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Huntington’s disease

Clinical correlates of disability and progression

From the Department of Neurology (Drs. Mahant and McCusker, and S. Graham) and Westmead Millennium Institute (Dr. Byth), Westmead Hospital; and University of Sydney (Dr. Mahant), NSW, Australia.

Address correspondence and reprint requests to Dr. E.A. McCusker, Director, Huntington Disease Service, Department of Neurology, Westmead Hospital, Westmead, NSW 2145, Australia; e-mail: elizabeth_mccusker{at}mail.wmi.usyd.edu.au

Objective: To define the phenotypic variation in a large population of patients with Huntington disease (HD) and to identity clinical features that predict disability and the rate of disease progression.

Methods: The authors analyzed data on 1,026 patients, followed for a median of 2.7 years, using a mixed effects model. The factors studied included the age at onset, the major clinical feature at onset, the severity of motor and cognitive impairment, and the level of disability.

Results: The mean age at onset was 41.5 (range 8 to 83) years, and patients were enrolled at all stages of disease. Younger onset was associated with more dystonia, less chorea, and a faster rate of motor, cognitive, and functional progression. The rate of progression was not related to the major clinical feature at onset or the sex of the affected parent. Disability correlated with the motor score (excluding chorea and dystonia) and the symbol-digit modalities test. Weight loss correlated with severe chorea.

Conclusions: The rate of progression of HD was significantly more rapid with a younger age at onset. Therefore, CAG repeat length may be an important determinant of not only the age at onset, but also the rate of disease progression. Chorea was associated with weight loss, but chorea and dystonia were not major determinants of disability.

Received December 23, 2002. Accepted in final form June 17, 2003.

*Members of the Huntington Study Group are listed in the Appendix on page 1091.

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