Objective: Explore the relationship of cognition and patient-reported assessment on fear of falling in people with Huntington’s Disease.

Background: Huntington’s Disease (HD) is a relentlessly progressive disorder characterized by cognitive, psychiatric, oculomotor, chorea and gait abnormalities. Traditional measures of disease impact and change rely on history, neurological examination, and incorporation of the United Huntington’s Disease Rating Scale. Incorporating examiner independent objective multi-dimensional quantitative measures of people with HD (PwHD) as they relate to patient perception might enhance appreciation of the real-world value of disease impact. This approach might provide unique insight to proactively identify opportunities to improve outcomes and to reduce adverse outcomes that might not be readily appreciated by clinical examination. Falling can be a significant problem for PwHD. Fall risk is typically assumed to be related to the motor impact of PwHD. The impact of cognitive impairment in PwHD on fear of falling might not be assessed in routine care but earlier identification of such impact might provide an opportunity to reduce adverse outcomes.

Method: Retrospective review of data collected through routine care of PwHD who completed multidimensional computerized cognitive testing and patient-reported outcome (PRO): Modified Falls Efficacy Scale (MFES). Cognitive domains collected were: Memory (MEM), Executive Function (EF), Visual Spatial (VS), Information Processing (IP), Verbal Function (VF), Attention (ATT), Motor Skills, and a Global Cognitive Summary Score (GCS).

Results: 18 PwHD, average age 48+/- 13. Significant relationships were identified by regression analysis (p<0.01) for the following: MFES vs GCS (r² = 0.37), MFES vs MEM (r² = 0.32), MFES vs EF (r² = 0.21), MFES vs VF (r² = 0.14), and MM vs ATT (r² = 0.16). 28% of PwHD reported low confidence in doing activities without falling.

Conclusion: Although PwHD commonly have physical symptoms that may increase fall risk and a fear of falling, cognitive impairment is related to fear of falling in PwHD. Self-reported fear of falling and computerized cognitive test scores demonstrate significant correlations across multiple cognitive domains. Cognition also plays a role in the fear of falling of PwHD. Future studies would be helpful to identify if earlier recognition of cognitive impairment can offer effective opportunities for focused effective intervention and improved care.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/huntingtons-disease-cognition-and-fear-of-falling/