Background Unbiased longitudinal studies are needed to understand the distributed neurodegenerative changes of Huntington's disease (HD). They may also provide tools for assessing disease-modifying interventions. The authors investigated the progression of regional atrophy in premanifest and early HD compared with controls.
Methods Nine controls, 17 premanifest and 21 early HD subjects underwent volumetric MRI at baseline and 2 years. Premanifest subjects were on average 18.1 years before predicted motor onset. Non-linear registration was used to model within-subject change over the scanning interval, and statistical parametric mapping was used to examine group differences and associations with clinical variables.
Results In early HD, increased grey-matter (GM) atrophy rates were evident throughout the subcortical GM and over selective cortical regions compared with controls. This group also demonstrated strikingly widespread increases in white-matter (WM) atrophy rates. The authors observed no significant differences between premanifest HD and controls. Longer CAG was associated with higher atrophy rates over large WM areas including brainstem and internal capsule and over small GM regions including thalamus and occipital cortex. Worse baseline motor score was associated with regionally increased rates in the thalamus, internal capsule and occipital lobe. Sample-size calculations indicate that 19 and 24 early HD subjects per treatment arm would need to complete a 2-year trial in order to detect a 50% reduction in WM and GM atrophy rates respectively.
Conclusions Degeneration of structural connectivity may play an important role in early HD symptoms. Assessment of WM and GM changes will be important in understanding the complexity of HD and its treatment.
- Huntington's disease
- longitudinal study
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NCF and SJT are joint senior authors.
Funding This work was funded by the Cure Huntington's Disease Initiative. NCF is funded by the Medical Research Council UK and is an NIHR senior investigator. JB is funded by an Alzheimer's Research Trust UK research fellowship with the kind support of the Kirby Laing Foundation. This work was undertaken at UCLH/UCL which received a proportion of funding from the Department of Health's NIHR Biomedical Research Centres funding scheme. This work was supported by a NIHR BRC award to Addenbrooke's Hospital. The Dementia Research Centre is an Alzheimer's Research Trust coordinating Centre.
Competing interests None.
Patient consent Obtained.
Ethics approval Ethics approval was provided by the National Hospital for Neurology and Neurosurgery and the Institute of Neurology Joint REC.
Provenance and peer review Not commissioned; externally peer reviewed.