title: Progression of motor subtypes in Huntington's disease: a 6-year follow-up study.
abstract: The objective of this study is to investigate the progression of predominantly choreatic and hypokinetic-rigid signs in Huntington's disease (HD) and their relationship with cognitive and general functioning over time. The motor signs in HD can be divided into predominantly choreatic and hypokinetic-rigid subtypes. It has been reported in cross-sectional studies that predominantly choreatic HD patients perform better on functional and cognitive assessments compared to predominantly hypokinetic-rigid HD patients. The course of these motor subtypes and their clinical profiles has not been investigated longitudinally. A total of 4135 subjects who participated in the European HD Network REGISTRY study were included and classified at baseline as either predominantly choreatic (n = 891), hypokinetic-rigid (n = 916), or mixed-motor (n = 2328), based on a previously used method. The maximum follow-up period was 6 years. The mixed-motor group was not included in the analyses. Linear mixed models were constructed to investigate changes in motor subtypes over time and their relationship with cognitive and functional decline. Over the 6-year follow-up period, the predominantly choreatic group showed a significant decrease in chorea, while hypokinetic-rigid symptoms slightly increased in the hypokinetic-rigid group. On the Total Functional Capacity, Stroop test, and Verbal fluency task the rate of change over time was significantly faster in the predominantly choreatic group, while on all other clinical assessments the decline was comparable for both groups. Our results suggest that choreatic symptoms decrease over time, whereas hypokinetic-rigid symptoms slightly increase in a large cohort of HD patients. Moreover, different motor subtypes can be related to different clinical profiles.
authors.affiliation: Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands. m.jacobs@lumc.nl.
authors.forename: M
authors.initials: M
authors.lastname: Jacobs
authors.affiliation: Center for Human Drug Research, Leiden, The Netherlands.
authors.forename: E P
authors.initials: EP
authors.lastname: Hart
authors.affiliation: Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: E W
authors.initials: EW
authors.lastname: van Zwet
authors.affiliation: Department of Neurology, Università Cattolica del Sacro Cuore, Rome, Italy.|Fondazione Don Carlo Gnocchi, Milan, Italy.
authors.forename: A R
authors.initials: AR
authors.lastname: Bentivoglio
authors.affiliation: Department of Neurology, University of Bern, Bern, Switzerland.
authors.forename: J M
authors.initials: JM
authors.lastname: Burgunder
authors.affiliation: Faculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UK.|Manchester Center of Genomic Medicine, St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust and Manchester Academic Health Science Center, Manchester, UK.
authors.forename: D
authors.initials: D
authors.lastname: Craufurd
authors.affiliation: George Huntington Institute, Muenster, Germany.|Department of Radiology, University of Muenster, Muenster, Germany.|Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Reilmann
authors.affiliation: Department of Neurology, Ruhr-University Bochum, Bochum, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Saft
authors.affiliation: Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
authors.forename: R A C
authors.initials: RA
authors.lastname: Roos
mesh_terms: D000328:Adult; D000368:Aged; D003072:Cognition Disorders / Q000209:etiology*; D018450:Disease Progression; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D006816:Huntington Disease / Q000145:classification* / Q000150:complications* / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D009483:Neuropsychological Tests; D012044:Regression Analysis; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric
keywords: Chorea; Huntington’s disease; Hypokinetic; Neuropsychological assessment