Objective: To describe the frequency of depression and suicidality among patients with Huntington disease (HD) stratified by HD stage and chorea severity.

Background: High rates of depression have been reported in those with HD¹; however, there is a paucity of real-world data to assess psychiatric burden (eg, depression and suicidality) in relation to chorea in HD.

Method: Enroll-HD is a global observational registry for participants with or at risk for HD. Participants are evaluated annually. Baseline data were collected (data cut 2013 – 31 October 2020) on Total Maximal Chorea (TMC) score, Total Functional Capacity (TFC), Hospital Anxiety and Depression scale (HADS), depression and suicidality (Problem Behavioral Assessment [PBA] binary scale), and suicidal ideation/behavior (Columbia-Suicide Severity Rating Scale [CSSRS]). Participants were grouped by HD status and stage (TFC score [according to Shoulson and Fahn staging] 7–‍13/Stage 1–‍2 [early], 3–‍6/Stage 3 [middle], 0–‍2/Stage 4–‍5 [late]) and by chorea severity (TMC score).

Results: Depression was more severe in the manifest group (n=10,917; mean [SD] HADS: 6.1 [4.2]) vs non-HD (n=4996; 3.4 [3.3]) and pre-manifest (n=5173; 3.6 [3.5]) groups, with an increasing trend towards later HD stages (early [n=7441], 5.7 [4.0]; middle [n=2330], 7.3 [4.4]; late [n=1120], 8.4 [4.9]). PBA scores exhibited a similar trend; the proportion of participants with depression and suicidality was highest in the early and middle TFC groups (non-HD, 10.4% and 2.2%; pre-manifest, 14.4% and 4.3%; manifest, 19.0% and 6.0% [early, 19.3% and 6.0%; middle, 19.1% and 6.5%; late, 16.5% and 4.9%]). CSSRS scores showed a similar pattern. Depression severity was high in all TMC strata, with no clear trend across strata (mean [SD] HADS: TMC score 0–‍7 [n=5055], 6.2 [4.2]; 8–‍14 [n=4374], 6.0 [4.2]; 15–‍21, [n=1310], 6.4 [4.1]; 22–‍28 [n=164], 7.6 [4.1]). Likewise, PBA and CSSRS scores indicated presence of suicidality but did not correlate with chorea severity.

Conclusion: Depression and suicidality were notably higher in the manifest population vs non-HD and pre-manifest groups, regardless of disease stage. Depression and suicidality were common in participants with significant chorea; however, these findings did not correlate with chorea severity. Additional studies are needed to assess the impact of chorea on psychiatric symptoms.

References: 1. Paoli RA, Botturi A, Ciammola A, et al. Neuropsychiatric burden in Huntington’s disease. Brain Sci. 2017;7(6):E67.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/analysis-of-depression-and-suicidality-throughout-the-course-of-huntington-disease-using-the-enroll-hd-registry/