BAL HARBOUR, FLA—An investigation of obsessive-compulsive symptoms in various stages of Huntington’s disease revealed that such behaviors might manifest as early as 13 years prior to onset of symptomatic Huntington’s disease. “Obsessive-compulsive symptoms have been reported in several movement disorders with known basal ganglia pathology, including Parkinson’s disease, Sydenham’s chorea, and Huntington’s disease,” said Jane S. Paulsen, PhD, senior author of the study, which was presented at the 15th Annual Meeting of the American Neuropsychiatric Association. However, until this study, little was known about symptomatic onset and whether gene-positive, presymptomatic persons with Huntington’s disease may experience obsessive-compulsive symptoms, she related. Dr. Paulsen is Director of the Huntington’s Disease Center of Excellence and the Division of Neuropsychology at the University of Iowa College of Medicine in Iowa City.

MARKERS OF DISEASE IN PRESYMPTOMATIC HUNTINGTON’S DISEASE

Dr. Paulsen and colleagues in the Department of Psychiatry examined the prevalence of obsessive-compulsive symptoms in 233 gene-positive persons who were free of neurologic signs of Huntington’s disease as part of the PREDICT-HD trial, a study designed to examine the early neurobiologic and neurobehavioral markers of disease in presymptomatic Huntington’s disease. The gene-positive group was compared with 15 gene-negative controls on the Leyton Obsessional Inventory: 20-Item Version, the Symptom Checklist 90-Revised Obsessive-Compulsive Dimension, as well as the Unified Huntington’s Disease Rating Scale (UHDRS) obsessive-compulsive items. The mean age in the gene-positive cohort was 41.5 (63% female), with an average of 13.6 years to estimated onset of clinically symptomatic Huntington’s disease.

The investigators found that neither the number of items endorsed nor the severity of symptoms on the Leyton Obsessional Inventory was significantly different between gene-positive and gene-negative groups. However, the T-score of the Symptom Checklist data “was significantly higher in gene-positive individuals [M = 55.74] than published normative data [M = 50],” Dr. Paulsen said.

Additionally, the investigators reported that obsessive-compulsive symptoms “increased with diagnostic confidence level (based on UHDRS motor exam) in gene-positive individuals,” and “patients with manifest Huntington’s disease endorsed greater frequencies of obsessions and compulsions with higher disease stage” (see Table).

PRESYMPTOMATIC PSYCHOPATHOLOGY

“Obsessive-compulsive symptoms were found in CAG-expanded individuals, even though they were estimated to be an average of 13 years from motor symptom onset,” Dr. Paulsen said. “However, symptom levels were mild and did not pass the threshold for clinical diagnosis,” she noted, and “the severity of obsessive-compulsive symptoms appears to increase with proximity to onset [and disease progression in patients with manifest Huntington’s disease].” Questions remain, however, about the cause of these symptoms and their impact on daily functioning, she noted.

Dr. Paulsen hopes that additional research and other longitudinal studies like PREDICT-HD “will provide valuable information regarding the course of obsessive-compulsive symptoms, including when patients convert to diagnosable obsessive-compulsive disorder and whether other factors mediate this condition.”

NR

—C. Justin Romano

Suggested Reading
Anderson KE, Louis ED, Stern Y, Marder KS. Cognitive correlates of obsessive and compulsive symptoms in Huntington’s disease. Am J Psychiatry. 2001;158:799-801.
Nehl C, Paulsen JS; Huntington Study Group. Cognitive and psychiatric aspects of Huntington disease contribute to functional capacity. J Nerv Ment Dis. 2004;192:72-74.

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