of patients with JOHD. © 2022 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Jordan L. Schultz
- Carver College of Medicine at the University of Iowa, Department of Psychiatry, 200 Hawkins Drive, Iowa City, IA
- Carver College of Medicine at the University of Iowa, Department of Neurology, 200 Hawkins Drive, Iowa City, IA
- University of Iowa College of Pharmacy, Division of Pharmacy Practice and Sciences, 200 Hawkins Drive, Iowa City, IA
| | - Douglas R. Langbehn
- Carver College of Medicine at the University of Iowa, Department of Psychiatry, 200 Hawkins Drive, Iowa City, IA
| | - Hend M. Al-Kaylani
- Carver College of Medicine at the University of Iowa, Department of Psychiatry, 200 Hawkins Drive, Iowa City, IA
| | - Ellen van der Plas
- Carver College of Medicine at the University of Iowa, Department of Psychiatry, 200 Hawkins Drive, Iowa City, IA
| | - Timothy R. Koscik
- Carver College of Medicine at the University of Iowa, Department of Psychiatry, 200 Hawkins Drive, Iowa City, IA
| | - Eric A. Epping
- Carver College of Medicine at the University of Iowa, Department of Psychiatry, 200 Hawkins Drive, Iowa City, IA
| | - Patricia B. Espe-Pfeifer
- Carver College of Medicine at the University of Iowa, Department of Psychiatry, 200 Hawkins Drive, Iowa City, IA
| | - Erin P. Martin
- Carver College of Medicine at the University of Iowa, Department of Psychiatry, 200 Hawkins Drive, Iowa City, IA
| | - David J. Moser
- Carver College of Medicine at the University of Iowa, Department of Psychiatry, 200 Hawkins Drive, Iowa City, IA
| | - Vincent A. Magnotta
- Carver College of Medicine at the University of Iowa, Department of Psychiatry, 200 Hawkins Drive, Iowa City, IA
- Carver College of Medicine at the University of Iowa, Department of Radiology, 200 Hawkins Drive, Iowa City, IA
| | - Peggy C. Nopoulos
- Carver College of Medicine at the University of Iowa, Department of Psychiatry, 200 Hawkins Drive, Iowa City, IA
- Carver College of Medicine at the University of Iowa, Department of Neurology, 200 Hawkins Drive, Iowa City, IA
- Stead Family Children’s Hospital at the University of Iowa, 200 Hawkins Drive, Iowa City, IA
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Langbehn DR. Response to Lee et al. Am J Hum Genet 2022; 109:1341-1342. [PMID: 35803235 PMCID: PMC9300877 DOI: 10.1016/j.ajhg.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Douglas R. Langbehn
- Departments of Psychiatry and Biostatistics, The University of Iowa, Iowa City, IA 52242, USA,Corresponding author
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Reasoner EE, van der Plas E, Al-Kaylani HM, Langbehn DR, Conrad AL, Schultz JL, Epping EA, Magnotta VA, Nopoulos PC. Behavioral features in child and adolescent huntingtin gene-mutation carriers. Brain Behav 2022; 12:e2630. [PMID: 35604958 PMCID: PMC9304841 DOI: 10.1002/brb3.2630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/11/2022] [Accepted: 05/03/2022] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION We compared neuropsychiatric symptoms between child and adolescent huntingtin gene-mutation carriers and noncarriers. Given previous evidence of atypical striatal development in carriers, we also assessed the relationship between neuropsychiatric traits and striatal development. METHODS Participants between 6 and 18 years old were recruited from families affected by Huntington's disease and tested for the huntingtin gene expansion. Neuropsychiatric traits were assessed using the Pediatric Behavior Scale and the Behavior Rating Inventory of Executive Function. Striatal volumes were extracted from 3T neuro-anatomical images. Multivariable linear regression models were conducted to evaluate the impact of group (i.e., gene nonexpanded [GNE] or gene expanded [GE]), age, and trajectory of striatal growth on neuropsychiatric symptoms. RESULTS There were no group differences in any behavioral measure with the exception of depression/anxiety score, which was higher in the GNE group compared to the GE group (estimate = 4.58, t(129) = 2.52, FDR = 0.051). The growth trajectory of striatal volume predicted depression scores (estimate = 0.429, 95% CI 0.15:0.71, p = .0029), where a negative slope of striatal volume over time was associated with lower depression/anxiety. CONCLUSIONS The current findings show that GE children may have lower depression/anxiety compared to their peers. Previously, we observed a unique pattern of early striatal hypertrophy and continued decrement in volume over time among GE children and adolescents. In contrast, GNE individuals largely show striatal volume growth. These findings suggest that the lower scores of depression and anxiety seen in GE children and adolescents may be associated with differential growth of the striatum.
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Affiliation(s)
- Erin E Reasoner
- Department of Psychiatry, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Ellen van der Plas
- Department of Psychiatry, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Hend M Al-Kaylani
- Department of Psychiatry, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Douglas R Langbehn
- Department of Psychiatry, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Amy L Conrad
- Stead Family Children's Hospital at the University of Iowa, Iowa City, Iowa, USA
| | - Jordan L Schultz
- Department of Psychiatry, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Eric A Epping
- Department of Psychiatry, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Vincent A Magnotta
- Department of Radiology, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Peggy C Nopoulos
- Department of Psychiatry, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA.,Stead Family Children's Hospital at the University of Iowa, Iowa City, Iowa, USA.,Department of Neurology, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
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Warner JH, Long JD, Mills JA, Langbehn DR, Ware J, Mohan A, Sampaio C. Standardizing the CAP Score in Huntington's Disease by Predicting Age-at-Onset. J Huntingtons Dis 2022; 11:153-171. [PMID: 35466943 DOI: 10.3233/jhd-210475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Huntington's disease (HD) is an autosomal dominant, neurological disease caused by an expanded CAG repeat near the N-terminus of the huntingtin (HTT) gene. A leading theory concerning the etiology of HD is that both onset and progression are driven by cumulative exposure to the effects of mutant (or CAG expanded) huntingtin (mHTT). The CAG-Age-Product (CAP) score (i.e., the product of excess CAG length and age) is a commonly used measure of this cumulative exposure. CAP score has been widely used as a predictor of a variety of disease state variables in HD. The utility of the CAP score has been somewhat diminished, however, by a lack of agreement on its precise definition. The most commonly used forms of the CAP score are highly correlated so that, for purposes of prediction, it makes little difference which is used. However, reported values of CAP scores, based on commonly used definitions, differ substantially in magnitude when applied to the same data. This complicates the process of inter-study comparison. OBJECTIVE In this paper, we propose a standardized definition for the CAP score which will resolve this difficulty. Our standardization is chosen so that CAP = 100 at the expected age of diagnosis. METHODS Statistical methods include novel survival analysis methodology applied to the 13 disease landmarks taken from the Enroll-HD database (PDS 5) and comparisons with the existing, gold standard, onset model. RESULTS Useful by-products of our work include up-to-date, age-at-onset (AO) results and a refined AO model suitable for use in other contexts, a discussion of several useful properties of the CAP score that have not previously been noted in the literature and the introduction of the concept of a toxicity onset model. CONCLUSION We suggest that taking L = 30 and K = 6.49 provides a useful standardization of the CAP score, suitable for use in the routine modeling of clinical data in HD.
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Affiliation(s)
| | - Jeffrey D Long
- Departments of Psychiatry, Biostatistics, University of Iowa, Iowa City, IA, USA
| | - James A Mills
- Departments of Psychiatry, Biostatistics, University of Iowa, Iowa City, IA, USA
| | - Douglas R Langbehn
- Departments of Psychiatry, Biostatistics, University of Iowa, Iowa City, IA, USA
| | | | - Amrita Mohan
- CHDI Management/CHDI Foundation, Princeton, NJ, USA
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Langbehn DR, Fine EM, Meier A, Hersch S. Utility of the Huntington's Disease Prognostic Index Score for a Perimanifest Clinical Trial. Mov Disord 2022; 37:1040-1046. [PMID: 35170086 PMCID: PMC9306552 DOI: 10.1002/mds.28944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/03/2022] [Indexed: 11/15/2022] Open
Abstract
Background Subtle neurodegenerative motor and cognitive impairments accumulate over a prodromal period several years before clinical diagnosis of Huntington's disease (HD). The inclusion of prodromal individuals in therapeutic trials would facilitate testing of therapies early in the disease course and the development of treatments intended to prevent or delay disability. Objectives We evaluate the normalized prognostic index (PIN) score as a tool to select participants for a perimanifest trial. We explore anticipated PIN‐based inclusion rates from the preHD screening population and estimate sample‐size requirements based on PIN threshold, trial duration, and outcome measure. Methods Individual participant data from ENROLL‐HD were used to fit mixed effect linear models to assess longitudinal changes in clinical metrics for participants with early‐manifest HD and PIN‐stratified preHD subcohorts. Results A PIN threshold of 0.0 was met by 40% of the preHD participants in ENROLL‐HD; 39.4% and 55.2% progressed to new diagnoses of early‐manifest HD within 2 and 3 years, respectively. Various PIN thresholds also enabled the selection of specified ratios of prodromal preHD to early manifest HD participants for a perimanifest trial. Estimated sample sizes for a trial enrolling prodromal preHD (PIN > 0.0) and stage 1 and 2 motor‐diagnosed participants varied depending on the composition of the screening pool, the length of follow‐up (1, 2, or 3 years), and outcome measure. Conclusions The composition of a perimanifest clinical trial population can be defined using preselected PIN thresholds, facilitating the assessment of potential disease‐modifying therapies in HD. © 2022 Voyager Therapeutics, Inc. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson Movement Disorder Society.
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Affiliation(s)
- Douglas R Langbehn
- Department of Psychiatry, University of Iowa Carver College of Medicine, Psychiatry Research, Iowa City, Iowa, USA
| | | | - Andreas Meier
- Voyager Therapeutics, Inc., Cambridge, Massachusetts, USA
| | - Steven Hersch
- Voyager Therapeutics, Inc., Cambridge, Massachusetts, USA.,Eisai Inc., Woodcliff Lake, New Jersey, USA.,Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Langbehn DR. Longer CAG repeat length is associated with shorter survival after disease onset in Huntington disease. Am J Hum Genet 2022; 109:172-179. [PMID: 34942093 DOI: 10.1016/j.ajhg.2021.12.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/03/2021] [Indexed: 01/10/2023] Open
Abstract
It is well known that the length of the CAG trinucleotide expansion of the huntingtin gene is associated with many aspects of Huntington disease progression. These include age of clinical onset and rate of initial progression of disease severity. The relationship between CAG length and survival in Huntington disease is less studied. To address this, we obtained the complete Registry HD database from the European Huntington Disease Network and reanalyzed the time from reported age of disease onset until death. We conducted semiparametric proportional hazards modeling of 8,422 participants who had experienced onset of clinical Huntington disease, either retrospectively or prospectively. Of these, 826 had a recorded age of death. To avoid biased model estimates, retrospective onset ages were represented by left truncation at study entry. After controlling for onset age, which tends to be younger in those with longer CAG repeat lengths, we found that CAG length had a substantial and highly significant influence upon survival time after disease onset. For a fixed age of onset, longer CAG expansions were predictive of shorter survival. This is consistent with other known relationships between CAG length and disease severity. We also show that older onset age predicts shorter lifespan after controlling for CAG length and that the influence of CAG on survival length is substantially greater in women. We demonstrate that apparent contradictions between these and previous analyses of the same data are primarily due to the question of whether to control for clinical onset age in the analysis of time until death.
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Affiliation(s)
- Douglas R Langbehn
- Departments of Psychiatry and Biostatistics, The University of Iowa, Iowa City, IA 52242, USA.
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10
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Reasoner EE, van der Plas E, Langbehn DR, Conrad AL, Koscik TR, Epping EA, Magnotta VA, Nopoulos PC. Cortical Features in Child and Adolescent Carriers of Mutant Huntingtin (mHTT). J Huntingtons Dis 2022; 11:173-178. [PMID: 35275555 PMCID: PMC9177765 DOI: 10.3233/jhd-210512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Molecular studies provide evidence that mutant huntingtin (mHTT) affects early cortical development; however, cortical development has not been evaluated in child and adolescent carriers of mHTT. OBJECTIVE To evaluate the impact of mHTT on the developmental trajectories of cortical thickness and surface area. METHODS Children and adolescents (6-18 years) participated in the KidsHD study. mHTT carrier status was determined for research purposes only to classify participants as gene expanded (GE) and gene non-expanded (GNE). Cortical features were extracted from 3T neuroimaging using FreeSurfer. Nonlinear mixed effects models were conducted to determine if age, group, and CAG repeat were associated with cortical morphometry. RESULTS Age-related changes in cortical morphometry were similar across groups. Expanded CAG repeat was not significantly associated with cortical features. CONCLUSION While striatal development is markedly different in GE and GNE, developmental change of the cortex appears grossly normal among child and adolescent carrier of mHTT.
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Affiliation(s)
- Erin E. Reasoner
- Department of Psychiatry, University of Iowa Hospital and Clinics, Iowa City, IA 52242
| | - Ellen van der Plas
- Department of Psychiatry, University of Iowa Hospital and Clinics, Iowa City, IA 52242
| | - Douglas R. Langbehn
- Department of Psychiatry, University of Iowa Hospital and Clinics, Iowa City, IA 52242
| | - Amy L. Conrad
- Stead Family Department of Pediatrics, University of Iowa Hospital and Clinics, Iowa City, IA 52242
| | - Timothy R. Koscik
- Department of Psychiatry, University of Iowa Hospital and Clinics, Iowa City, IA 52242
| | - Eric A. Epping
- Department of Psychiatry, University of Iowa Hospital and Clinics, Iowa City, IA 52242
| | - Vincent A. Magnotta
- Department of Psychiatry, University of Iowa Hospital and Clinics, Iowa City, IA 52242,Department of Radiology, University of Iowa Hospital and Clinics, Iowa City, IA 52242
| | - Peggy C. Nopoulos
- Department of Psychiatry, University of Iowa Hospital and Clinics, Iowa City, IA 52242,Stead Family Department of Pediatrics, University of Iowa Hospital and Clinics, Iowa City, IA 52242,Department of Neurology, University of Iowa Hospital and Clinics, Iowa City, IA 52242
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11
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Tong TT, Vaidya JG, Kramer JR, Kuperman S, Langbehn DR, O’Leary DS. Impact of binge drinking during college on resting state functional connectivity. Drug Alcohol Depend 2021; 227:108935. [PMID: 34388578 PMCID: PMC8464531 DOI: 10.1016/j.drugalcdep.2021.108935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 06/05/2021] [Accepted: 06/21/2021] [Indexed: 10/20/2022]
Abstract
AIM The current study examined the longitudinal effects of standard binge drinking (4+/5+ drinks for females/males in 2 hours) and extreme binge drinking (8+/10+ drinks for females/males in 2 hours) on resting-state functional connectivity. METHOD 119 college students (61 males) were recruited in groups of distinct bingeing patterns at baseline: non-bingeing controls, standard and extreme bingers. Resting-state scans were first obtained when participants were freshmen/sophomores and again approximately two years later. Associations between longitudinal bingeing (reported during this two-year gap) and network connectivity were examined. Network connectivity was calculated by aggregating all edges affiliated with the same network (an edge is a functional connection between two brain regions). The relationship between longitudinal bingeing and connectivity edges was also studied using connectome-based predictive modeling (CPM). RESULTS Greater standard bingeing was negatively associated with change in connectivity between Default Mode Network and Ventral Attention Network (DMN-VAN; False Discovery Rate corrected), controlling for initial binge groups, longitudinal network changes, motions, scanner, SES, sex, and age. The correlations between change in DMN-VAN connectivity and change in cognitive performance (Stroop, Digit Span, Letter Fluency, and Trail Making) were also tested, but the results were not significant. Lastly, CPM failed to identify a generalizable predictive model of longitudinal bingeing from change in connectivity edges. CONCLUSIONS Binge drinking is associated with abnormality in networks implicated in attention and self-focused processes, which, in turn, have been implicated in rumination, craving, and relapse. More extensive alterations in functional connectivity might be observed with heavier or longer binge drinking pattern.
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Affiliation(s)
- Tien T. Tong
- Interdisciplinary Graduate Program in Neuroscience, The University of Iowa, 200 Hawkins Dr., Iowa City, IA 52242, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1399 Park Ave., New York, NY 10029, USA
| | - Jatin G. Vaidya
- Department of Psychiatry, Carver College of Medicine, The University of Iowa, 200 Hawkins Dr., Iowa City, IA 52242, USA
| | - John R. Kramer
- Department of Psychiatry, Carver College of Medicine, The University of Iowa, 200 Hawkins Dr., Iowa City, IA 52242, USA
| | - Samuel Kuperman
- Department of Psychiatry, Carver College of Medicine, The University of Iowa, 200 Hawkins Dr., Iowa City, IA, 52242, USA.
| | - Douglas R. Langbehn
- Department of Psychiatry, Carver College of Medicine, The University of Iowa, 200 Hawkins Dr., Iowa City, IA 52242, USA
| | - Daniel S. O’Leary
- Department of Psychiatry, Carver College of Medicine, The University of Iowa, 200 Hawkins Dr., Iowa City, IA 52242, USA
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12
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Andrews SC, Langbehn DR, Craufurd D, Durr A, Leavitt BR, Roos RA, Tabrizi SJ, Stout JC. Apathy predicts rate of cognitive decline over 24 months in premanifest Huntington's disease. Psychol Med 2021; 51:1338-1344. [PMID: 32063235 DOI: 10.1017/s0033291720000094] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Cognitive impairment is a core feature of Huntington's disease (HD), however, the onset and rate of cognitive decline is highly variable. Apathy is the most common neuropsychiatric symptom of HD, and is associated with cognitive impairment. The aim of this study was to investigate apathy as a predictor of subsequent cognitive decline over 2 years in premanifest and early HD, using a prospective, longitudinal design. METHODS A total of 118 premanifest HD gene carriers, 111 early HD and 118 healthy control participants from the multi-centre TRACK-HD study were included. Apathy symptoms were assessed at baseline using the apathy severity rating from the Short Problem Behaviours Assessment. A composite of 12 outcome measures from nine cognitive tasks was used to assess cognitive function at baseline and after 24 months. RESULTS In the premanifest group, after controlling for age, depression and motor signs, more apathy symptoms predicted faster cognitive decline over 2 years. In contrast, in the early HD group, more motor signs, but not apathy, predicted faster subsequent cognitive decline. In the control group, only older age predicted cognitive decline. CONCLUSIONS Our findings indicate that in premanifest HD, apathy is a harbinger for cognitive decline. In contrast, after motor onset, in early diagnosed HD, motor symptom severity more strongly predicts the rate of cognitive decline.
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Affiliation(s)
- S C Andrews
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
- Neuroscience Research Australia, Sydney, NSW, Australia
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - D R Langbehn
- Department of Psychiatry, University of Iowa, Iowa City, USA
| | - D Craufurd
- Manchester Centre for Genomic Medicine, Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - A Durr
- Sorbonne Université, Institut du Cerveau et de la Moelle épinière (ICM), University Hospital Pitié-Salpêtrière, AP-HP, Inserm U 1127, CNRS UMR 7225, Paris, France
| | - B R Leavitt
- Department of Medical Genetics, Centre for Molecular Medicine and Therapeutics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - R A Roos
- Department Neurology LUMC, Universiteit Leiden, Leiden, The Netherlands
| | - S J Tabrizi
- Department of Neurodegenerative Diseases, University College London, Queen Square Institute of Neurology, and National Hospital for Neurology and Neurosurgery, London, UK
| | - J C Stout
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
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13
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Schultz JL, van der Plas E, Langbehn DR, Conrad AL, Nopoulos PC. Age-Related Cognitive Changes as a Function of CAG Repeat in Child and Adolescent Carriers of Mutant Huntingtin. Ann Neurol 2021; 89:1036-1040. [PMID: 33521985 DOI: 10.1002/ana.26039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 01/29/2021] [Accepted: 01/29/2021] [Indexed: 11/08/2022]
Abstract
Limited data exists regarding the disease course of Huntington's Disease (HD) in children and young adults. Here, we evaluate the trajectory of various cognitive skill development as a function of cytosine-adenine-guanine (CAG) repeat length in children and adolescents that carry the mutation that causes HD. We discovered that the development of verbal skills seems to plateau earlier as CAG repeat length increases. These findings increase our understanding of the relationship between neurodegeneration and neurodevelopment and may have far-reaching implications for future gene-therapy treatment strategies. ANN NEUROL 2021;89:1036-1040.
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Affiliation(s)
- Jordan L Schultz
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA, USA.,Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, IA, USA.,Department of Pharmacy Practice and Sciences, University of Iowa College of Pharmacy, Iowa City, IA, USA
| | - Ellen van der Plas
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Douglas R Langbehn
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Amy L Conrad
- Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Peg C Nopoulos
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA, USA.,Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, IA, USA.,Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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14
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Estevez-Fraga C, Scahill RI, Durr A, Leavitt BR, Roos RAC, Langbehn DR, Rees G, Gregory S, Tabrizi SJ. Composite UHDRS Correlates With Progression of Imaging Biomarkers in Huntington's Disease. Mov Disord 2021; 36:1259-1264. [PMID: 33471951 DOI: 10.1002/mds.28489] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 11/10/2020] [Accepted: 12/07/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The composite Unified Huntington's Disease Rating Scale (cUHDRS) is a multidimensional measure of progression in Huntington's disease (HD) being used as a primary outcome in clinical trials investigating potentially disease-modifying huntingtin-lowering therapies. OBJECTIVE Evaluating volumetric and structural connectivity correlates of the cUHDRS. METHODS One hundred and nineteen premanifest and 119 early-HD participants were included. Gray and white matter (WM) volumes were correlated with cUHDRS cross-sectionally and longitudinally using voxel-based morphometry. Correlations between baseline fractional anisotropy (FA); mean, radial, and axial diffusivity; and baseline cUHDRS were examined using tract-based spatial statistics. RESULTS Worse performance in the cUHDRS over time correlated with longitudinal volume decreases in the occipito-parietal cortex and centrum semiovale, whereas lower baseline scores correlated with decreased volume in the basal ganglia and surrounding WM. Lower cUHDRS scores were also associated with reduced FA and increased diffusivity at baseline. CONCLUSION The cUHDRS correlates with imaging biomarkers and tracks atrophy progression in HD supporting its biological relevance. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Carlos Estevez-Fraga
- Huntington's Disease Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Rachael I Scahill
- Huntington's Disease Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Alexandra Durr
- Sorbonne Université, Paris Brain Institute (ICM), AP-HP, Inserm, CNRS, Pitié-Salpêtrière University Hospital, Paris, France
| | - Blair R Leavitt
- Centre for Molecular Medicine and Therapeutics, Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Raymund A C Roos
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Geraint Rees
- Wellcome Centre for Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Sarah Gregory
- Huntington's Disease Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Sarah J Tabrizi
- Huntington's Disease Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
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15
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Janouschek H, Langbehn DR, Nickl-Jockschat T, Grözinger M. The impact of seizure quality on ect treatment efficacy. Psychiatry Res 2020; 293:113466. [PMID: 33198041 DOI: 10.1016/j.psychres.2020.113466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 09/15/2020] [Indexed: 11/16/2022]
Affiliation(s)
- H Janouschek
- Department of Psychiatry and Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
| | - D R Langbehn
- Departments of Psychiatry and Biostatistics, Carver College of Medicine and Iowa College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - T Nickl-Jockschat
- Department of Psychiatry and Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA, USA; Department of Neuroscience and Pharmacology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - M Grözinger
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
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16
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Schultz JL, Harshman LA, Langbehn DR, Nopoulos PC. Hypertension Is Associated With an Earlier Age of Onset of Huntington's Disease. Mov Disord 2020; 35:1558-1564. [PMID: 32339315 PMCID: PMC9853516 DOI: 10.1002/mds.28062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/23/2020] [Accepted: 03/27/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Hypertension (HTN) is associated with worsening clinical outcomes in neurodegenerative diseases. The relationship between HTN and the age of diagnosis (ADx) of Huntington's disease (HD) is not clear, however. This study sought to determine if the presence of HTN in adult patients with premanifest HD was associated with an earlier ADx compared with normotensive patients with HD. METHODS Premanifest participants from Enroll-HD were included if they had a cytosine-adenine-guanine greater than or equal to 36, baseline diagnostic confidence level less than 4, baseline total functional capacity score greater than 11, and baseline motor score less than 21. There were 3020 premanifest participants with HD, and 293 reported a diagnosis of HTN. HTN was transformed into a time-dependent variable, and a Cox proportional hazard survival model determine if the presence of HTN affected the time to motor conversion. Baseline cytosine-adenine-guanine-age product score, cytosine-adenine-guanine repeat length, baseline age, sex, baseline body mass index, smoking history, and region were included as covariates. RESULTS Participants with HTN had an increased annualized hazard of motor conversion compared to normotensive participants with HD (hazard ratio, 1.29; 95% confidence interval, 1.02-1.64; P = 0.034). CONCLUSIONS A previous study reported a protective effect of HTN in HD, but did not account for the fact that the prevalence of HTN increases with age. By controlling for this confounder, we more accurately outline the association between the ADx of HD to demonstrate that a diagnosis of HTN may be associated with an earlier ADx of HD. These results represent an association, however, and further investigation is warranted. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Jordan L. Schultz
- Carver College of Medicine at the University of Iowa, Department of Psychiatry, 200 Hawkins Drive, Iowa City, IA 52242,Carver College of Medicine at the University of Iowa, Department of Neurology, 200 Hawkins Drive, Iowa City, IA 52242,University of Iowa College of Pharmacy, Division of Pharmacy Practice and Sciences, 100 Newton Road, Iowa City, IA 52242
| | - Lyndsay A. Harshman
- Stead Family Department of Pediatrics at the University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242
| | - Douglas R. Langbehn
- Carver College of Medicine at the University of Iowa, Department of Psychiatry, 200 Hawkins Drive, Iowa City, IA 52242
| | - Peg C. Nopoulos
- Carver College of Medicine at the University of Iowa, Department of Psychiatry, 200 Hawkins Drive, Iowa City, IA 52242,Carver College of Medicine at the University of Iowa, Department of Neurology, 200 Hawkins Drive, Iowa City, IA 52242,Stead Family Department of Pediatrics at the University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242
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17
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Langbehn DR, Hersch S. Clinical Outcomes and Selection Criteria for Prodromal Huntington's Disease Trials. Mov Disord 2020; 35:2193-2200. [PMID: 32686867 PMCID: PMC7818458 DOI: 10.1002/mds.28222] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/04/2020] [Accepted: 06/30/2020] [Indexed: 11/08/2022] Open
Abstract
Background Huntington's disease (HD) develops in individuals with extended cytosine‐adenine‐guanine (CAG) repeats within the huntingtin (HTT) gene, causing neurodegeneration and progressive motor and cognitive symptoms. The inclusion of mutant HTT carriers in whom overt symptoms are not yet fully manifest in therapeutic trials would enable the development of treatments that delay or halt the accumulation of significant disability. Objectives The present analyses assess whether screening prediagnosis (preHD) individuals based on a normalized prognostic index (PIN) score would enable the selection of prodromal preHD subjects in whom longitudinal changes in established outcome measures might provide robust signals. It also compares the relative statistical effect size of longitudinal change for these measures. Methods Individual participant data from 2 studies were used to develop mixed effect linear models to assess longitudinal changes in clinical metrics for participants with preHD and PIN‐stratified subcohorts. Relative effect sizes were calculated in 5 preHD studies and internally normalized to evaluate the strength and consistency of each metric across cohorts. Results Longitudinal modeling data demonstrate the amplification of effect sizes when preHD subcohorts were selected by PIN score thresholds of >0.0 and >0.4. These models and relative effect sizes across 5 studies consistently indicate that the Unified Huntington's Disease Rating Scale total motor score exhibits the greatest change in preHD. Conclusions These analyses suggest that the employment of PIN scores to homogenize and stratify preHD cohorts could improve the efficiency of current outcome measures, the most robust of which is the total motor score. © 2020 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
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Affiliation(s)
- Douglas R Langbehn
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Steven Hersch
- Voyager Therapeutics, Inc., Cambridge, Massachusetts, USA.,Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
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18
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Tong TT, Vaidya JG, Kramer JR, Kuperman S, Langbehn DR, O’Leary DS. Behavioral inhibition and reward processing in college binge drinkers with and without marijuana use. Drug Alcohol Depend 2020; 213:108119. [PMID: 32599494 PMCID: PMC7736054 DOI: 10.1016/j.drugalcdep.2020.108119] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 06/02/2020] [Accepted: 06/05/2020] [Indexed: 12/22/2022]
Abstract
AIM Binge drinking is common during college, and studies have shown that many college students drink in quantities that far exceed the standard binge drinking threshold. Previous research has noted personality differences in individuals who engage in binge drinking, but few studies have examined neurobiological differences in both standard bingers (4/5 drinks in two hours for females/males; sBinge) and extreme binge drinkers (8+/10+ drinks in two hours for females/males; eBinge). METHOD The current study of 221 college students used functional magnetic resonance imaging (fMRI) to study neural activation on a stop signal task (SST) to assess behavioral inhibition and a monetary incentive delay (MID) task to assess activation to rewards and losses. Non-bingeing controls, sBinge, and eBinge freshmen and sophomores were recruited. In addition, because binge/extreme binge drinking is often associated with marijuana (MJ) use, MJ + sBinge and MJ + eBinge groups were also included. RESULTS All five groups showed strong activation in expected key cortical and striatal regions on both the SST and the MID. However, there were no significant differences between groups either at the whole-brain level or in specific regions of interest. Behavioral performance on the fMRI tasks also did not differ between groups. CONCLUSIONS These results suggest that our sample of individuals who engage in binge or extreme binge drinking with or without MJ co-use do not differ in brain activity on reward and inhibitory tasks. Neural differences may be present on other cognitive tasks or may emerge later after more sustained use of alcohol, MJ, and other drugs.
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Affiliation(s)
- Tien T. Tong
- Interdisciplinary Graduate Program in Neuroscience, The University of Iowa, 200 Hawkins Dr., Iowa City, IA 52242, USA
| | - Jatin G. Vaidya
- Department of Psychiatry, Carver College of Medicine, The University of Iowa, 200 Hawkins Dr., Iowa City, IA 52242, USA
| | - John R. Kramer
- Department of Psychiatry, Carver College of Medicine, The University of Iowa, 200 Hawkins Dr., Iowa City, IA 52242, USA
| | - Samuel Kuperman
- Department of Psychiatry, Carver College of Medicine, The University of Iowa, 200 Hawkins Dr., Iowa City, IA 52242, USA.
| | - Douglas R. Langbehn
- Department of Psychiatry, Carver College of Medicine, The University of Iowa, 200 Hawkins Dr., Iowa City, IA 52242, USA
| | - Daniel S. O’Leary
- Department of Psychiatry, Carver College of Medicine, The University of Iowa, 200 Hawkins Dr., Iowa City, IA 52242, USA
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19
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Sun W, Zhou D, Warner JH, Langbehn DR, Hochhaus G, Wang Y. Huntington's Disease Progression: A Population Modeling Approach to Characterization Using Clinical Rating Scales. J Clin Pharmacol 2020; 60:1051-1060. [DOI: 10.1002/jcph.1598] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/03/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Wan Sun
- Quantitative Clinical PharmacologyTakeda Pharmaceuticals Cambridge Massachusetts USA
- Division of PharmacometricsFood and Drug Administration Silver Spring Maryland USA
| | - Di Zhou
- Division of PharmacometricsFood and Drug Administration Silver Spring Maryland USA
| | - John H. Warner
- CHDI Management/CHDI Foundation Princeton New Jersey USA
| | | | | | - Yaning Wang
- Division of PharmacometricsFood and Drug Administration Silver Spring Maryland USA
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20
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Tereshchenko A, van der Plas E, Mathews KD, Epping E, Conrad AL, Langbehn DR, Nopoulos P. Developmental Trajectory of Height, Weight, and BMI in Children and Adolescents at Risk for Huntington's Disease: Effect of mHTT on Growth. J Huntingtons Dis 2020; 9:245-251. [PMID: 32894247 PMCID: PMC7683066 DOI: 10.3233/jhd-200407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The gene (Huntingtin or HTT) causing Huntington's disease (HD) is vital for development and is expressed throughout the brain and body lifelong. The mutant form (mHTT) may influence growth and development. OBJECTIVE To determine the impact of mHTT on human measures of growth, including height, weight, and body mass index (BMI), between child and adolescent carriers of mHTT and control peers. METHODS Children ages 6-18 years of age (n = 186) at risk for HD were enrolled in the KidsHD study. For research purposes only, genetic testing was performed to classify participants as Gene-Expanded (GE = 78) or as Gene Non-Expanded (GNE = 108). Outcome measures included height, weight, and body mass index (BMI). Mixed models were used to determine if non-linear age trends differed between groups for BMI, height, and weight. RESULTS Differences were seen in the trajectory of BMI in which the GE group reached a plateau in late adolescence with no further increase, compared with a nearly linear increase in the GNE group. There was a significant sex interaction pattern where GE males were taller than GNE males in adolescence, in the presence of similar weight. In contrast, GE females weighed significantly less than their GNE counterparts in adolescence, in the presence of similar height. CONCLUSION Measures of growth are abnormal in child and adolescent carriers of mHTT, decades before HD onset. Although further studies are needed for replication, the current findings suggest that developmental aberrations may be systemic and a vital part of disease pathology.
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Affiliation(s)
- Alexander Tereshchenko
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Ellen van der Plas
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Katherine D. Mathews
- Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA
- Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Eric Epping
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Amy L. Conrad
- Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Douglas R. Langbehn
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA, USA
- University of Iowa College of Public Health Administration, Iowa City, IA, USA
| | - Peg Nopoulos
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA, USA
- Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA
- Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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Langbehn DR, Stout JC, Gregory S, Mills JA, Durr A, Leavitt BR, Roos RAC, Long JD, Owen G, Johnson HJ, Borowsky B, Craufurd D, Reilmann R, Landwehrmeyer GB, Scahill RI, Tabrizi SJ. Association of CAG Repeats With Long-term Progression in Huntington Disease. JAMA Neurol 2019; 76:1375-1385. [PMID: 31403680 PMCID: PMC6692683 DOI: 10.1001/jamaneurol.2019.2368] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 05/02/2019] [Indexed: 11/14/2022]
Abstract
IMPORTANCE In Huntington disease (HD), mutation severity is defined by the length of the CAG trinucleotide sequence, a well-known predictor of clinical onset age. The association with disease trajectory is less well characterized. Quantifiable summary measures of trajectory applicable over decades of early disease progression are lacking. An accurate model of the age-CAG association with early progression is critical to clinical trial design, informing both sample size and intervention timing. OBJECTIVE To succinctly capture the decades-long early progression of HD and its dependence on CAG repeat length. DESIGN, SETTING, AND PARTICIPANTS Prospective study at 4 academic HD treatment and research centers. Participants were the combined sample from the TRACK-HD and Track-On HD studies consisting of 290 gene carriers (presymptomatic to stage II), recruited from research registries at participating centers, and 153 nonbiologically related controls, generally spouses or friends. Recruitment was targeted to match a balanced, prespecified spectrum of age, CAG repeat length, and diagnostic status. In the TRACK-HD and Track-On HD studies, 13 and 5 potential participants, respectively, failed study screening. Follow-up ranged from 0 to 6 years. The study dates were January 2008 to November 2014. These analyses were performed between December 2015 and January 2019. MAIN OUTCOMES AND MEASURES The outcome measures were principal component summary scores of motor-cognitive function and of brain volumes. The main outcome was the association of these scores with age and CAG repeat length. RESULTS We analyzed 2065 visits from 443 participants (247 female [55.8%]; mean [SD] age, 44.4 [10.3] years). Motor-cognitive measures were highly correlated and had similar CAG repeat length-dependent associations with age. A composite summary score accounted for 67.6% of their combined variance. This score was well approximated by a score combining 3 items (total motor score, Symbol Digit Modalities Test, and Stroop word reading) from the Unified Huntington's Disease Rating Scale. For either score, initial progression age and then acceleration rate were highly CAG repeat length dependent. The acceleration continues through at least stage II disease. In contrast, 3 distinct patterns emerged among brain measures (basal ganglia, gray matter, and a combination of whole-brain, ventricular, and white matter volumes). The basal ganglia pattern showed considerable change in even the youngest participants but demonstrated minimal acceleration of loss with aging. Each clinical and brain summary score was strongly associated with the onset and rate of decline in total functional capacity. CONCLUSIONS AND RELEVANCE Results of this study suggest that succinct summary measures of function and brain loss characterize HD progression across a wide disease span. CAG repeat length strongly predicts their decline rate. This work aids our understanding of the age and CAG repeat length-dependent association between changes in the brain and clinical manifestations of HD.
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Affiliation(s)
| | - Julie C. Stout
- School of Psychology and Psychiatry, Monash University, Melbourne, Victoria, Australia
| | - Sarah Gregory
- Huntington’s Disease Centre, UCL Institute of Neurology, University College London, Queen Square, London, United Kingdom
| | | | - Alexandra Durr
- Institut du Cerveau et de la Moelle Epinière (ICM), Genetic Department, Assistance Publique–Hôpitaux de Paris, Sorbonne Université, Institut National de la Santé et de la Recherche Médicale Unité 1127, Le Centre National de la Recherche Scientifique, Unités Mixtes de Recherche 7225, Pitié-Salpêtrière University Hospital, Paris, France
| | - Blair R. Leavitt
- Centre for Molecular Medicine and Therapeutics, Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Raymund A. C. Roos
- Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands
| | | | - Gail Owen
- Huntington’s Disease Centre, UCL Institute of Neurology, University College London, Queen Square, London, United Kingdom
| | - Hans J. Johnson
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City
| | | | - David Craufurd
- Manchester Academic Health Sciences Centre, Central Manchester University Hospitals National Health Service Foundation Trust, University of Manchester, Manchester, United Kingdom
| | - Ralf Reilmann
- George-Huntington-Institute, Department of Radiology, University of Münster, Münster, Germany
- Hertie-Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
| | | | - Rachael I. Scahill
- Huntington’s Disease Centre, UCL Institute of Neurology, University College London, Queen Square, London, United Kingdom
| | - Sarah J. Tabrizi
- Huntington’s Disease Centre, UCL Institute of Neurology, University College London, Queen Square, London, United Kingdom
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22
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van der Plas E, Langbehn DR, Conrad AL, Koscik TR, Tereshchenko A, Epping EA, Magnotta VA, Nopoulos PC. Abnormal brain development in child and adolescent carriers of mutant huntingtin. Neurology 2019; 93:e1021-e1030. [PMID: 31371571 DOI: 10.1212/wnl.0000000000008066] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/20/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The huntingtin gene is critical for the formation and differentiation of the CNS, which raises questions about the neurodevelopmental effect of CAG expansion mutations within this gene (mHTT) that cause Huntington disease (HD). We sought to test the hypothesis that child and adolescent carriers of mHTT exhibit different brain growth compared to peers without the mutation by conducting structural MRI in youth who are at risk for HD. We also explored whether the length of CAG expansion affects brain development. METHODS Children and adolescents (age 6-18) with a parent or grandparent diagnosed with HD underwent MRI and blinded genetic testing to confirm the presence or absence of mHTT. Seventy-five individuals were gene-expanded (GE) and 97 individuals were gene-nonexpanded (GNE). The GE group was estimated to be on average 35 years from clinical onset. Following an accelerated longitudinal design, age-related changes in brain regions were estimated. RESULTS Age-related striatal volume changes differed significantly between the GE and GNE groups, with initial hypertrophy and more rapid volume decline in GE. This pattern was exaggerated with CAG expansion length for CAG > 50. A similar age-dependent group difference was observed for the globus pallidus, but not in other major regions. CONCLUSION Our results suggest that pathogenesis of HD begins with abnormal brain development. An understanding of potential neurodevelopmental features associated with mHTT may be needed for optimized implementation of preventative gene silencing therapies, such that normal aspects of neurodevelopment are preserved as neurodegeneration is forestalled.
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Affiliation(s)
- Ellen van der Plas
- From the Department of Psychiatry (E.v.d.P., T.R.K.), University of Iowa Hospitals & Clinics; and the Departments of Psychiatry (D.R.L., A.T., E.A.E., P.C.N.), Biostatistics (D.R.L., A.T.), and Radiology (V.A.M.) and Stead Family Department of Pediatrics (A.L.C.), University of Iowa, Iowa City.
| | - Douglas R Langbehn
- From the Department of Psychiatry (E.v.d.P., T.R.K.), University of Iowa Hospitals & Clinics; and the Departments of Psychiatry (D.R.L., A.T., E.A.E., P.C.N.), Biostatistics (D.R.L., A.T.), and Radiology (V.A.M.) and Stead Family Department of Pediatrics (A.L.C.), University of Iowa, Iowa City
| | - Amy L Conrad
- From the Department of Psychiatry (E.v.d.P., T.R.K.), University of Iowa Hospitals & Clinics; and the Departments of Psychiatry (D.R.L., A.T., E.A.E., P.C.N.), Biostatistics (D.R.L., A.T.), and Radiology (V.A.M.) and Stead Family Department of Pediatrics (A.L.C.), University of Iowa, Iowa City
| | - Timothy R Koscik
- From the Department of Psychiatry (E.v.d.P., T.R.K.), University of Iowa Hospitals & Clinics; and the Departments of Psychiatry (D.R.L., A.T., E.A.E., P.C.N.), Biostatistics (D.R.L., A.T.), and Radiology (V.A.M.) and Stead Family Department of Pediatrics (A.L.C.), University of Iowa, Iowa City
| | - Alexander Tereshchenko
- From the Department of Psychiatry (E.v.d.P., T.R.K.), University of Iowa Hospitals & Clinics; and the Departments of Psychiatry (D.R.L., A.T., E.A.E., P.C.N.), Biostatistics (D.R.L., A.T.), and Radiology (V.A.M.) and Stead Family Department of Pediatrics (A.L.C.), University of Iowa, Iowa City
| | - Eric A Epping
- From the Department of Psychiatry (E.v.d.P., T.R.K.), University of Iowa Hospitals & Clinics; and the Departments of Psychiatry (D.R.L., A.T., E.A.E., P.C.N.), Biostatistics (D.R.L., A.T.), and Radiology (V.A.M.) and Stead Family Department of Pediatrics (A.L.C.), University of Iowa, Iowa City
| | - Vincent A Magnotta
- From the Department of Psychiatry (E.v.d.P., T.R.K.), University of Iowa Hospitals & Clinics; and the Departments of Psychiatry (D.R.L., A.T., E.A.E., P.C.N.), Biostatistics (D.R.L., A.T.), and Radiology (V.A.M.) and Stead Family Department of Pediatrics (A.L.C.), University of Iowa, Iowa City
| | - Peggy C Nopoulos
- From the Department of Psychiatry (E.v.d.P., T.R.K.), University of Iowa Hospitals & Clinics; and the Departments of Psychiatry (D.R.L., A.T., E.A.E., P.C.N.), Biostatistics (D.R.L., A.T.), and Radiology (V.A.M.) and Stead Family Department of Pediatrics (A.L.C.), University of Iowa, Iowa City
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23
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Vaidya JG, Elmore AL, Wallace AL, Langbehn DR, Kramer JR, Kuperman S, O'Leary DS. Association Between Age and Familial Risk for Alcoholism on Functional Connectivity in Adolescence. J Am Acad Child Adolesc Psychiatry 2019; 58:692-701. [PMID: 30768382 PMCID: PMC7428193 DOI: 10.1016/j.jaac.2018.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 12/20/2018] [Accepted: 01/30/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Youth with a family history of alcohol use disorder (family history positive [FHP]) are at increased risk for developing maladaptive substance use relative to family history negative (FHN) peers. Building on earlier studies demonstrating morphological differences and distinct patterns of neural activation in FHP, the purpose of the present study was to investigate differential intrinsic functional connectivity among brain networks indexing premorbid risk of developing alcohol use disorder (AUD). METHOD The current study examined intrinsic functional connectivity using resting state functional magnetic resonance imaging in 191 adolescents 13 to 18 years of age with and without family history of AUD via independent component analysis, a method enabling data-driven investigation of internetwork and intranetwork connectivity among brain regions at rest. RESULTS Analyses revealed significantly lower intranetwork connectivity in FHP compared to FHN participants between the dorsal premotor cortex and other sensorimotor network regions. Reduced intranetwork connectivity in this region was further correlated with the number of biological family members with AUD and mood disorders. Robust differences were also evident in internetwork connectivity as a function of age. However, there was no evidence for family history by age interactions. CONCLUSION Intra- but not internetwork connectivity appears to differentiate FHP and FHN adolescents, whereas age differences within adolescence are marked by differences in internetwork connectivity.
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O'Leary DS, Langbehn DR, Kramer JR, Kuperman S, Fuhrmeister LA, Vaidya JG. Personality traits and negative consequences associated with binge drinking and marijuana use in college students. Am J Drug Alcohol Abuse 2019; 45:400-409. [PMID: 31042417 DOI: 10.1080/00952990.2019.1601200] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background: Binge drinking is common in college students, and many drink in quantities greater than the standard definition of bingeing. Combined use of additional substances, particularly marijuana, is also common. Objectives: Increased impulsivity and sensation seeking are risk factors for bingeing, and this study was designed to characterize their association with extreme compared to standard bingeing, as well as with combined bingeing and marijuana use. Negative consequences of alcohol use were also investigated. Methods: Self-report personality measures and a measure of the negative consequences of alcohol use were given to a sample of 221 college students (109 females) sorted into a control and 4 binge groups based upon their patterns of bingeing and marijuana use. Narrowly defined, non-overlapping measures of impulsivity and sensation seeking were analyzed to assess the association of these personality measures with substance-use patterns and negative consequences of bingeing. Results: Standard bingers did not differ from non-bingeing controls on either impulsivity or sensation seeking, whereas extreme bingers had significantly higher impulsivity and sensation seeking scores than controls and also significantly higher sensation seeking than standard bingers. Exploratory analyses of a broader set of personality scales showed that a disinhibition scale was also significant predictor of substance use group. A number of personality traits significantly predicted substance use patterns as well as specific negative consequences of bingeing. Conclusions: Impulsivity, sensation seeking and disinhibition are significant associates of substance use patterns and the negative consequences of use in college students.
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Affiliation(s)
- Daniel S O'Leary
- a Psychiatry Department , University of Iowa Carver College of Medicine
| | | | - John R Kramer
- a Psychiatry Department , University of Iowa Carver College of Medicine
| | - Samuel Kuperman
- a Psychiatry Department , University of Iowa Carver College of Medicine
| | | | - Jatin G Vaidya
- a Psychiatry Department , University of Iowa Carver College of Medicine
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25
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Selvik SG, Hummelen B, Romild U, Langbehn DR, Pedersen G. The Iowa Personality Disorder Screen: A validation study in a psychiatric population that receives long-term group psychotherapy for personality related problems. Personal Ment Health 2018; 12:229-240. [PMID: 29722177 DOI: 10.1002/pmh.1418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 02/14/2018] [Accepted: 02/18/2018] [Indexed: 11/07/2022]
Abstract
Personality disorder (PD) is common among psychiatric patients, and diagnosing such disorders is of great importance for the choice of treatment. Diagnosing PD is a demanding and time-consuming process. The utilities of several PD screening instruments have been studied in different populations, but not in a population who receives long-term group psychotherapy. In the current study, we investigate the predictive properties of the Iowa Personality Disorder Screen (IPDS) in a sample of 694 psychiatric outpatients with and without PD who were admitted for psychodynamic long-term group therapy from 2012 to 2014. The definitive, reference diagnoses were defined according to the SCID-II, by which 484 patients (68%) warranted a PD diagnosis. The IPDS correctly classified 67.4 percent of all participants. Sensitivity (0.75) and specificity (0.51) were lower than in previous validation studies of IPDS. We discuss possible explanations related to the general concept of PD and, more specifically, to our study sample. Because of the weaker predictive properties of IPDS, we advise caution in use of the IPDS in similar clinical settings. Copyright © 2018 John Wiley & Sons, Ltd.
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Affiliation(s)
- S G Selvik
- Department for Mental Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Psychiatric Hospital Namsos, Helse Nord-Trøndelag, Namsos, Norway
| | - B Hummelen
- Department of Research and Development, Division of Mental Health and Addiction, Oslo University Hospital, Norway
| | | | - D R Langbehn
- Department of Psychiatry, University of Iowa Health Care, USA
| | - G Pedersen
- Department of Personality Psychiatry, Division of Mental Health and Addiction, Oslo University Hospital, Norway.,NORMENT, Institute of Clinical Medicine, University of Oslo, Norway
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26
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Henderson KE, Vaidya JG, Kramer JR, Kuperman S, Langbehn DR, O'Leary DS. Cortical Thickness in Adolescents with a Family History of Alcohol Use Disorder. Alcohol Clin Exp Res 2017; 42:89-99. [PMID: 29105114 DOI: 10.1111/acer.13543] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 10/26/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Individuals with a family history (FH+) of alcohol use disorder (AUD) have a higher risk for developing an AUD than those with no family history (FH-) of AUD. In addition, FH+ individuals tend to perform worse on neuropsychological measures and show heightened impulsivity, which may be due to underlying differences in brain structure such as cortical thickness. The primary aim of this study was to investigate differences in cortical thickness in FH+ compared to FH- adolescents. Secondary aims were to (i) investigate differences in executive functioning and impulsivity, and (ii) examine associations between brain structure and behavior. METHODS Brain scans of 95 FH- and 93 FH+ subjects aged 13 to 18 were obtained using magnetic resonance imaging. FH+ subjects were required to have at least 1 biological parent with a history of an AUD. FH+ and FH- individuals had limited or no past alcohol use, thereby minimizing potential effects of alcohol. Subjects were evaluated on impulsivity and executive functioning tasks. Thicknesses of cortical lobes and subregions were analyzed using FreeSurfer. Regions showing group differences were examined for group-by-age interactions and correlations with neuropsychological and personality measures. RESULTS FH+ adolescents had thinner cortices in frontal and parietal lobes, notably in the medial orbitofrontal, lateral orbitofrontal, and superior parietal cortices. The difference in cortical thickness between family history groups was strongest among the youngest subjects. FH+ subjects were also more impulsive and had poorer performance on a spatial memory task. CONCLUSIONS These findings demonstrate frontal and parietal structural differences in FH+ adolescents that might underlie cognitive and behavioral characteristics associated with AUD risk.
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Affiliation(s)
- Kate E Henderson
- Interdisciplinary Graduate Program in Neuroscience, The University of Iowa, Iowa City, Iowa
| | - Jatin G Vaidya
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - John R Kramer
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Samuel Kuperman
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Douglas R Langbehn
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Daniel S O'Leary
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa
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28
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Long JD, Mills JA, Leavitt BR, Durr A, Roos RA, Stout JC, Reilmann R, Landwehrmeyer B, Gregory S, Scahill RI, Langbehn DR, Tabrizi SJ. Survival End Points for Huntington Disease Trials Prior to a Motor Diagnosis. JAMA Neurol 2017; 74:1352-1360. [PMID: 28975278 PMCID: PMC5710578 DOI: 10.1001/jamaneurol.2017.2107] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 06/13/2017] [Indexed: 01/29/2023]
Abstract
Importance Predictive genetic testing in Huntington disease (HD) enables therapeutic trials in HTT gene expansion mutation carriers prior to a motor diagnosis. Progression-free survival (PFS) is the composite of a motor diagnosis or a progression event, whichever comes first. Objective To determine if PFS provides feasible sample sizes for trials with mutation carriers who have not yet received a motor diagnosis. Design, Setting, and Participants This study uses data from the 2-phase, longitudinal cohort studies called Track and from a longitudinal cohort study called the Cooperative Huntington Observational Research Trial (COHORT). Track had 167 prediagnosis mutation carriers and 156 noncarriers, whereas COHORT had 366 prediagnosis mutation carriers and noncarriers. Track studies were conducted at 4 sites in 4 countries (Canada, France, England, and the Netherlands) from which data were collected from January 17, 2008, through November 17, 2014. The COHORT was conducted at 38 sites in 3 countries (Australia, Canada, and the United States) from which data were collected from February 14, 2006, through December 31, 2009. Results from the Track data were externally validated with data from the COHORT. The required sample size was estimated for a 2-arm prediagnosis clinical trial. Data analysis took place from May 1, 2016, to June 10, 2017. Main Outcomes and Measures The primary end point is PFS. Huntington disease progression events are defined for the Unified Huntington's Disease Rating Scale total motor score, total functional capacity, symbol digit modalities test, and Stroop word test. Results Of Track's 167 prediagnosis mutation carriers, 93 (55.6%) were women, and the mean (SD) age was 40.06 (8.92) years; of the 156 noncarriers, 87 (55.7%) were women, and the mean (SD) age was 45.58 (10.30) years. Of the 366 COHORT participants, 229 (62.5%) were women and the mean (SD) age was 42.21 (12.48) years. The PFS curves of the Track mutation carriers showed good external validity with the COHORT mutation carriers after adjusting for initial progression. For required sample size, PFS with a motor diagnosis or total motor score progression required about 4 times fewer participants than a motor diagnosis alone. Including additional cognitive progression events further reduced the number. For example, a 3-year trial with 10% attrition and a treatment effect of 50% requires a total of 661 with motor diagnosis as the survival end point but only 177 with a total motor score PFS. Conclusions and Relevance Reasonably sized prediagnosis Huntington disease trials can be planned with PFS, and there is evidence of generalizability of this approach.
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Affiliation(s)
- Jeffrey D. Long
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City
- Department of Biostatistics, Carver College of Medicine, University of Iowa, Iowa City
| | - James A. Mills
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City
| | - Blair R. Leavitt
- Centre for Molecular Medicine and Therapeutics, Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexandra Durr
- Department of Genetics and Cytogenetics, and INSERM UMR S679, Institut du Cerveau et de la Moelle Epinière, Hôpital de la Salpêtrière, Paris, France
| | - Raymund A. Roos
- Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands
| | - Julie C. Stout
- School of Psychology and Psychiatry, Monash University, Melbourne, Victoria, Australia
| | - Ralf Reilmann
- Department of Neurology, University of Münster, Münster, Germany
| | - Bernhard Landwehrmeyer
- Cure Huntington’s Disease Initiative Foundation, Department of Neurology, University of Ulm, Ulm, Germany
| | - Sarah Gregory
- Huntington’s Disease Research Centre, Institute of Neurology, University College London, London, England
| | | | - Douglas R. Langbehn
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City
- Department of Biostatistics, Carver College of Medicine, University of Iowa, Iowa City
| | - Sarah J. Tabrizi
- Huntington's Disease Centre, Department of Neurodegenerative Disease, Institute of Neurology, University College London, Queen Square, London, England
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Frost C, Mulick A, Scahill RI, Owen G, Aylward E, Leavitt BR, Durr A, Roos RAC, Borowsky B, Stout JC, Reilmann R, Langbehn DR, Tabrizi SJ, Sampaio C. Design optimization for clinical trials in early-stage manifest Huntington's disease. Mov Disord 2017; 32:1610-1619. [PMID: 28906031 DOI: 10.1002/mds.27122] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 06/22/2017] [Accepted: 07/03/2017] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES The purpose of this study was to inform the design of randomized clinical trials in early-stage manifest Huntington's disease through analysis of longitudinal data from TRACK-Huntington's Disease (TRACK-HD), a multicenter observational study. METHODS We compute sample sizes required for trials with candidate clinical, functional, and imaging outcomes, whose aims are to reduce rates of change. The calculations use a 2-stage approach: first using linear mixed models to estimate mean rates of change and components of variability from TRACK-HD data and second using these to predict sample sizes for a range of trial designs. RESULTS For each outcome, the primary drivers of the required sample size were the anticipated treatment effect and the duration of treatment. Extending durations from 1 to 2 years yielded large sample size reductions. Including interim visits and incorporating stratified randomization on predictors of outcome together with covariate adjustment gave more modest, but nontrivial, benefits. Caudate atrophy, expressed as a percentage of its baseline, was the outcome that gave smallest required sample sizes. DISCUSSION Here we consider potential required sample sizes for clinical trials estimated from naturalistic observation of longitudinal change. Choice among outcome measures for a trial must additionally consider their relevance to patients and the expected effect of the treatment under study. For all outcomes considered, our results provide compelling arguments for 2-year trials, and we also demonstrate the benefits of incorporating stratified randomization coupled with covariate adjustment, particularly for trials with caudate atrophy as the primary outcome. The benefits of enrichment are more debatable, with statistical benefits offset by potential recruitment difficulties and reduced generalizability. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Chris Frost
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Amy Mulick
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Rachael I Scahill
- Huntington's Disease Centre, UCL Institute of Neurology, Department of Neurodegenerative Disease, University College London, London, UK
| | - Gail Owen
- Huntington's Disease Centre, UCL Institute of Neurology, Department of Neurodegenerative Disease, University College London, London, UK
| | - Elizabeth Aylward
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Blair R Leavitt
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexandra Durr
- Brain and Spine Institute, INSERM U1127, Centre National de la Recherche Scientifique, UMR7225, Sorbonne Universités, University Pierre and Marie Curie, Paris VI UMR_S1127, Paris, France
- Assistance Publique - Hôpitaux de Paris, Genetic Department, Pitié -Salpêtrière University Hospital, Paris, France
| | - Raymund A C Roos
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Beth Borowsky
- CHDI Management, CHDI Foundation, Princeton, New Jersey, USA
- Clinical Development, Neurodegenerative Diseases, Teva Pharmaceuticals, Malvern Pennsylvania, USA
| | - Julie C Stout
- School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Ralf Reilmann
- George Huntington Institute, Muenster, Germany
- Institute for Clinical Radiology, University of Muenster, Muenster, Germany
- Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | | | - Sarah J Tabrizi
- Huntington's Disease Centre, UCL Institute of Neurology, Department of Neurodegenerative Disease, University College London, London, UK
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30
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Coryell WH, Langbehn DR, Norris AW, Yao JR, Dindo LN, Calarge CA. Polyunsaturated fatty acid composition and childhood adversity: Independent correlates of depressive symptom persistence. Psychiatry Res 2017; 256:305-311. [PMID: 28666200 PMCID: PMC6193447 DOI: 10.1016/j.psychres.2017.06.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 03/15/2017] [Accepted: 06/12/2017] [Indexed: 01/08/2023]
Abstract
Childhood experiences, personality, and polyunsaturated essential fatty acid (PUFA) composition have all been shown to affect the likelihood of depressive symptoms. Few studies have addressed relationships between these factors in their influence on the occurrence or course of depressive symptoms. The following analysis was designed to do so. Subjects, 15-20 years old, had either begun antidepressant treatment within the preceding month (n = 88), or had never taken psychiatric medications (n = 92). Baseline assessments included a structured diagnostic interview, the self-completed Multiphasic Personality Questionnaire, and a determination of plasma PUFA phospholipid composition. Depressive symptom levels were assessed at baseline and again at 4, 8 and 12 months. Omega-3 composition and general childhood trauma scores were unrelated to each other but both correlated, in predicted directions, with negative emotionality. Low omega-3 composition and history of childhood trauma were associated with persistence of depressive symptoms during follow-up, largely through their effects on negative emotionality. Negative emotionality appears to comprise a final common pathway to depressive disorder through which the diverse risk factors of childhood adversity and low omega-3 composition are expressed.
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Affiliation(s)
- William H. Coryell
- Department of Psychiatry, University of Iowa Carver College of Medicine, 500 Newton Road, Suite 2-205 MEB, Iowa City, Iowa, 52242-1900, USA,Corresponding Author: University of Iowa, Carver College of Medicine, Department of Psychiatry Research, 500 Newton Road, Suite 2-205 MEB, Iowa City, IA 52242-1900, Phone: (319) 353-4434, Fax: (319) 353-3003
| | - Douglas R. Langbehn
- Department of Psychiatry, University of Iowa Carver College of Medicine, 500 Newton Road, Suite 1-290 MEB, Iowa City, Iowa, 52242-1900, USA
| | - Andrew W. Norris
- Department of Pediatrics, University of Iowa Carver College of Medicine, 285 Newton Road, 1270B CBRB, Iowa City, Iowa, 52242-1900, USA
| | - Jian-Rong Yao
- Department of Pediatrics, University of Iowa Carver College of Medicine, 285 N Road, 1270 CBRB, Iowa City, IA 52242-1900, USA.
| | - Lilian N. Dindo
- Department of Psychiatry, Baylor College of Medicine, Houston, Texas, USA
| | - Chadi A. Calarge
- Department of Psychiatry and Pediatrics, Baylor College of Medicine, Houston, Texas, USA
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31
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Gregory S, Long JD, Klöppel S, Razi A, Scheller E, Minkova L, Papoutsi M, Mills JA, Durr A, Leavitt BR, Roos RAC, Stout JC, Scahill RI, Langbehn DR, Tabrizi SJ, Rees G. Operationalizing compensation over time in neurodegenerative disease. Brain 2017; 140:1158-1165. [PMID: 28334888 PMCID: PMC5382953 DOI: 10.1093/brain/awx022] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 10/26/2016] [Accepted: 12/21/2016] [Indexed: 12/22/2022] Open
Affiliation(s)
- Sarah Gregory
- Wellcome Trust Centre for Neuroimaging, Institute of Neurology, University College London, London, UK
| | - Jeffrey D. Long
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa, City, IA, USA
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Stefan Klöppel
- Albert-Ludwigs-University Freiburg, University Medical Center, Division Freiburg Brain Imaging, Freiburg, Germany
- Albert-Ludwigs-University Freiburg, University Medical Center, Department of Psychiatry and Psychotherapy, Freiburg, Germany
- University Hospital for Old Age Psychiatry, Murtenstrasse 21, 3010 Bern, Switzerland
| | - Adeel Razi
- Wellcome Trust Centre for Neuroimaging, Institute of Neurology, University College London, London, UK
- Department of Electronic Engineering, N.E.D University of Engineering and Technology, Karachi, Pakistan
| | - Elisa Scheller
- Albert-Ludwigs-University Freiburg, University Medical Center, Division Freiburg Brain Imaging, Freiburg, Germany
- Albert-Ludwigs-University Freiburg, University Medical Center, Department of Psychiatry and Psychotherapy, Freiburg, Germany
- Albert-Ludwigs-University Freiburg, Department of Psychology, Laboratory for Biological and Personality Psychology, Freiburg, Germany
| | - Lora Minkova
- Albert-Ludwigs-University Freiburg, University Medical Center, Division Freiburg Brain Imaging, Freiburg, Germany
- Albert-Ludwigs-University Freiburg, University Medical Center, Department of Psychiatry and Psychotherapy, Freiburg, Germany
- Albert-Ludwigs-University Freiburg, Department of Psychology, Laboratory for Biological and Personality Psychology, Freiburg, Germany
| | - Marina Papoutsi
- Department of Neurodegenerative Disease, UCL Institute of Neurology, University College London, London, UK
| | - James A. Mills
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa, City, IA, USA
| | - Alexandra Durr
- APHP Department of Genetics, Groupe Hospitalier Pitié-Salpêtrière, and Institut du Cerveau et de la Moelle, INSERM U1127, CNRS UMR7225, UPMC Université Paris VI UMR_S1127, Paris France
| | - Blair R. Leavitt
- Centre for Molecular Medicine and Therapeutics, Department of Medical Genetics, University of British Columbia, Canada
| | - Raymund A. C. Roos
- Leiden University Medical Center, Department of Neurology, Leiden, The Netherlands
| | - Julie C. Stout
- School of Psychological Sciences and Institute of Clinical and Cognitive Neuroscience, Monash University, Melbourne, Australia
| | - Rachael I. Scahill
- Department of Neurodegenerative Disease, UCL Institute of Neurology, University College London, London, UK
| | - Douglas R. Langbehn
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa, City, IA, USA
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Sarah J. Tabrizi
- Department of Neurodegenerative Disease, UCL Institute of Neurology, University College London, London, UK
| | - Geraint Rees
- Wellcome Trust Centre for Neuroimaging, Institute of Neurology, University College London, London, UK
- Institute of Cognitive Neuroscience, University College London, London, UK
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32
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Hensman Moss DJ, Flower MD, Lo KK, Miller JRC, van Ommen GJB, ’t Hoen PAC, Stone TC, Guinee A, Langbehn DR, Jones L, Plagnol V, van Roon-Mom WMC, Holmans P, Tabrizi SJ. Huntington's disease blood and brain show a common gene expression pattern and share an immune signature with Alzheimer's disease. Sci Rep 2017; 7:44849. [PMID: 28322270 PMCID: PMC5359597 DOI: 10.1038/srep44849] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 02/14/2017] [Indexed: 12/25/2022] Open
Abstract
There is widespread transcriptional dysregulation in Huntington's disease (HD) brain, but analysis is inevitably limited by advanced disease and postmortem changes. However, mutant HTT is ubiquitously expressed and acts systemically, meaning blood, which is readily available and contains cells that are dysfunctional in HD, could act as a surrogate for brain tissue. We conducted an RNA-Seq transcriptomic analysis using whole blood from two HD cohorts, and performed gene set enrichment analysis using public databases and weighted correlation network analysis modules from HD and control brain datasets. We identified dysregulated gene sets in blood that replicated in the independent cohorts, correlated with disease severity, corresponded to the most significantly dysregulated modules in the HD caudate, the most prominently affected brain region, and significantly overlapped with the transcriptional signature of HD myeloid cells. High-throughput sequencing technologies and use of gene sets likely surmounted the limitations of previously inconsistent HD blood expression studies. Our results suggest transcription is disrupted in peripheral cells in HD through mechanisms that parallel those in brain. Immune upregulation in HD overlapped with Alzheimer's disease, suggesting a common pathogenic mechanism involving macrophage phagocytosis and microglial synaptic pruning, and raises the potential for shared therapeutic approaches.
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Affiliation(s)
- Davina J. Hensman Moss
- Department of Neurodegenerative Disease, University College London Institute of Neurology, London, WC1B 5EH, UK
| | - Michael D. Flower
- Department of Neurodegenerative Disease, University College London Institute of Neurology, London, WC1B 5EH, UK
| | - Kitty K. Lo
- University College London Genetics Institute, University College London, London, WC1E 6BT, UK
| | - James R. C. Miller
- Department of Neurodegenerative Disease, University College London Institute of Neurology, London, WC1B 5EH, UK
| | - Gert-Jan B. van Ommen
- Department of Human Genetics, Leiden University Medical Center, Leiden, Postzone S-4-P, The Netherlands
| | - Peter A. C. ’t Hoen
- Department of Human Genetics, Leiden University Medical Center, Leiden, Postzone S-4-P, The Netherlands
| | - Timothy C. Stone
- MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, CF24 4HQ, UK
| | - Amelia Guinee
- Faculty of Education, University of Cambridge, CB2 8PQ, Cambridge UK
| | - Douglas R. Langbehn
- Departments of Psychiatry and Biostatistics, University of Iowa, IA 52242, USA
| | - Lesley Jones
- MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, CF24 4HQ, UK
| | - Vincent Plagnol
- University College London Genetics Institute, University College London, London, WC1E 6BT, UK
| | | | - Peter Holmans
- MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, CF24 4HQ, UK
| | - Sarah J. Tabrizi
- Department of Neurodegenerative Disease, University College London Institute of Neurology, London, WC1B 5EH, UK
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Long JD, Langbehn DR, Tabrizi SJ, Landwehrmeyer BG, Paulsen JS, Warner J, Sampaio C. Validation of a prognostic index for Huntington's disease. Mov Disord 2016; 32:256-263. [PMID: 27892614 DOI: 10.1002/mds.26838] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 09/06/2016] [Accepted: 09/09/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Characterizing progression in Huntington's disease is important for study the natural course and selecting appropriate participants for clinical trials. OBJECTIVES The aim was to develop a prognostic index for motor diagnosis in Huntington's disease and examine its predictive performance in external observational studies. METHODS The prediagnosis Neuro-biological Predictors of Huntington's Disease study (N = 945 gene-positive) was used to select a Cox regression model for computing a prognostic index. Cross-validation was used for selecting a model with good internal validity performance using the research sites as natural splits of the data set. Then, the external predictive performance was assessed using prediagnosis data from three additional observational studies, The Cooperative Huntington Observational Research Trial (N = 358), TRACK-HD (N = 118), and REGISTRY (N = 480). RESULTS Model selection yielded a prognostic index computed as the weighted combination of the UHDRS total motor score, Symbol Digit Modalities Test, baseline age, and cytosine-adenine-guanine expansion. External predictive performance was very good for the first two of the three studies, with the third being a much more progressed cohort than the other studies. The databases were pooled and a final Cox regression model was estimated. The regression coefficients were scaled to produce the prognostic index for Huntington's disease, and a normed version, which is scaled relative to a 10-year 50% probability of motor diagnosis. CONCLUSION The positive results of this comprehensive validity analysis provide evidence that the prognostic index is generally useful for predicting Huntington's disease progression in terms of risk of future motor diagnosis. The variables for the index are routinely collected in ongoing observational studies and the index can be used to identify cohorts for clinical trial recruitment. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Jeffrey D Long
- Departments of Psychiatry, University of Iowa, Iowa City, Iowa, USA.,Departments of Biostatistics, University of Iowa, Iowa City, Iowa, USA
| | - Douglas R Langbehn
- Departments of Psychiatry, University of Iowa, Iowa City, Iowa, USA.,Departments of Biostatistics, University of Iowa, Iowa City, Iowa, USA
| | - Sarah J Tabrizi
- Department of Neurodegenerative Disease, UCL Huntington's Disease Centre, University College London Institute of Neurology, London, United Kingdom
| | - Bernhard G Landwehrmeyer
- CHDI Management/CHDI Foundation, Princeton, New Jersey, USA.,Department of Neurology, University of Ulm, Ulm, Germany
| | - Jane S Paulsen
- Departments of Psychiatry, University of Iowa, Iowa City, Iowa, USA.,Departments of Psychology, University of Iowa, Iowa City, Iowa, USA.,Departments of Neurology, University of Iowa, Iowa City, Iowa, USA
| | - John Warner
- CHDI Management/CHDI Foundation, Princeton, New Jersey, USA
| | - Cristina Sampaio
- CHDI Management/CHDI Foundation, Princeton, New Jersey, USA.,Laboratory of Clinical Pharmacology and Therapeutics, University of Lisbon, Lisbon, Portugal
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Gregory S, Long JD, Klöppel S, Razi A, Scheller E, Minkova L, Papoutsi M, Mills JA, Stout J, Scahill RI, Langbehn DR, Tabrizi SJ, Rees G. D20 Operationalising compensation over time in neurodegenerative disease. J Neurol Psychiatry 2016. [DOI: 10.1136/jnnp-2016-314597.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Johnson EB, Dürr A, Leavitt B, Roos RAC, Langbehn DR, Tabriz SJ, Scahill RI. D9 An evaluation of methods for the volumetric measurement of grey matter in huntington’s disease. J Neurol Psychiatry 2016. [DOI: 10.1136/jnnp-2016-314597.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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36
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Gregory S, Klöppel S, Long JD, Razi A, Scheller E, Minkova L, Dürr A, Roos RAC, Leavitt BR, Mills JA, Stout J, Scahill RI, Langbehn DR, Rees G, Tabrizi SJ. D21 Longitudinal compensation in the cognitive network in huntington’s disease. J Neurol Psychiatry 2016. [DOI: 10.1136/jnnp-2016-314597.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Crawford H, Langbehn DR, Scahill RI, Rees G, Tabrizi SJ, Orth M, Gregory S. D16 White matter microstructure and natural biological variation in huntington’s disease. J Neurol Psychiatry 2016. [DOI: 10.1136/jnnp-2016-314597.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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38
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Johnson EB, Rees EM, Labuschagne I, Durr A, Leavitt BR, Roos RAC, Reilmann R, Johnson H, Hobbs NZ, Langbehn DR, Stout JC, Tabrizi SJ, Scahill RI. The impact of occipital lobe cortical thickness on cognitive task performance: An investigation in Huntington's Disease. Neuropsychologia 2015; 79:138-46. [PMID: 26519555 DOI: 10.1016/j.neuropsychologia.2015.10.033] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 10/07/2015] [Accepted: 10/26/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND The occipital lobe is an important visual processing region of the brain. Following consistent findings of early neural changes in the occipital lobe in Huntington's Disease (HD), we examined cortical thickness across four occipital regions in premanifest (preHD) and early HD groups compared with controls. Associations between cortical thickness in gene positive individuals and performance on six cognitive tasks, each with a visual component, were examined. In addition, the association between cortical thickness in gene positive participants and one non-visual motor task was also examined for comparison. METHODS Cortical thickness was determined using FreeSurfer on T1-weighted 3T MR datasets from controls (N=97), preHD (N=109) and HD (N=69) from the TRACK-HD study. Regression models were fitted to assess between-group differences in cortical thickness, and relationships between performance on the cognitive tasks, the motor task and occipital thickness were examined in a subset of gene-positive participants (N=141). RESULTS Thickness of the occipital cortex in preHD and early HD participants was reduced compared with controls. Regionally-specific associations between reduced cortical thickness and poorer performance were found for five of the six cognitive tasks, with the strongest associations in lateral occipital and lingual regions. No associations were found with the cuneus. The non-visual motor task was not associated with thickness of any region. CONCLUSIONS The heterogeneous pattern of associations found in the present study suggests that occipital thickness negatively impacts cognition, but only in regions that are linked to relatively advanced visual processing (e.g., lateral occipital, lingual regions), rather than in basic visual processing regions such as the cuneus. Our results show, for the first time, the functional implications of occipital atrophy highlighted in recent studies in HD.
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Affiliation(s)
| | - Elin M Rees
- UCL Institute of Neurology, University College London, UK
| | - Izelle Labuschagne
- School of Psychological Sciences, Monash University, Clayton, Victoria, Australia; School of Psychology, Australian Catholic University, Melbourne, Victoria, Australia
| | - Alexandra Durr
- Department of Genetics and Cytogenetics, and INSERMUMR S679, APHP, ICM Institute, Hôpital de la Salpêtrière, Paris, France
| | - Blair R Leavitt
- Centre for Molecular Medicine and Therapeutics, Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Raymund A C Roos
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Hans Johnson
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
| | - Nicola Z Hobbs
- UCL Institute of Neurology, University College London, UK
| | | | - Julie C Stout
- School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
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Bečanović K, Nørremølle A, Neal SJ, Kay C, Collins JA, Arenillas D, Lilja T, Gaudenzi G, Manoharan S, Doty CN, Beck J, Lahiri N, Portales-Casamar E, Warby SC, Connolly C, De Souza RAG, Tabrizi SJ, Hermanson O, Langbehn DR, Hayden MR, Wasserman WW, Leavitt BR. A SNP in the HTT promoter alters NF-κB binding and is a bidirectional genetic modifier of Huntington disease. Nat Neurosci 2015; 18:807-16. [PMID: 25938884 DOI: 10.1038/nn.4014] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 04/06/2015] [Indexed: 12/11/2022]
Abstract
Cis-regulatory variants that alter gene expression can modify disease expressivity, but none have previously been identified in Huntington disease (HD). Here we provide in vivo evidence in HD patients that cis-regulatory variants in the HTT promoter are bidirectional modifiers of HD age of onset. HTT promoter analysis identified a NF-κB binding site that regulates HTT promoter transcriptional activity. A non-coding SNP, rs13102260:G > A, in this binding site impaired NF-κB binding and reduced HTT transcriptional activity and HTT protein expression. The presence of the rs13102260 minor (A) variant on the HD disease allele was associated with delayed age of onset in familial cases, whereas the presence of the rs13102260 (A) variant on the wild-type HTT allele was associated with earlier age of onset in HD patients in an extreme case-based cohort. Our findings suggest a previously unknown mechanism linking allele-specific effects of rs13102260 on HTT expression to HD age of onset and have implications for HTT silencing treatments that are currently in development.
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Affiliation(s)
- Kristina Bečanović
- 1] Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada. [2] Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anne Nørremølle
- Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Scott J Neal
- Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chris Kay
- Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer A Collins
- Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Arenillas
- Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tobias Lilja
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Giulia Gaudenzi
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Shiana Manoharan
- Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Crystal N Doty
- Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jessalyn Beck
- Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nayana Lahiri
- UCL Institute of Neurology, University College London, London, UK
| | - Elodie Portales-Casamar
- Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Simon C Warby
- Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Colúm Connolly
- Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rebecca A G De Souza
- Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah J Tabrizi
- UCL Institute of Neurology, University College London, London, UK
| | - Ola Hermanson
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Douglas R Langbehn
- Department of Psychiatry and Biostatistics, University of Iowa, Iowa City, Iowa, USA
| | - Michael R Hayden
- Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Wyeth W Wasserman
- Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Blair R Leavitt
- Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
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Gregory S, Scahill RI, Seunarine KK, Stopford C, Zhang H, Zhang J, Orth M, Durr A, Roos RA, Langbehn DR, Long JD, Johnson H, Rees G, Tabrizi SJ, Craufurd D. Neuropsychiatry and White Matter Microstructure in Huntington's Disease. J Huntingtons Dis 2015; 4:239-49. [PMID: 26443926 PMCID: PMC4684097 DOI: 10.3233/jhd-150160] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Neuropsychiatric symptoms in Huntington's disease (HD) are often evident prior to clinical diagnosis. Apathy is highly correlated with disease progression, while depression and irritability occur at different stages of the disease, both before and after clinical onset. Little is understood about the neural bases of these neuropsychiatric symptoms and to what extent those neural bases are analogous to neuropsychiatric disorders in the general population. OBJECTIVE We used Diffusion Tensor Imaging (DTI) to investigate structural connectivity between brain regions and any putative microstructural changes associated with depression, apathy and irritability in HD. METHODS DTI data were collected from 39 premanifest and 45 early-HD participants in the Track-HD study and analysed using whole-brain Tract-Based Spatial Statistics. We used regression analyses to identify white matter tracts whose structural integrity (as measured by fractional anisotropy, FA) was correlated with HADS-depression, PBA-apathy or PBA-irritability scores in gene-carriers and related to cumulative probability to onset (CPO). RESULTS For those with the highest CPO, we found significant correlations between depression scores and reduced FA in the splenium of the corpus callosum. In contrast, those with lowest CPO demonstrated significant correlations between irritability scores and widespread FA reductions. There was no significant relationship between apathy and FA throughout the whole brain. CONCLUSIONS We demonstrate that white matter changes associated with both depression and irritability in HD occur at different stages of disease progression concomitant with their clinical presentation.
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Affiliation(s)
- Sarah Gregory
- Wellcome Trust Centre for Neuroimaging, UCL, London, UK
- Institute of Cognitive Neuroscience, University College London, UK
| | - Rachael I. Scahill
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
| | - Kiran K. Seunarine
- Developmental Imaging and Biophysics Section, UCL Institute of Child Health, London, UK
| | - Cheryl Stopford
- Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK
- Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Hui Zhang
- Department of Computer Science and Centre for Medical Image Computing, UCL, London, UK
| | - Jiaying Zhang
- Department of Computer Science and Centre for Medical Image Computing, UCL, London, UK
| | - Michael Orth
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Alexandra Durr
- APHP Department of Genetics, Groupe Hospitalier Pitié-Salpêtrière, and Institut du Cerveau et de la Moelle, INSERM U1127, CNRS UMR7225, Sorbonne Universités – UPMC Université Paris VI UMR_S1127, Paris, France
| | - Raymund A.C. Roos
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Douglas R. Langbehn
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Jeffrey D. Long
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Hans Johnson
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA, USA
| | - Geraint Rees
- Wellcome Trust Centre for Neuroimaging, UCL, London, UK
- Institute of Cognitive Neuroscience, University College London, UK
| | - Sarah J. Tabrizi
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - David Craufurd
- Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK
- Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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42
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Crawford HE, Hobbs NZ, Keogh R, Langbehn DR, Frost C, Johnson H, Landwehrmeyer B, Reilmann R, Craufurd D, Stout JC, Durr A, Leavitt BR, Roos RAC, Tabrizi SJ, Scahill RI. Corpus callosal atrophy in premanifest and early Huntington's disease. J Huntingtons Dis 2014; 2:517-26. [PMID: 25062736 DOI: 10.3233/jhd-130077] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Volumetric MRI studies have highlighted the pronounced loss of white matter in premanifest and early Huntington's Disease (HD). The current study focussed on the corpus callosum (CC) since it provides interhemispheric connections to vulnerable cortical areas. OBJECTIVES To investigate cross-sectional and longitudinal group differences in CC volume and hypothesis-driven associations with three cognitive tasks. METHODS Baseline and 24-month 3T MRI were analysed from 106 premanifest (PreHD), (59 preHD-A ≥10.8 and 47 preHD-B <10.8 years from predicted onset), 84 early HD (53 Stage 1 (HD1) and 31 Stage 2 (HD2)) and 101 control subjects from the TRACK-HD study, using a semi-automated technique for CC delineation. Between-group differences in volume and 24-month atrophy rates, and correlations with cognitive performance were investigated using regression models, adjusting for potential confounders. RESULTS PreHD-B, HD1 and HD2 had statistically significantly smaller baseline CC volumes (p < 0.001) and all groups had elevated 24-month atrophy rates compared with controls (p < 0.001). Smaller baseline CC volume was associated with impaired performance in the Circle Tracing Indirect task in early HD (p < 0.05). Positive, non-statistically significant relationships with Stroop Word Reading were shown in both gene-positive groups. There was no evidence of an association with the Trail Making B task. CONCLUSIONS We found reduced CC volume and elevated 24-month atrophy rates, even in individuals far from disease onset. Structural degeneration of interhemispheric connections may contribute to cognitive deficits, such as performance in the Circle Tracing Indirect task in HD. Examination of different image acquisitions may provide more specific information about underlying CC degeneration.
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Affiliation(s)
| | - Nicola Z Hobbs
- UCL Institute of Neurology, University College London, UK
| | - Ruth Keogh
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Douglas R Langbehn
- Departments of Psychiatry and Biostatistics (Secondary), University of Iowa, Iowa City, IA, USA
| | - Chris Frost
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Hans Johnson
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
| | | | - Ralf Reilmann
- Department of Neurology, University of Münster, Münster, Germany
| | - David Craufurd
- Institute of Human Development, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK and Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Julie C Stout
- School of Psychology and Psychiatry, Monash University, VIC, Australia
| | - Alexandra Durr
- Department of Genetics and Cytogenetics, and INSERM UMR S679, APHP Hôpital de la Salpêtrière, Paris, France
| | - Blair R Leavitt
- Centre for Molecular Medicine & Therapeutics, Dept. of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Raymund A C Roos
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
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Ross CA, Aylward EH, Wild EJ, Langbehn DR, Long JD, Warner JH, Scahill RI, Leavitt BR, Stout JC, Paulsen JS, Reilmann R, Unschuld PG, Wexler A, Margolis RL, Tabrizi SJ. Huntington disease: natural history, biomarkers and prospects for therapeutics. Nat Rev Neurol 2014; 10:204-16. [PMID: 24614516 DOI: 10.1038/nrneurol.2014.24] [Citation(s) in RCA: 653] [Impact Index Per Article: 65.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Huntington disease (HD) can be seen as a model neurodegenerative disorder, in that it is caused by a single genetic mutation and is amenable to predictive genetic testing, with estimation of years to predicted onset, enabling the entire range of disease natural history to be studied. Structural neuroimaging biomarkers show that progressive regional brain atrophy begins many years before the emergence of diagnosable signs and symptoms of HD, and continues steadily during the symptomatic or 'manifest' period. The continued development of functional, neurochemical and other biomarkers raises hopes that these biomarkers might be useful for future trials of disease-modifying therapeutics to delay the onset and slow the progression of HD. Such advances could herald a new era of personalized preventive therapeutics. We describe the natural history of HD, including the timing of emergence of motor, cognitive and emotional impairments, and the techniques that are used to assess these features. Building on this information, we review recent progress in the development of biomarkers for HD, and potential future roles of these biomarkers in clinical trials.
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Affiliation(s)
- Christopher A Ross
- Division of Neurobiology, Johns Hopkins University, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | - Russell L Margolis
- Division of Neurobiology, Johns Hopkins University, 600 North Wolfe Street, Baltimore, MD 21287, USA
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Tabrizi SJ, Scahill RI, Owen G, Durr A, Leavitt BR, Roos RA, Borowsky B, Landwehrmeyer B, Frost C, Johnson H, Craufurd D, Reilmann R, Stout JC, Langbehn DR. Predictors of phenotypic progression and disease onset in premanifest and early-stage Huntington's disease in the TRACK-HD study: analysis of 36-month observational data. Lancet Neurol 2013; 12:637-49. [PMID: 23664844 DOI: 10.1016/s1474-4422(13)70088-7] [Citation(s) in RCA: 571] [Impact Index Per Article: 51.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND TRACK-HD is a multinational prospective observational study of Huntington's disease (HD) that examines clinical and biological findings of disease progression in individuals with premanifest HD (preHD) and early-stage HD. We aimed to describe phenotypic changes in these participants over 36 months and identify baseline predictors of progression. METHODS Individuals without HD but carrying the mutant huntingtin gene (classed as preHD-A if ≥10·8 years and preHD-B if <10·8 years from predicted onset), participants with early HD (classed as HD1 if they had a total functional capacity score of 11-13 and HD2 if they had a score of 7-10), and healthy control individuals were assessed at four study sites in the Netherlands, the UK, France, and Canada. We measured 36-month change for 3T MRI, clinical, cognitive, quantitative motor, and neuropsychiatric assessments and examined their prognostic value. We also assessed the relation between disease progression and the combined effect of CAG repeat length and age. All participants were analysed according to their baseline subgroups. Longitudinal results were analysed using a combination of repeated-measure weighted least squares models and, when examining risk of new diagnosis, survival analysis. FINDINGS At baseline, 366 participants were enrolled between Jan 17, and Aug 26, 2008, and of these 298 completed 36-month follow-up: 97 controls, 58 participants with preHD-A, 46 with preHD-B, 66 with HD1, and 31 with HD2. In the preHD-B group, several quantitative motor and cognitive tasks showed significantly increased rates of decline at 36 months, compared with controls, whereas few had at 24 months. Of the cognitive measures, the symbol digit modality test was especially sensitive (adjusted mean loss 4·11 points [95% CI 1·49-6·73] greater than controls; p=0·003). Among psychiatric indicators, apathy ratings specifically showed significant increases (0·34 points [95% CI 0·02-0·66] greater than controls; p=0·038). There was little evidence of reliable change in non-imaging measures in the preHD-A group, with the exception of the speeded tapping inter-tap interval (0·01 s [95% CI 0·01-0·02] longer than controls; p=0·0001). Several baseline imaging, quantitative motor, and cognitive measures had prognostic value, independent of age and CAG repeat length, for predicting subsequent clinical diagnosis in preHD. Of these, grey-matter volume and inter-tap interval were particularly sensitive (p=0·013 and 0·002, respectively). Longitudinal change in these two measures was also greater in participants with preHD who received a diagnosis of HD during the study compared with those who did not, after controlling for CAG repeat length and age-related risk (p=0·006 and 0·0003, respectively). In early HD, imaging, quantitative motor, and cognitive measures were predictive of decline in total functional capacity and tracked longitudinal change; also, neuropsychiatric changes consistent with frontostriatal pathological abnormalities were associated with this loss of functional capacity (problem behaviours assessment composite behaviour score p<0·0001). Age and CAG repeat length explained variance in longitudinal change of multimodal measures, with the effect more prominent in preHD. INTERPRETATION We have shown changes in several outcome measures in individuals with preHD over 36 months. These findings further our understanding of HD progression and have implications for clinical trial design. FUNDING CHDI Foundation.
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Affiliation(s)
- Sarah J Tabrizi
- UCL Institute of Neurology, University College London, London, UK.
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Crawford HE, Hobbs NZ, Cole J, Rees EM, Owen G, Langbehn DR, Frost C, Landwehrmeyer B, Reilmann R, Craufurd D, Stout JC, Durr A, Leavitt B, Roos RA, Tabrizi SJ, Scahill RI. G03 Corpus callosal atrophy in Huntington's disease. J Neurol Psychiatry 2012. [DOI: 10.1136/jnnp-2012-303524.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Rowe KC, Paulsen JS, Langbehn DR, Wang C, Mills J, Beglinger LJ, Smith MM, Epping EA, Fiedorowicz JG, Duff K, Ruggle A, Moser DJ. Patterns of serotonergic antidepressant usage in prodromal Huntington disease. Psychiatry Res 2012; 196:309-14. [PMID: 22397915 PMCID: PMC3763706 DOI: 10.1016/j.psychres.2011.09.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Revised: 09/01/2011] [Accepted: 09/05/2011] [Indexed: 02/08/2023]
Abstract
Antidepressant usage in prodromal Huntington Disease (HD) remains uncharacterized, despite its relevance in designing experiments, studying outcomes of HD, and evaluating the efficacy of therapeutic interventions. We searched baseline medication logs of 787 prodromal HD and 215 healthy comparison (HC) participants for antidepressant use. Descriptive and mixed-effects logistic regression modeling characterized usage across participants. At baseline, approximately one in five prodromal HD participants took antidepressants. Of those, the vast majority took serotonergic antidepressants (selective serotonin reuptake inhibitor (SSRI) or serotonin/norepinephrine reuptake inhibitor (SNRI)). Significantly more prodromal HD participants used serotonergic antidepressants than their HC counterparts. Because of the prevalence of these medications, further analyses focused on this group alone. Mixed-effects logistic regression modeling revealed significant relationships of both closer proximity to diagnosis and female sex with greater likelihood to be prescribed a serotonergic antidepressant. More prodromal HD participants took antidepressants in general and specifically the subclass of serotonergic antidepressants than their at-risk counterparts, particularly when they were closer to predicted time of conversion to manifest HD. These propensities must be considered in studies of prodromal HD participants.
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Affiliation(s)
- Kelly C. Rowe
- Department of Psychiatry, The University of Iowa Carver College of Medicine, Iowa City, IA, USA,Interdepartmental Neuroscience Program, The University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Jane S. Paulsen
- Department of Psychiatry, The University of Iowa Carver College of Medicine, Iowa City, IA, USA,Interdepartmental Neuroscience Program, The University of Iowa Carver College of Medicine, Iowa City, IA, USA,Department of Neurology, The University of Iowa Carver College of Medicine, Iowa City, IA, USA,Department of Psychology, The University of Iowa Carver College of Medicine, Iowa City, IA, USA,Corresponding author at: The University of Iowa Carver College of Medicine, 1-305 Medical Education Building, Iowa City, IA, USA. Tel.: +1 52242 1000; 319 353 4551; fax: +1 319 353 3003
| | - Douglas R. Langbehn
- Department of Psychiatry, The University of Iowa Carver College of Medicine, Iowa City, IA, USA,Department of Biostatistics, The University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Chiachi Wang
- Department of Psychiatry, The University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - James Mills
- Department of Psychiatry, The University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Leigh J. Beglinger
- Department of Psychiatry, The University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Megan M. Smith
- Department of Psychiatry, The University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Eric A. Epping
- Department of Psychiatry, The University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Jess G. Fiedorowicz
- Department of Psychiatry, The University of Iowa Carver College of Medicine, Iowa City, IA, USA,Department of Epidemiology, The University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Kevin Duff
- Department of Neurology, The University of Utah, Salt Lake City, UT, USA
| | - Adam Ruggle
- Department of Psychiatry, The University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - David J. Moser
- Department of Psychiatry, The University of Iowa Carver College of Medicine, Iowa City, IA, USA,Interdepartmental Neuroscience Program, The University of Iowa Carver College of Medicine, Iowa City, IA, USA
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Tabrizi SJ, Reilmann R, Roos RAC, Durr A, Leavitt B, Owen G, Jones R, Johnson H, Craufurd D, Hicks SL, Kennard C, Landwehrmeyer B, Stout JC, Borowsky B, Scahill RI, Frost C, Langbehn DR. Potential endpoints for clinical trials in premanifest and early Huntington's disease in the TRACK-HD study: analysis of 24 month observational data. Lancet Neurol 2011; 11:42-53. [PMID: 22137354 DOI: 10.1016/s1474-4422(11)70263-0] [Citation(s) in RCA: 390] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND TRACK-HD is a prospective observational biomarker study in premanifest and early Huntington's disease (HD). In this report we define a battery of potential outcome measures for therapeutic trials. METHODS We assessed longitudinal data collected at baseline, 12 months, and 24 months at sites in Leiden (Netherlands), London (UK), Paris (France), and Vancouver (Canada). Participants were individuals without HD but carrying the mutant HTT gene (ie, premanifest HD), patients with early HD, and healthy control individuals matched by age and sex to the combined HD groups. Data were collected with 3T MRI, clinical, cognitive, quantitative motor, oculomotor, and neuropsychiatric assessments. We estimated adjusted, between-group differences in rates of change in these measures and concomitant longitudinal effect sizes. FINDINGS Longitudinal data were available for 116 control individuals, 117 premanifest gene carriers, and 116 participants with early HD. Significantly greater progressive grey-matter, white-matter, whole-brain, and regional atrophy was recorded in the premanifest and early HD groups than in the control group. Effect sizes for atrophy rates between participants with early HD and controls were largest in the caudate (2·04, 95% CI 1·68 to 2·48) and white matter (1·70, 1·40 to 2·08). Functional, quantitative motor, and cognitive measures deteriorated to a greater extent in the early HD group than in controls, with the largest effect size in the symbol digit modality test (1·00, 0·67 to 1·27). In the early HD group, changes in structural imaging and various cognitive and quantitative motor scores were associated with worsening total motor score (TMS) and total functional capacity (TFC). In the premanifest group, despite significant declines in regional and overall brain volumes, few functional variables showed significant 24 month change compared with controls; TMS, emotion recognition, and speeded tapping were exceptions. Premanifest individuals with progression, predefined as an increase in TMS score of 5 points or more, any TFC decline, or a new diagnostic confidence score of 4, exhibited higher rates of brain atrophy and deterioration on some quantitative motor tasks compared with other premanifest participants. INTERPRETATION On the basis of longitudinal effect size, we recommend several objective outcome measures for clinical trials in participants with early HD. Hypothetical treatment effects defined by slower longitudinal changes in these measures would be detectable over a realistic timescale with practical sample sizes. The restricted 24 month cognitive or motor decline in the premanifest sample illustrates the greater challenge in trial design for this group. FUNDING CHDI/HighQ Foundation Inc.
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Affiliation(s)
- Sarah J Tabrizi
- UCL Institute of Neurology, University College London, Queen Square, London, UK.
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48
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Scahill RI, Hobbs NZ, Say MJ, Bechtel N, Henley SMD, Hyare H, Langbehn DR, Jones R, Leavitt BR, Roos RAC, Durr A, Johnson H, Lehéricy S, Craufurd D, Kennard C, Hicks SL, Stout JC, Reilmann R, Tabrizi SJ. Clinical impairment in premanifest and early Huntington's disease is associated with regionally specific atrophy. Hum Brain Mapp 2011; 34:519-29. [PMID: 22102212 DOI: 10.1002/hbm.21449] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Revised: 07/19/2010] [Accepted: 08/08/2010] [Indexed: 11/06/2022] Open
Abstract
TRACK-HD is a multicentre longitudinal observational study investigating the use of clinical assessments and 3-Tesla magnetic resonance imaging as potential biomarkers for future therapeutic trials in Huntington's disease (HD). The cross-sectional data from this large well-characterized dataset provide the opportunity to improve our knowledge of how the underlying neuropathology of HD may contribute to the clinical manifestations of the disease across the spectrum of premanifest (PreHD) and early HD. Two hundred and thirty nine gene-positive subjects (120 PreHD and 119 early HD) from the TRACK-HD study were included. Using voxel-based morphometry (VBM), grey and white matter volumes were correlated with performance in four domains: quantitative motor (tongue force, metronome tapping, and gait); oculomotor [anti-saccade error rate (ASE)]; cognition (negative emotion recognition, spot the change and the University of Pennsylvania smell identification test) and neuropsychiatric measures (apathy, affect and irritability). After adjusting for estimated disease severity, regionally specific associations between structural loss and task performance were found (familywise error corrected, P < 0.05); impairment in tongue force, metronome tapping and ASE were all associated with striatal loss. Additionally, tongue force deficits and ASE were associated with volume reduction in the occipital lobe. Impaired recognition of negative emotions was associated with volumetric reductions in the precuneus and cuneus. Our study reveals specific associations between atrophy and decline in a range of clinical modalities, demonstrating the utility of VBM correlation analysis for investigating these relationships in HD.
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Affiliation(s)
- Rachael I Scahill
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London, United Kingdom.
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49
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Noyes R, Kukoyi OA, Longley SL, Langbehn DR, Stuart SP. Effects of continuity of care and patient dispositional factors on the physician-patient relationship. Ann Clin Psychiatry 2011; 23:180-5. [PMID: 21808749 PMCID: PMC4920260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND We developed a questionnaire to examine the influence of physician and patient variables on the quality of the physician-patient relationship. METHODS More than 300 family medicine patients completed self-report measures of the physician-patient relationship and variables likely to influence it. RESULTS The quality of relationship was related to continuity of physician care (having a primary physician, duration of that relationship, and frequency of visits) and to patient dispositional variables (neuroticism, positive and negative affectivity) but not to demographic variables. The regression model included having a primary physician, duration of relationship with that physician, and positive affectivity. Relationship quality was, in turn, associated with outcomes (adherence to care, treatment response, satisfaction with care, and commitment to physician). CONCLUSIONS The quality of physician-patient relationship is influenced by physician continuity and patient dispositional variables. Better understanding of these may contribute to the therapeutic potential of this important relationship.
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Affiliation(s)
- Russell Noyes
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA.
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50
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Carlozzi NE, Stout JC, Mills JA, Duff K, Beglinger LJ, Aylward EH, Whitlock KB, Solomon AC, Queller S, Langbehn DR, Johnson SA, Paulsen JS. Estimating premorbid IQ in the prodromal phase of a neurodegenerative disease. Clin Neuropsychol 2011; 25:757-77. [PMID: 21660882 PMCID: PMC3159182 DOI: 10.1080/13854046.2011.577811] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Estimates of premorbid intellect are often used in neuropsychological assessment to make inferences about cognitive decline. To optimize the method of controlling for premorbid intellect in assessments of prodromal neurodegenerative disease, we examined performance on the American National Adult Reading Test (ANART; administered during Years 1 and 3) and the two-subtest version of the Wechsler Abbreviated Scale of Intelligence (WASI; administered in Years 2 and 4) in an ongoing prospective longitudinal study of 371 participants with prodromal Huntington disease and 51 participants with normal CAG repeats. Although both measures performed similarly, the ANART demonstrated slightly lower variability in performance over a 2-year period and had slightly higher test-retest reliability than the WASI.
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Affiliation(s)
- Noelle E. Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, United States
| | - Julie C. Stout
- Department of Psychological and Brain Sciences, Indiana University, United States
- School of Psychology and Psychiatry, Monash University, Australia
| | - James A. Mills
- Department of Psychiatry, University of Iowa, United States
- Department of Biostatistics, University of Iowa, United States
| | - Kevin Duff
- Department of Neurology, University of Utah
| | | | | | - Kathryn B. Whitlock
- Department of Psychological and Brain Sciences, Indiana University, United States
| | - Andrea C. Solomon
- Department of Psychological and Brain Sciences, Indiana University, United States
| | - Sarah Queller
- Department of Psychological and Brain Sciences, Indiana University, United States
| | - Douglas R. Langbehn
- Department of Psychiatry, University of Iowa, United States
- Department of Biostatistics, University of Iowa, United States
| | | | - Jane S. Paulsen
- Department of Psychiatry, University of Iowa, United States
- Department of Neurology, University of Iowa, United States
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