Motor abnormalities in premanifest persons with Huntington's disease: The PREDICT-HD study

University of Rochester, Rochester, New York, USA.
Movement Disorders (Impact Factor: 5.63). 09/2009; 24(12):1763-72. DOI: 10.1002/mds.22601
Source: PubMed

ABSTRACT The PREDICT-HD study seeks to identify clinical and biological markers of Huntington's disease in premanifest individuals who have undergone predictive genetic testing. We compared baseline motor data between gene-expansion carriers (cases) and nongene-expansion carriers (controls) using t-tests and Chi-square. Cases were categorized as near, mid, or far from diagnosis using a CAG-based formula. Striatal volumes were calculated using volumetric magnetic resonance imaging measurements. Multiple linear regression associated total motor score, motor domains, and individual motor items with estimated diagnosis and striatal volumes. Elevated total motor scores at baseline were associated with higher genetic probability of disease diagnosis in the near future (partial R(2) 0.14, P < 0.0001) and smaller striatal volumes (partial R(2) 0.15, P < 0.0001). Nearly all motor domain scores showed greater abnormality with increasing proximity to diagnosis, although bradykinesia and chorea were most highly associated with diagnostic immediacy. Among individual motor items, worse scores on finger tapping, tandem gait, Luria, saccade initiation, and chorea show unique association with diagnosis probability. Even in this premanifest population, subtle motor abnormalities were associated with a higher probability of disease diagnosis and smaller striatal volumes. Longitudinal assessment will help inform whether motor items will be useful measures in preventive clinical trials.

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    • "and PREDICT-HD Investigators and Coordinators of the Huntington Study Group 2006 , 2008 ; Duff et al . , 2007 ; Biglan et al . , 2009"
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    ABSTRACT: There is growing consensus that intervention and treatment of Huntington disease (HD) should occur at the earliest stage possible. Various early-intervention methods for this fatal neurodegenerative disease have been identified, but preventive clinical trials for HD are limited by a lack of knowledge of the natural history of the disease and a dearth of appropriate outcome measures. Objectives of the current study are to document the natural history of premanifest HD progression in the largest cohort ever studied and to develop a battery of imaging and clinical markers of premanifest HD progression that can be used as outcome measures in preventive clinical trials. Neurobiological predictors of Huntington's disease is a 32-site, international, observational study of premanifest HD, with annual examination of 1013 participants with premanifest HD and 301 gene-expansion negative controls between 2001 and 2012. Findings document 39 variables representing imaging, motor, cognitive, functional, and psychiatric domains, showing different rates of decline between premanifest HD and controls. Required sample size and models of premanifest HD are presented to inform future design of clinical and preclinical research. Preventive clinical trials in premanifest HD with participants who have a medium or high probability of motor onset are calculated to be as resource-effective as those conducted in diagnosed HD and could interrupt disease 7-12 years earlier. Methods and measures for preventive clinical trials in premanifest HD more than a dozen years from motor onset are also feasible. These findings represent the most thorough documentation of a clinical battery for experimental therapeutics in stages of premanifest HD, the time period for which effective intervention may provide the most positive possible outcome for patients and their families affected by this devastating disease.
    Frontiers in Aging Neuroscience 04/2014; 6:78. DOI:10.3389/fnagi.2014.00078 · 2.84 Impact Factor
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    • "The performance of prHD subjects provided an opportunity to assess whether subtle deficits in motor skill learning emerge prior to the time of clinical diagnosis. Previous studies have described abnormalities of movement execution (De Boo et al., 1997; Kirkwood et al., 1999, 2000; Smith et al., 2000; Farrow et al., 2006; Rao et al., 2008; Biglan et al., 2009; Tabrizi et al., 2009), dual-task motor control (Mazzoni and Wexler, 2009), and sequence learning (Ghilardi et al., 2008). At the group level, we found that prHD subjects performed similarly to CTL subjects in motor execution and skill learning. "
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    ABSTRACT: The basal ganglia are known to play a crucial role in movement execution, but their importance for motor skill learning remains unclear. Obstacles to our understanding include the lack of a universally accepted definition of motor skill learning (definition confound), and difficulties in distinguishing learning deficits from execution impairments (performance confound). We studied how healthy subjects and subjects with a basal ganglia disorder learn fast accurate reaching movements. We addressed the definition and performance confounds by: (1) focusing on an operationally defined core element of motor skill learning (speed-accuracy learning), and (2) using normal variation in initial performance to separate movement execution impairment from motor learning abnormalities. We measured motor skill learning as performance improvement in a reaching task with a speed-accuracy trade-off. We compared the performance of subjects with Huntington's disease (HD), a neurodegenerative basal ganglia disorder, to that of premanifest carriers of the HD mutation and of control subjects. The initial movements of HD subjects were less skilled (slower and/or less accurate) than those of control subjects. To factor out these differences in initial execution, we modeled the relationship between learning and baseline performance in control subjects. Subjects with HD exhibited a clear learning impairment that was not explained by differences in initial performance. These results support a role for the basal ganglia in both movement execution and motor skill learning.
    Frontiers in Human Neuroscience 11/2013; 7:752. DOI:10.3389/fnhum.2013.00752 · 2.90 Impact Factor
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    • "Although considerable attention has focused on the role of differential striatal projection neuron loss in the progression of HD motor symptoms (Deng et al., 2004; Glass et al., 2000; Reiner et al., 1988; Richfield et al., 1995), little attention has focused on the neuronal pathology underlying the emerging motor symptoms reported in premanifest HD individuals . For example, numerous studies have noted that premanifest HD individuals are slowed in the initiation and/or execution of a variety of motor tasks involving the eyes, hands or lower limbs (Bechtel et al., 2010; Biglan et al., 2009; Blekher et al., 2004; de Boo et al., 1997; Delval et al., 2011; Kirkwood et al., 1999, 2000; Rao et al., 2008, 2011; Siemers et al., 1996; Tabrizi et al., 2011; Turner et al., 2011). This defect is mild in premanifest cases not yet near clinical onset, but more severe in those near onset (Bechtel et al., 2010; Kirkwood et al., 2000; Rao et al., 2008, 2011; Rupp et al., 2010). "
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    ABSTRACT: Motor slowing, forebrain white matter loss, and striatal shrinkage have been reported in premanifest Huntington's disease (HD) prior to overt striatal neuron loss. We carried out detailed LM and EM studies in a genetically precise HD mimic, heterozygous Q140 HD knock-in mice, to examine the possibility that loss of corticostriatal and thalamostriatal terminals prior to striatal neuron loss underlies these premanifest HD abnormalities. In our studies, we used VGLUT1 and VGLUT2 immunolabeling to detect corticostriatal and thalamostriatal (respectively) terminals in dorsolateral (motor) striatum over the first year of life, prior to striatal projection neuron pathology. VGLUT1+ axospinous corticostriatal terminals represented about 55% of all excitatory terminals in striatum, and VGLUT2+ axospinous thalamostriatal terminals represented about 35%, with VGLUT1+ and VGLUT2+ axodendritic terminals accounting for the remainder. In Q140 mice, a significant 40% shortfall in VGLUT2+ axodendritic thalamostriatal terminals and a 20% shortfall in axospinous thalamostriatal terminals was already observed at 1month of age, but VGLUT1+ terminals were normal in abundance. The 20% deficiency in VGLUT2+ thalamostriatal axospinous terminals persisted at 4 and 12months in Q140 mice, and an additional 30% loss of VGLUT1+ corticostriatal terminals was observed at 12months. The early and persistent deficiency in thalamostriatal axospinous terminals in Q140 mice may reflect a development defect, and the impoverishment of this excitatory drive to striatum may help explain early motor defects in Q140 mice and in premanifest HD. The loss of corticostriatal terminals at 1year in Q140 mice is consistent with prior evidence from other mouse models of corticostriatal disconnection early during progression, and can explain both the measurable bradykinesia and striatal white matter loss in late premanifest HD.
    Neurobiology of Disease 08/2013; 60. DOI:10.1016/j.nbd.2013.08.009 · 5.20 Impact Factor
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