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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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2
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Holm SP, Wolfer AM, Pointeau GH, Lipsmeier F, Lindemann M. Practice effects in performance outcome measures in patients living with neurologic disorders – A systematic review. Heliyon 2022; 8:e10259. [PMID: 36082322 PMCID: PMC9445299 DOI: 10.1016/j.heliyon.2022.e10259] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/05/2021] [Accepted: 08/05/2022] [Indexed: 10/26/2022] Open
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Ramirez-Garcia G, Galvez V, Diaz R, Campos-Romo A, Fernandez-Ruiz J. Montreal Cognitive Assessment (MoCA) performance in Huntington's disease patients correlates with cortical and caudate atrophy. PeerJ 2022; 10:e12917. [PMID: 35402100 PMCID: PMC8988933 DOI: 10.7717/peerj.12917] [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: 09/03/2021] [Accepted: 01/20/2022] [Indexed: 01/11/2023] Open
Abstract
Huntington's Disease (HD) is an autosomal neurodegenerative disease characterized by motor, cognitive, and psychiatric symptoms. Cognitive impairment develops gradually in HD patients, progressing later into a severe cognitive dysfunction. The Montreal Cognitive Assessment (MoCA) is a brief screening test commonly employed to detect mild cognitive impairment, which has also been useful to assess cognitive decline in HD patients. However, the relationship between MoCA performance and brain structural integrity in HD patients remains unclear. Therefore, to explore this relationship we analyzed if cortical thinning and subcortical nuclei volume differences correlated with HD patients' MoCA performance. Twenty-two HD patients and twenty-two healthy subjects participated in this study. T1-weighted images were acquired to analyze cortical thickness and subcortical nuclei volumes. Group comparison analysis showed a significantly lower score in the MoCA global performance of HD patients. Also, the MoCA total score correlated with cortical thinning of fronto-parietal and temporo-occipital cortices, as well as with bilateral caudate volume differences in HD patients. These results provide new insights into the effectiveness of using the MoCA test to detect cognitive impairment and the brain atrophy pattern associated with the cognitive status of prodromal/early HD patients.
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Affiliation(s)
- Gabriel Ramirez-Garcia
- Departamento de Fisiología, Universidad Nacional Autónoma de Mexico, Ciudad de Mexico, Mexico
| | - Victor Galvez
- Escuela de Psicología, Universidad Panamericana, Ciudad de Mexico, Mexico
| | - Rosalinda Diaz
- Departamento de Fisiología, Universidad Nacional Autónoma de Mexico, Ciudad de Mexico, Mexico
| | - Aurelio Campos-Romo
- Facultad de Medicina, Unidad Periférica de Neurociencias, Universidad Nacional Autónoma de México/Instituto Nacional de Neurologia y Neurocirugia, Ciudad de Mexico, Mexico
| | - Juan Fernandez-Ruiz
- Departamento de Fisiología, Universidad Nacional Autónoma de Mexico, Ciudad de Mexico, Mexico
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Abstract
OBJECTIVE This study aims to systematically review evidence of the accuracy of the Montreal Cognitive Assessment (MoCA) for evaluating the presence of cognitive impairment in patients with Huntington's disease (HD) and to outline the quality and quantity of research evidence available about the use of the MoCA in this population. METHODS We conducted a systematic literature review, searching four databases from inception until April 2020. RESULTS We identified 26 studies that met the inclusion criteria: two case-control studies comparing the MoCA to a battery of tests, three studies comparing MoCA to Mini-Mental State Examination, two studies estimating the prevalence of cognitive impairment in individuals with HD and 19 studies or clinical trials in which the MoCA was used as an instrument for the cognitive assessment of participants with HD. We found no cross-sectional studies in which participants received the index test (MoCA) and a reference standard diagnostic assessment composed of an extensive neuropsychological battery. The publication period ranged from 2010 to 2020. CONCLUSIONS In patients with HD, the MoCA provides information about disturbances in general cognitive function. Even if the MoCA demonstrated good sensitivity and specificity when used at the recommended threshold score of 26, further cross-sectional studies are required to examine the optimum cutoff score for detecting cognitive impairments in patients with HD. Moreover, more studies are necessary to determine whether the MoCA adequately assesses cognitive status in individuals with HD.
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5
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De Paepe AE, Ara A, Garcia-Gorro C, Martinez-Horta S, Perez-Perez J, Kulisevsky J, Rodriguez-Dechicha N, Vaquer I, Subira S, Calopa M, Muñoz E, Santacruz P, Ruiz-Idiago J, Mareca C, de Diego-Balaguer R, Camara E. Gray Matter Vulnerabilities Predict Longitudinal Development of Apathy in Huntington's Disease. Mov Disord 2021; 36:2162-2172. [PMID: 33998063 DOI: 10.1002/mds.28638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/20/2020] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Apathy, a common neuropsychiatric disturbance in Huntington's disease (HD), is subserved by a complex neurobiological network. However, no study has yet employed a whole-brain approach to examine underlying regional vulnerabilities that may precipitate apathy changes over time. OBJECTIVES To identify whole-brain gray matter volume (GMV) vulnerabilities that may predict longitudinal apathy development in HD. METHODS Forty-five HD individuals (31 female) were scanned and evaluated for apathy and other neuropsychiatric features using the short-Problem Behavior Assessment for a maximum total of six longitudinal visits (including baseline). In order to identify regions where changes in GMV may describe changes in apathy, we performed longitudinal voxel-based morphometry (VBM) on those 33 participants with a magnetic resonance imaging (MRI) scan on their second visit at 18 ± 6 months follow-up (78 MRI datasets). We next employed a generalized linear mixed-effects model (N = 45) to elucidate whether initial and specific GMV may predict apathy development over time. RESULTS Utilizing longitudinal VBM, we revealed a relationship between increases in apathy and specific GMV atrophy in the right middle cingulate cortex (MCC). Furthermore, vulnerability in the right MCC volume at baseline successfully predicted the severity and progression of apathy over time. CONCLUSIONS This study highlights that individual differences in apathy in HD may be explained by variability in atrophy and initial vulnerabilities in the right MCC, a region implicated in action-initiation. These findings thus serve to facilitate the prediction of an apathetic profile, permitting targeted, time-sensitive interventions in neurodegenerative disease with potential implications in otherwise healthy populations. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Audrey E De Paepe
- Cognition and Brain Plasticity Unit, Bellvitge Biomedical Research Institute - IDIBELL, Barcelona, Spain.,Department of Cognition, Development and Educational Psychology, Universitat de Barcelona, Barcelona, Spain
| | - Alberto Ara
- Cognition and Brain Plasticity Unit, Bellvitge Biomedical Research Institute - IDIBELL, Barcelona, Spain.,Department of Cognition, Development and Educational Psychology, Universitat de Barcelona, Barcelona, Spain.,Institute of Neurosciences, Universitat de Barcelona, Barcelona, Spain
| | - Clara Garcia-Gorro
- Cognition and Brain Plasticity Unit, Bellvitge Biomedical Research Institute - IDIBELL, Barcelona, Spain.,Department of Cognition, Development and Educational Psychology, Universitat de Barcelona, Barcelona, Spain
| | - Saül Martinez-Horta
- European Huntington's Disease Network, Ulm, Germany.,Movement Disorders Unit, Department of Neurology, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,CIBERNED (Center for Networked Biomedical Research on Neurodegenerative Diseases), Carlos III Institute, Madrid, Spain
| | - Jesus Perez-Perez
- European Huntington's Disease Network, Ulm, Germany.,Movement Disorders Unit, Department of Neurology, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,CIBERNED (Center for Networked Biomedical Research on Neurodegenerative Diseases), Carlos III Institute, Madrid, Spain
| | - Jaime Kulisevsky
- European Huntington's Disease Network, Ulm, Germany.,Movement Disorders Unit, Department of Neurology, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,CIBERNED (Center for Networked Biomedical Research on Neurodegenerative Diseases), Carlos III Institute, Madrid, Spain
| | | | - Irene Vaquer
- Hestia Duran i Reynals, Hospital Duran i Reynals, Hospitalet de Llobregat, Barcelona, Spain
| | - Susana Subira
- Hestia Duran i Reynals, Hospital Duran i Reynals, Hospitalet de Llobregat, Barcelona, Spain.,Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Matilde Calopa
- Movement Disorders Unit, Neurology Service, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Esteban Muñoz
- European Huntington's Disease Network, Ulm, Germany.,Movement Disorders Unit, Neurology Service, Hospital Clínic, Barcelona, Spain.,IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain.,Facultat de Medicina, University of Barcelona, Barcelona, Spain
| | - Pilar Santacruz
- Movement Disorders Unit, Neurology Service, Hospital Clínic, Barcelona, Spain
| | - Jesus Ruiz-Idiago
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Hospital Mare de Deu de la Mercè, Barcelona, Spain
| | - Celia Mareca
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ruth de Diego-Balaguer
- Cognition and Brain Plasticity Unit, Bellvitge Biomedical Research Institute - IDIBELL, Barcelona, Spain.,Department of Cognition, Development and Educational Psychology, Universitat de Barcelona, Barcelona, Spain.,Institute of Neurosciences, Universitat de Barcelona, Barcelona, Spain.,European Huntington's Disease Network, Ulm, Germany.,ICREA (Catalan Institute for Research and Advanced Studies), Barcelona, Spain
| | - Estela Camara
- Cognition and Brain Plasticity Unit, Bellvitge Biomedical Research Institute - IDIBELL, Barcelona, Spain.,Department of Cognition, Development and Educational Psychology, Universitat de Barcelona, Barcelona, Spain.,European Huntington's Disease Network, Ulm, Germany
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Mühlbäck A, Frank W, Klempířová O, Bezdíček O, Schmitt L, Hofstetter N, Landwehrmeyer GB, Klempíř J. Validation Study of a German Cognitive Battery for Huntington's Disease: Relationship Between Cognitive Performance, Functional Decline, and Disease Burden. Arch Clin Neuropsychol 2021; 36:74-86. [PMID: 32613239 PMCID: PMC7809684 DOI: 10.1093/arclin/acaa038] [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: 02/04/2020] [Revised: 04/27/2020] [Accepted: 06/02/2020] [Indexed: 11/14/2022] Open
Abstract
Objective Cognitive decline is a key characteristic of Huntington’s disease (HD). This study aimed to investigate the diagnostic accuracy of a cognitive battery with six tests used by most HD research centers to assess cognitive impairment in HD. Method In total, 106 HD patients in different disease stages with more (HD-CD, N = 30) and less cognitive impairments (HD-NC, N = 70) and 100 healthy controls (NC) were matched by age, sex, and education and were examined using a standardized protocol including cognitive, motor, and functional assessments. Results One-way between-groups analysis of variance showed that controls performed significantly better than HD patients and that HD-NC significantly outperformed HD-CD patients in all cognitive tests (NC > HD-NC > HD-CD), with all Games-Howell post-hoc tests p < .001. Analyses using area under the receiver-operating characteristic curve (AUC) disclosed the diagnostic accuracy of all tests included in the battery to discriminate between NC and HD patients with AUC ranging from 0.809 to 0.862 (all p < .001) and between HD-CD and HD-NC patients with AUC ranging from 0.833 to 0.899 (all p < .001). In both analysis, Stroop Color Naming Test showed the highest discriminative potential. Additional analyses showed that cognitive deficits in all domains progressed with disease duration. Moreover, cognitive performance correlated with the severity of motor and functional impairment (all p < .001) and with the Disease Burden Score regardless of disease duration and age. Conclusion Our results indicate that the cognitive battery is a suitable tool for assessing cognitive impairment in HD.
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Affiliation(s)
- Alžbeta Mühlbäck
- Department of Neuropsychiatry, Huntington Center South, kbo-Isar-Amper-Klinikum, Taufkirchen (Vils), Germany.,Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.,Department of Neurology, University Hospital of Ulm, Ulm, Germany
| | - Wiebke Frank
- Department of Neurology, University Hospital of Ulm, Ulm, Germany
| | - Olga Klempířová
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Ondřej Bezdíček
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Lena Schmitt
- Department of Neuropsychiatry, Huntington Center South, kbo-Isar-Amper-Klinikum, Taufkirchen (Vils), Germany
| | - Nina Hofstetter
- Department of Interdisciplinary Pain Therapy, Day Clinic, Klinikum Erding, Erding, Germany
| | | | - Jiří Klempíř
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
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Yitzhak N, Gurevich T, Inbar N, Lecker M, Atias D, Avramovich H, Aviezer H. Recognition of emotion from subtle and non-stereotypical dynamic facial expressions in Huntington's disease. Cortex 2020; 126:343-54. [DOI: 10.1016/j.cortex.2020.01.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 08/31/2019] [Accepted: 01/27/2020] [Indexed: 11/19/2022]
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Winder JY, Achterberg WP, Gardiner SL, Roos RAC. Longitudinal assessment of the Unified Huntington's Disease Rating Scale (UHDRS) and UHDRS-For Advanced Patients (UHDRS-FAP) in patients with late stage Huntington's disease. Eur J Neurol 2019; 26:780-785. [PMID: 30576046 DOI: 10.1111/ene.13889] [Citation(s) in RCA: 9] [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: 09/07/2018] [Accepted: 12/17/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Symptoms and signs in patients with Huntington's disease are usually assessed with the Unified Huntington's Disease Rating Scale (UHDRS). Ceiling and floor effects hamper the measurement of disease progression in patients with late stage Huntington's disease and therefore the UHDRS-For Advanced Patients (UHDRS-FAP) has been developed. The aim of this longitudinal study was to examine if the UHDRS-FAP and UHDRS are sensitive enough to detect change over time in late stage Huntington's disease. METHODS Forty nursing home residents and patients receiving day-care were assessed with the UHDRS, UHDRS-FAP and Care Dependency Scale (CDS). After 6 months, the assessment scales were completed again in 29 patients. Changes between baseline and follow-up were calculated using paired t tests. Wilcoxon signed-rank tests were used to calculate longitudinal changes for middle and late stage patients separately. RESULTS The motor and cognitive score of the UHDRS-FAP deteriorated during 6 months' follow-up, whilst the motor and cognitive score of the UHDRS did not show change. Two functional domains of the UHDRS and the CDS also declined. The behavioral score significantly improved with both rating scales in late stage patients. CONCLUSIONS Our results suggest that the UHDRS-FAP motor and cognitive score, the functional domains of the UHDRS, and the CDS can detect disease progression in late stage Huntington's disease. Therefore, the use of these scores in nursing homes is recommended to optimize care by monitoring disease progression and by evaluating the effect of interventions in clinical care. Psychiatric symptoms seem to fade away as the disease progresses.
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Affiliation(s)
- J Y Winder
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - W P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.,Huntington Center Topaz Overduin, Katwijk, The Netherlands
| | - S L Gardiner
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - R A C Roos
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
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9
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Winder JY, Achterberg WP, Marinus J, Gardiner SL, Roos RAC. Assessment Scales for Patients with Advanced Huntington's Disease: Comparison of the UHDRS and UHDRS-FAP. Mov Disord Clin Pract 2018; 5:527-533. [PMID: 30515443 DOI: 10.1002/mdc3.12646] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 03/19/2018] [Revised: 05/07/2018] [Accepted: 05/25/2018] [Indexed: 11/08/2022] Open
Abstract
Background The standard clinical assessment tool in Huntington's disease is the Unified Huntington's Disease Rating Scale (UHDRS). In patients with advanced Huntington's disease ceiling and floor effects of the UHDRS hamper the detection of changes. Therefore, the UHDRS-For Advanced Patients (UHDRS-FAP) has been designed for patients with late-stage Huntington's disease. Objectives This cross-sectional study aims to examine if the UHDRS-FAP can differentiate better between patients with advanced Huntington's disease than the UHDRS. Methods Forty patients, who were institutionalized or received day-care, were assessed with the UHDRS, UHDRS-FAP, and Care Dependency Scale (CDS). The severity of Huntington's disease was defined by the Total Functional Capacity (TFC). Comparisons between consecutive TFC stages were performed for all domains of the UHDRS, UHDRS-FAP, and CDS using Mann-Whitney U tests. Results The motor scores of the UHDRS-FAP and UHDRS were the only subscales with significantly worse scores in TFC stage 5 compared to stage 4. In TFC stages 4-5, the range of the UHDRS-FAP motor score was broader, the standard error of measurement was lower, and the effect size r was higher than for the UHDRS motor score. The CDS declined significantly across all TFC stages. Conclusions Our results suggest that the UHDRS-FAP motor score might differentiate better between patients with severe Huntington's disease than the UHDRS motor score. Therefore, the UHDRS-FAP motor score is potentially a better instrument than the UHDRS motor score to improve disease monitoring and, subsequently, care in patients with advanced Huntington's disease in long-term care facilities.
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Affiliation(s)
- Jessica Y Winder
- Department of Neurology Leiden University Medical Center Leiden The Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care Leiden University Medical Center Leiden The Netherlands.,Huntington Center Topaz Overduin Katwijk The Netherlands
| | - Johan Marinus
- Department of Neurology Leiden University Medical Center Leiden The Netherlands
| | - Sarah L Gardiner
- Department of Neurology Leiden University Medical Center Leiden The Netherlands.,Department of Human Genetics Leiden University Medical Center Leiden The Netherlands
| | - Raymund A C Roos
- Department of Neurology Leiden University Medical Center Leiden The Netherlands
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10
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Winder JY, Roos RA, Burgunder J, Marinus J, Reilmann R. Interrater Reliability of the Unified Huntington's Disease Rating Scale-Total Motor Score Certification. Mov Disord Clin Pract 2018; 5:290-295. [PMID: 30363437 PMCID: PMC6174470 DOI: 10.1002/mdc3.12618] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 12/06/2017] [Revised: 02/06/2018] [Accepted: 03/09/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The clinical assessment of motor symptoms in Huntington's disease is usually performed with the Unified Huntington's Disease Rating Scale-Total Motor Score (UHDRS-TMS). A high interrater reliability is desirable to monitor symptom progression. Therefore, a teaching video and a system for annual online certification has been developed and implemented. OBJECTIVES The aim of this study is to investigate the interrater reliability of the UHDRS-TMS and of its subitems, and to examine the performance of raters in consecutive years. METHODS Data from the online UHDRS-TMS certification were used. The interrater reliability was assessed for all first-time participants (n = 944) between 2009 and 2016. Intraclass correlation coefficients (ICC) were calculated for each year separately and the mean was taken as the total ICC. RESULTS The UHDRS-TMS (ICC = 0.847), tandem walking (0.824), pronate/supinate hands left (0.713), and retropulsion pull test (0.706) showed good interrater reliability. Poor interrater reliability was found for maximal dystonia of the left and right upper extremity (0.187 and 0.322, respectively), maximal dystonia of the left and right lower extremity (0.200 and 0.256, respectively), and maximal dystonia of the trunk (0.389), tongue protrusion (0.266), and rigidity arms left (0.390). Raters performed significantly worse on follow-up certification compared to their first certification. CONCLUSIONS Our results suggest that the rating of dystonia (absent, slight, mild, moderate, or marked) is subjective and difficult to interpret, especially on video. Therefore, changing the dystonia items of the UHDRS-TMS should be explored. We also recommend that raters should watch the UHDRS-TMS teaching video before each certification.
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Affiliation(s)
- Jessica Y. Winder
- Department of NeurologyLeiden University Medical CenterLeidenThe Netherlands
| | - Raymund A.C. Roos
- Department of NeurologyLeiden University Medical CenterLeidenThe Netherlands
| | - Jean‐Marc Burgunder
- Department of NeurologyUniversity of BernBernSwitzerland
- Swiss Huntington CenterGümligenSwitzerland
| | - Johan Marinus
- Department of NeurologyLeiden University Medical CenterLeidenThe Netherlands
| | - Ralf Reilmann
- George Huntington InstituteMuensterGermany
- Department of RadiologyUniversity of MuensterMuensterGermany
- Department of Neurodegenerative Diseases and Hertie‐Institute for Clinical Brain ResearchUniversity of TuebingenTuebingenGermany
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Cooley SA, Heaps JM, Bolzenius JD, Salminen LE, Baker LM, Scott SE, Paul RH. Longitudinal Change in Performance on the Montreal Cognitive Assessment in Older Adults. Clin Neuropsychol 2015; 29:824-35. [PMID: 26373627 DOI: 10.1080/13854046.2015.1087596] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The Montreal Cognitive Assessment (MoCA) is a brief screening measure commonly used to determine cognitive status among older adults. Despite the popularity of the MoCA, there has been little research into how performance on the MoCA changes over time in healthy older adults. METHODS The present study examined a sample of older adults (n = 53) recruited for a longitudinal study of healthy aging. Change in total MoCA score at three time points (baseline, 12 months, and 48 months) and scores from the Repeatable Battery for the Assessment of Neuropsychological Status at five time points (RBANS; baseline 12 months, 24 months, 36 months, and 48 months) were assessed using repeated measures analyses. RESULTS Total MoCA score significantly increased across time, particularly between the first and second administrations. Scores did not significantly differ between the second (12 month) and third (48 month) administrations. When grouped by baseline performance, individuals who scored low at baseline significantly improved performance at 12-month testing, but had little change between 12- and 48-month testing. Conversely, individuals who scored high at baseline did not significantly change between baseline and 12-month testing, but improved between 12- and 48-month testing. RBANS scores did not significantly change over time. CONCLUSIONS These results suggest that the MoCA may be susceptible to practice effects, particularly between the first and second administrations. These practice effects should be taken into consideration when repeatedly employing the MoCA to screen for cognitive status in healthy older adults.
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Affiliation(s)
- Sarah A Cooley
- a Department of Psychology , University of Missouri-Saint Louis , Saint Louis , MO , USA
| | - Jodi M Heaps
- a Department of Psychology , University of Missouri-Saint Louis , Saint Louis , MO , USA.,b Missouri Institute of Mental Health , Berkeley , MO , USA
| | - Jacob D Bolzenius
- a Department of Psychology , University of Missouri-Saint Louis , Saint Louis , MO , USA
| | - Lauren E Salminen
- a Department of Psychology , University of Missouri-Saint Louis , Saint Louis , MO , USA
| | - Laurie M Baker
- a Department of Psychology , University of Missouri-Saint Louis , Saint Louis , MO , USA
| | - Staci E Scott
- a Department of Psychology , University of Missouri-Saint Louis , Saint Louis , MO , USA
| | - Robert H Paul
- a Department of Psychology , University of Missouri-Saint Louis , Saint Louis , MO , USA.,b Missouri Institute of Mental Health , Berkeley , MO , USA
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