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Horta-Barba A, Martinez-Horta S, Pérez-Pérez J, Puig-Davi A, de Lucia N, de Michele G, Salvatore E, Kehrer S, Priller J, Migliore S, Squitieri F, Castaldo A, Mariotti C, Mañanes V, Lopez-Sendon JL, Rodriguez N, Martinez-Descals A, Júlio F, Januário C, Delussi M, de Tommaso M, Noguera S, Ruiz-Idiago J, Sitek EJ, Wallner R, Nuzzi A, Pagonabarraga J, Kulisevsky J. Measuring cognitive impairment and monitoring cognitive decline in Huntington's disease: a comparison of assessment instruments. J Neurol 2023; 270:5408-5417. [PMID: 37462754 PMCID: PMC10576674 DOI: 10.1007/s00415-023-11804-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 04/14/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Progressive cognitive decline is an inevitable feature of Huntington's disease (HD) but specific criteria and instruments are still insufficiently developed to reliably classify patients into categories of cognitive severity and to monitor the progression of cognitive impairment. METHODS We collected data from a cohort of 180 positive gene-carriers: 33 with premanifest HD and 147 with manifest HD. Using a specifically developed gold-standard for cognitive status we classified participants into those with normal cognition, those with mild cognitive impairment, and those with dementia. We administered the Parkinson's Disease-Cognitive Rating Scale (PD-CRS), the MMSE and the UHDRS cogscore at baseline, and at 6-month and 12-month follow-up visits. Cutoff scores discriminating between the three cognitive categories were calculated for each instrument. For each cognitive group and instrument we addressed cognitive progression, sensitivity to change, and the minimally clinical important difference corresponding to conversion from one category to another. RESULTS The PD-CRS cutoff scores for MCI and dementia showed excellent sensitivity and specificity ratios that were not achieved with the other instruments. Throughout follow-up, in all cognitive groups, PD-CRS captured the rate of conversion from one cognitive category to another and also the different patterns in terms of cognitive trajectories. CONCLUSION The PD-CRS is a valid and reliable instrument to capture MCI and dementia syndromes in HD. It captures the different trajectories of cognitive progression as a function of cognitive status and shows sensitivity to change in MCI and dementia.
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Affiliation(s)
- Andrea Horta-Barba
- Department of Medicine, Autonomous University of Barcelona (UAB), Bellaterra, Spain
- Movement Disorders Unit, Neurology Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
- Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- European Huntington's Disease Network (EHDN), Ulm, Germany
| | - Saul Martinez-Horta
- Department of Medicine, Autonomous University of Barcelona (UAB), Bellaterra, Spain
- Movement Disorders Unit, Neurology Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
- Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- European Huntington's Disease Network (EHDN), Ulm, Germany
| | - Jesús Pérez-Pérez
- Department of Medicine, Autonomous University of Barcelona (UAB), Bellaterra, Spain
- Movement Disorders Unit, Neurology Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
- Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- European Huntington's Disease Network (EHDN), Ulm, Germany
| | - Arnau Puig-Davi
- Movement Disorders Unit, Neurology Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
- Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- European Huntington's Disease Network (EHDN), Ulm, Germany
| | - Natascia de Lucia
- European Huntington's Disease Network (EHDN), Ulm, Germany
- University of Naples "Federico II", Naples, Italy
| | - Giuseppe de Michele
- European Huntington's Disease Network (EHDN), Ulm, Germany
- University of Naples "Federico II", Naples, Italy
| | - Elena Salvatore
- European Huntington's Disease Network (EHDN), Ulm, Germany
- University of Naples "Federico II", Naples, Italy
| | - Stefanie Kehrer
- European Huntington's Disease Network (EHDN), Ulm, Germany
- Department of Neuropsychiatry, Charité-Universitätsmedizin, Berlin, Germany
| | - Josef Priller
- European Huntington's Disease Network (EHDN), Ulm, Germany
- Department of Neuropsychiatry, Charité-Universitätsmedizin, Berlin, Germany
| | - Simone Migliore
- Huntington and Rare Diseases Unit, Fondazione IRCCS Casa Sollievo Della Sofferenza Research Hospital, San Giovanni Rotondo, Italy
| | - Ferdinando Squitieri
- Huntington and Rare Diseases Unit, Fondazione IRCCS Casa Sollievo Della Sofferenza Research Hospital, San Giovanni Rotondo, Italy
| | - Anna Castaldo
- European Huntington's Disease Network (EHDN), Ulm, Germany
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Caterina Mariotti
- European Huntington's Disease Network (EHDN), Ulm, Germany
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Veronica Mañanes
- European Huntington's Disease Network (EHDN), Ulm, Germany
- Department of Neurology, Hospital Universitario Ramon Y Cajal, Madrid, Spain
| | - Jose Luis Lopez-Sendon
- European Huntington's Disease Network (EHDN), Ulm, Germany
- Department of Neurology, Hospital Universitario Ramon Y Cajal, Madrid, Spain
| | - Noelia Rodriguez
- European Huntington's Disease Network (EHDN), Ulm, Germany
- Department of Neurology, Fundación Jimenez Diaz, Madrid, Spain
| | - Asunción Martinez-Descals
- European Huntington's Disease Network (EHDN), Ulm, Germany
- Department of Neurology, Fundación Jimenez Diaz, Madrid, Spain
| | - Filipa Júlio
- European Huntington's Disease Network (EHDN), Ulm, Germany
- Coimbra Institute for Biomedical Imaging and Translational Research-CIBIT, University of Coimbra, Coimbra, Portugal
- Neurology Department, Coimbra University Hospital, Coimbra, Portugal
| | - Cristina Januário
- European Huntington's Disease Network (EHDN), Ulm, Germany
- Coimbra Institute for Biomedical Imaging and Translational Research-CIBIT, University of Coimbra, Coimbra, Portugal
- Neurology Department, Coimbra University Hospital, Coimbra, Portugal
| | - Marianna Delussi
- European Huntington's Disease Network (EHDN), Ulm, Germany
- Applied Neurophysiology and Pain Unit, Apulian Center for Huntington's Disease SMBNOS Department, "Aldo Moro" University, Bari, Italy
| | - Marina de Tommaso
- European Huntington's Disease Network (EHDN), Ulm, Germany
- Applied Neurophysiology and Pain Unit, Apulian Center for Huntington's Disease SMBNOS Department, "Aldo Moro" University, Bari, Italy
| | - Sandra Noguera
- European Huntington's Disease Network (EHDN), Ulm, Germany
- Hospital Mare de Deu de La Mercè, Barcelona, Spain
| | - Jesús Ruiz-Idiago
- European Huntington's Disease Network (EHDN), Ulm, Germany
- Hospital Mare de Deu de La Mercè, Barcelona, Spain
| | - Emilia J Sitek
- European Huntington's Disease Network (EHDN), Ulm, Germany
- Department of Neurological and Psychiatric Nursing, Faculty of Health Science Medical, University of Gdansk, Gdańsk, Poland
- Department of Neurology, St. Adalbert Hospital, Copernicus, Gdańsk, Poland
| | - Renata Wallner
- Department of Psychiatry, Medical University of Wroclaw, Wroclaw, Poland
| | - Angela Nuzzi
- European Huntington's Disease Network (EHDN), Ulm, Germany
| | - Javier Pagonabarraga
- Department of Medicine, Autonomous University of Barcelona (UAB), Bellaterra, Spain
- Movement Disorders Unit, Neurology Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
- Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- European Huntington's Disease Network (EHDN), Ulm, Germany
| | - Jaime Kulisevsky
- Department of Medicine, Autonomous University of Barcelona (UAB), Bellaterra, Spain.
- Movement Disorders Unit, Neurology Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain.
- Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain.
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.
- European Huntington's Disease Network (EHDN), Ulm, Germany.
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Horta-Barba A, Martinez-Horta S, Perez-Perez J, Sampedro F, de Lucia N, De Michele G, Salvatore E, Kehrer S, Priller J, Migliore S, Squitieri F, Castaldo A, Mariotti C, Mañanes V, Lopez-Sendon JL, Rodriguez N, Martinez-Descals A, Júlio F, Janurio C, Delussi M, de Tommaso M, Noguera S, Ruiz-Idiago J, Sitek EJ, Wallner R, Nuzzi A, Pagonabarraga J, Kulisevsky J. Arithmetic Word-Problem Solving as Cognitive Marker of Progression in Pre-Manifest and Manifest Huntington's Disease. J Huntingtons Dis 2021; 10:459-468. [PMID: 34602494 DOI: 10.3233/jhd-210480] [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 Arithmetic word-problem solving depends on the interaction of several cognitive processes that may be affected early in the disease in gene-mutation carriers for Huntington's disease (HD). OBJECTIVE Our goal was to examine the pattern of performance of arithmetic tasks in premanifest and manifest HD, and to examine correlations between arithmetic task performance and other neuropsychological tasks. METHODS We collected data from a multicenter cohort of 165 HD gene-mutation carriers. The sample consisted of 31 premanifest participants: 16 far-from (>12 years estimated time to diagnosis; preHD-A) and 15 close-to (≤12 years estimated time to diagnosis; preHD-B), 134 symptomatic patients (early-mild HD), and 37 healthy controls (HC). We compared performance between groups and explored the associations between arithmetic word-problem solving and neuropsychological and clinical variables. RESULTS Total arithmetic word-problem solving scores were lower in preHD-B patients than in preHD-A (p < 0.05) patients and HC (p < 0.01). Early-mild HD patients had lower scores than preHD patients (p < 0.001) and HC (p < 0.001). Compared to HC, preHD and early-mild HD participants made more errors as trial complexity increased. Moreover, arithmetic word-problem solving scores were significantly associated with measures of global cognition (p < 0.001), frontal-executive functions (p < 0.001), attention (p < 0.001) visual working memory (p < 0.001), mental rotation (p < 0.001), and confrontation naming (p < 0.05). CONCLUSION Arithmetic word-problem solving is affected early in the course of HD and is related to deficient processes in frontal-executive and mentalizing-related processes.
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Affiliation(s)
- Andrea Horta-Barba
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Department of Medicine, Autonomous University of Barcelona (UAB), Barcelona, Spain.,European Huntington's Disease Network (EHDN)
| | - Saul Martinez-Horta
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Department of Medicine, Autonomous University of Barcelona (UAB), Barcelona, Spain.,European Huntington's Disease Network (EHDN)
| | - Jesús Perez-Perez
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Department of Medicine, Autonomous University of Barcelona (UAB), Barcelona, Spain.,European Huntington's Disease Network (EHDN)
| | - Frederic Sampedro
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Natascia de Lucia
- European Huntington's Disease Network (EHDN).,University of Naples "Federico II", Naples, Italy
| | - Giuseppe De Michele
- European Huntington's Disease Network (EHDN).,University of Naples "Federico II", Naples, Italy
| | - Elena Salvatore
- European Huntington's Disease Network (EHDN).,University of Naples "Federico II", Naples, Italy
| | - Stefanie Kehrer
- European Huntington's Disease Network (EHDN).,Department of Neuropsychiatry, Charité - Universitätsmedizin, Berlin, Germany
| | - Josef Priller
- European Huntington's Disease Network (EHDN).,Department of Neuropsychiatry, Charité - Universitätsmedizin, Berlin, Germany
| | - Simone Migliore
- Huntington and Rare Diseases Unit, Fondazione IRCCS Casa Sollievo della, Sofferenza Research Hospital, San Giovanni Rotondo, Italy
| | - Ferdinando Squitieri
- Huntington and Rare Diseases Unit, Fondazione IRCCS Casa Sollievo della, Sofferenza Research Hospital, San Giovanni Rotondo, Italy
| | - Anna Castaldo
- European Huntington's Disease Network (EHDN).,Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Caterina Mariotti
- European Huntington's Disease Network (EHDN).,Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Veronica Mañanes
- European Huntington's Disease Network (EHDN).,Department of Neurology, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Jose Luis Lopez-Sendon
- European Huntington's Disease Network (EHDN).,Department of Neurology, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Noelia Rodriguez
- European Huntington's Disease Network (EHDN).,Department of Neurology. Fundación Jimenez Diaz, Madrid, Spain
| | - Asunción Martinez-Descals
- European Huntington's Disease Network (EHDN).,Department of Neurology. Fundación Jimenez Diaz, Madrid, Spain
| | - Filipa Júlio
- European Huntington's Disease Network (EHDN).,Coimbra Institute for Biomedical Imaging and Translational Research - CIBIT, University of Coimbra, Coimbra, Portugal.,Neurology Department, Coimbra University Hospital, Coimbra, Portugal
| | - Cristina Janurio
- European Huntington's Disease Network (EHDN).,Coimbra Institute for Biomedical Imaging and Translational Research - CIBIT, University of Coimbra, Coimbra, Portugal.,Neurology Department, Coimbra University Hospital, Coimbra, Portugal
| | - Marianna Delussi
- European Huntington's Disease Network (EHDN).,Applied Neurophysiology and Pain Unit, Apulian Center for Huntington's Disease SMBNOS Department, "Aldo Moro" University, Bari, Italy
| | - Marina de Tommaso
- European Huntington's Disease Network (EHDN).,Applied Neurophysiology and Pain Unit, Apulian Center for Huntington's Disease SMBNOS Department, "Aldo Moro" University, Bari, Italy
| | - Sandra Noguera
- European Huntington's Disease Network (EHDN).,Hospital Mare de Deu de la Mercè, Barcelona, Spain
| | - Jesus Ruiz-Idiago
- European Huntington's Disease Network (EHDN).,Hospital Mare de Deu de la Mercè, Barcelona, Spain
| | - Emilia J Sitek
- European Huntington's Disease Network (EHDN).,Department of Neurological and Psychiatric Nursing, Faculty of Health Science, Medical University of Gdansk, Gdańsk, Poland.,Department of Neurology, St. Adalbert Hospital, Gdańsk, Poland
| | - Renata Wallner
- Department of Psychiatry, Medical University of Wroclaw, Wroclaw, Poland
| | | | - Javier Pagonabarraga
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Department of Medicine, Autonomous University of Barcelona (UAB), Barcelona, Spain.,European Huntington's Disease Network (EHDN)
| | - Jaime Kulisevsky
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Department of Medicine, Autonomous University of Barcelona (UAB), Barcelona, Spain.,European Huntington's Disease Network (EHDN)
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3
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Martinez-Horta S, Horta-Barba A, Perez-Perez J, Sampedro F, de Lucia N, De Michele G, Kehrer S, Priller J, Migliore S, Squitieri F, Castaldo A, Mariotti C, Mañanes V, Lopez-Sendon JL, Rodriguez N, Martinez-Descals A, Garcia-Ruiz P, Júlio F, Januário C, Delussi M, de Tommaso M, Noguera S, Ruiz-Idiago J, Sitek EJ, Nuzzi A, Pagonabarraga J, Kulisevsky J. Utility of the Parkinson's disease-Cognitive Rating Scale for the screening of global cognitive status in Huntington's disease. J Neurol 2020; 267:1527-1535. [PMID: 32030521 DOI: 10.1007/s00415-020-09730-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/22/2020] [Accepted: 01/24/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cognitive impairment is an essential feature of Huntington's disease (HD) and dementia is a predictable outcome in all patients. However, validated instruments to assess global cognitive performance in the field of HD are lacking. OBJECTIVES We aimed to explore the utility of the Parkinson's disease-Cognitive Rating Scale (PD-CRS) for the screening of global cognition in HD. METHODS A multicenter cohort of 132 HD patients at different disease stages and 33 matched healthy controls were classified as having preserved cognition, mild cognitive impairment (HD-MCI) or dementia (HD-Dem) according to the Clinical Dementia Rating and Functional Independence Score. The PD-CRS and the Mini-Mental State Examination were administered. Receiver operating characteristic curve analysis was used to determine optimal cutoffs to differentiate patients according to their cognitive status. RESULTS A PD-CRS cutoff score ≤ 81/82 was optimal to detect HD-MCI (sensitivity = 93%; specificity = 80%; area under the curve (AUC) = 0.940), and ≤ 63/64 was optimal to detect HD-Dem (sensitivity = 90%; specificity = 87%; AUC = 0.933). MMSE scores failed to show robust psychometric properties in this context. DISCUSSION The PD-CRS is a valid and reliable instrument to assess global cognition in HD in routine clinical care and clinical trials.
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Affiliation(s)
- Saul Martinez-Horta
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, 08041, Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Autonomous University of Barcelona, Barcelona, Spain.,European Huntington's Disease Network (EHDN), Ulm, Germany
| | - Andrea Horta-Barba
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, 08041, Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,European Huntington's Disease Network (EHDN), Ulm, Germany
| | - Jesús Perez-Perez
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, 08041, Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Autonomous University of Barcelona, Barcelona, Spain.,European Huntington's Disease Network (EHDN), Ulm, Germany
| | - Frederic Sampedro
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, 08041, Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Autonomous University of Barcelona, Barcelona, Spain
| | - Natascia de Lucia
- European Huntington's Disease Network (EHDN), Ulm, Germany.,University of Naples "Federico II", Naples, Italy
| | - Giuseppe De Michele
- European Huntington's Disease Network (EHDN), Ulm, Germany.,University of Naples "Federico II", Naples, Italy
| | - Stefanie Kehrer
- European Huntington's Disease Network (EHDN), Ulm, Germany.,Department of Neuropsychiatry, Charité, Universitätsmedizin, Berlin, Germany
| | - Josef Priller
- European Huntington's Disease Network (EHDN), Ulm, Germany.,Department of Neuropsychiatry, Charité, Universitätsmedizin, Berlin, Germany
| | - Simone Migliore
- Huntington and Rare Diseases Unit, Fondazione IRCCS Casa Sollievo della Sofferenza Research Hospital, San Giovanni Rotondo, Italy
| | - Ferdinando Squitieri
- Huntington and Rare Diseases Unit, Fondazione IRCCS Casa Sollievo della Sofferenza Research Hospital, San Giovanni Rotondo, Italy
| | - Anna Castaldo
- European Huntington's Disease Network (EHDN), Ulm, Germany.,Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Caterina Mariotti
- European Huntington's Disease Network (EHDN), Ulm, Germany.,Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Veronica Mañanes
- European Huntington's Disease Network (EHDN), Ulm, Germany.,Department of Neurology, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Jose Luis Lopez-Sendon
- European Huntington's Disease Network (EHDN), Ulm, Germany.,Department of Neurology, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Noelia Rodriguez
- European Huntington's Disease Network (EHDN), Ulm, Germany.,Department of Neurology, Fundación Jimenez Diaz, Madrid, Spain
| | - Asunción Martinez-Descals
- European Huntington's Disease Network (EHDN), Ulm, Germany.,Department of Neurology, Fundación Jimenez Diaz, Madrid, Spain
| | - Pedro Garcia-Ruiz
- European Huntington's Disease Network (EHDN), Ulm, Germany.,Department of Neurology, Fundación Jimenez Diaz, Madrid, Spain
| | - Filipa Júlio
- European Huntington's Disease Network (EHDN), Ulm, Germany.,Neurology Department, Coimbra University Hospital, Coimbra, Portugal.,Coimbra Institute for Biomedical Imaging and Translational Research - CIBIT, University of Coimbra, Coimbra, Portugal
| | - Cristina Januário
- European Huntington's Disease Network (EHDN), Ulm, Germany.,Neurology Department, Coimbra University Hospital, Coimbra, Portugal.,Coimbra Institute for Biomedical Imaging and Translational Research - CIBIT, University of Coimbra, Coimbra, Portugal
| | - Marianna Delussi
- European Huntington's Disease Network (EHDN), Ulm, Germany.,SMBNOS Department, Bari Aldo Moro University, Bari, Italy
| | - Marina de Tommaso
- European Huntington's Disease Network (EHDN), Ulm, Germany.,SMBNOS Department, Bari Aldo Moro University, Bari, Italy
| | - Sandra Noguera
- European Huntington's Disease Network (EHDN), Ulm, Germany.,Hospital Mare de Deu de la Mercè, Barcelona, Spain
| | - Jesus Ruiz-Idiago
- European Huntington's Disease Network (EHDN), Ulm, Germany.,Hospital Mare de Deu de la Mercè, Barcelona, Spain.,Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Emilia J Sitek
- European Huntington's Disease Network (EHDN), Ulm, Germany.,Department of Neurological and Psychiatric Nursing, Faculty of Health Sciences, Medical University of Gdansk, Gdańsk, Poland.,Department of Neurology, St. Adalbert Hospital, Copernicus, PL, Gdańsk, Poland
| | - Angela Nuzzi
- European Huntington's Disease Network (EHDN), Ulm, Germany
| | - Javier Pagonabarraga
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, 08041, Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Autonomous University of Barcelona, Barcelona, Spain.,European Huntington's Disease Network (EHDN), Ulm, Germany
| | - Jaime Kulisevsky
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, 08041, Barcelona, Spain. .,Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain. .,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain. .,Autonomous University of Barcelona, Barcelona, Spain. .,European Huntington's Disease Network (EHDN), Ulm, Germany.
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