title: Modelling the natural history of Huntington's disease progression.
abstract: BACKGROUND
  The lack of reliable biomarkers to track disease progression is a major problem in clinical research of chronic neurological disorders. Using Huntington's disease (HD) as an example, we describe a novel approach to model HD and show that the progression of a neurological disorder can be predicted for individual patients.
  
  
  METHODS
  Starting with an initial cohort of 343 patients with HD that we have followed since 1995, we used data from 68 patients that satisfied our filtering criteria to model disease progression, based on the Unified Huntington's Disease Rating Scale (UHDRS), a measure that is routinely used in HD clinics worldwide.
  
  
  RESULTS
  Our model was validated by: (A) extrapolating our equation to model the age of disease onset, (B) testing it on a second patient data set by loosening our filtering criteria, (C) cross-validating with a repeated random subsampling approach and (D) holdout validating with the latest clinical assessment data from the same cohort of patients. With UHDRS scores from the past four clinical visits (over a minimum span of 2 years), our model predicts disease progression of individual patients over the next 2 years with an accuracy of 89-91%. We have also provided evidence that patients with similar baseline clinical profiles can exhibit very different trajectories of disease progression.
  
  
  CONCLUSIONS
  This new model therefore has important implications for HD research, most obviously in the development of potential disease-modifying therapies. We believe that a similar approach can also be adapted to model disease progression in other chronic neurological disorders.
authors.affiliation: Department of Clinical Neurosciences, John van Geest Centre for Brain Repair, University of Cambridge, Cambridge, UK.
authors.forename: W L
authors.initials: WL
authors.lastname: Kuan
authors.affiliation: Department of Engineering, University of Cambridge, Cambridge, UK.
authors.forename: A
authors.initials: A
authors.lastname: Kasis
authors.affiliation: Department of Engineering, University of Cambridge, Cambridge, UK.
authors.forename: Y
authors.initials: Y
authors.lastname: Yuan
authors.affiliation: Department of Clinical Neurosciences, John van Geest Centre for Brain Repair, University of Cambridge, Cambridge, UK.
authors.forename: S L
authors.initials: SL
authors.lastname: Mason
authors.affiliation: Department of Clinical Neurosciences, John van Geest Centre for Brain Repair, University of Cambridge, Cambridge, UK.
authors.forename: A S
authors.initials: AS
authors.lastname: Lazar
authors.affiliation: Department of Clinical Neurosciences, John van Geest Centre for Brain Repair, University of Cambridge, Cambridge, UK.
authors.forename: R A
authors.initials: RA
authors.lastname: Barker
authors.affiliation: Department of Engineering, University of Cambridge, Cambridge, UK Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Walferdange, Luxembourg.
authors.forename: J
authors.initials: J
authors.lastname: Goncalves
mesh_terms: D017668:Age of Onset; D015331:Cohort Studies; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D006801:Humans; D006816:Huntington Disease / Q000235:genetics / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D015203:Reproducibility of Results; D018911:Trinucleotide Repeats / Q000235:genetics
keywords: CLINICAL NEUROLOGY; HUNTINGTON'S; MOVEMENT DISORDERS; STATISTICS