title: The effect of multidisciplinary rehabilitation on brain structure and cognition in Huntington's disease: an exploratory study.
abstract: BACKGROUND
  There is a wealth of evidence detailing gray matter degeneration and loss of cognitive function over time in individuals with Huntington's disease (HD). Efforts to attenuate disease-related brain and cognitive changes have been unsuccessful to date. Multidisciplinary rehabilitation, comprising motor and cognitive intervention, has been shown to positively impact on functional capacity, depression, quality of life and some aspects of cognition in individuals with HD. This exploratory study aimed to evaluate, for the first time, whether multidisciplinary rehabilitation can slow further deterioration of disease-related brain changes and related cognitive deficits in individuals with manifest HD.
  
  
  METHODS
  Fifteen participants who manifest HD undertook a multidisciplinary rehabilitation intervention spanning 9 months. The intervention consisted of once-weekly supervised clinical exercise, thrice-weekly self-directed home based exercise and fortnightly occupational therapy. Participants were assessed using MR imaging and validated cognitive measures at baseline and after 9 months.
  
  
  RESULTS
  Participants displayed significantly increased gray matter volume in the right caudate and bilaterally in the dorsolateral prefrontal cortex after 9 months of multidisciplinary rehabilitation. Volumetric increases in gray matter were accompanied by significant improvements in verbal learning and memory (Hopkins Verbal Learning-Test). A significant association was found between gray matter volume increases in the dorsolateral prefrontal cortex and performance on verbal learning and memory.
  
  
  CONCLUSIONS
  This study provides preliminary evidence that multidisciplinary rehabilitation positively impacts on gray matter changes and cognitive functions relating to verbal learning and memory in individuals with manifest HD. Larger controlled trials are required to confirm these preliminary findings.
authors: School of Medical Sciences, Edith Cowan University Perth, Western Australia, Australia.
authors: Travis M
authors: TM
authors: Cruickshank
authors: School of Medical Sciences, Edith Cowan University Perth, Western Australia, Australia.
authors: Jennifer A
authors: JA
authors: Thompson
authors: School of Psychological Sciences, Monash University Melbourne, Victoria, Australia.
authors: Juan F
authors: JF
authors: Domínguez D
authors: School of Medical Sciences, Edith Cowan University Perth, Western Australia, Australia.
authors: Alvaro P
authors: AP
authors: Reyes
authors: Department of Surgery, UWA and Neurological Intervention and Imaging Service of Western Australia Perth, Western Australia, Australia.
authors: Mike
authors: M
authors: Bynevelt
authors: School of Psychological Sciences, Monash University Melbourne, Victoria, Australia.
authors: Nellie
authors: N
authors: Georgiou-Karistianis
authors: John van Geest Centre for Brain Repair Cambridge, U.K.
authors: Roger A
authors: RA
authors: Barker
authors: School of Medical Sciences, Edith Cowan University Perth, Western Australia, Australia ; School of Pathology and Laboratory Medicine, University of Western Australia Perth, Western Australia, Australia.
authors: Mel R
authors: MR
authors: Ziman
mesh_terms: D000368:Aged; D001921:Brain / Q000473:pathology* / Q000503:physiopathology; D001931:Brain Mapping; D003071:Cognition / Q000502:physiology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006816:Huntington Disease / Q000473:pathology* / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D008019:Life Style; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects
keywords: Cognition; Huntington's disease; executive function; neuropathology; rehabilitation
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