HD patients present a broad range of psychological disturbances such as cognitive rigidity, mood disturbances, lack of empathy and breakdowns of social relationships that might also manifest even before the onset of motor dysfunction (Marvel and Paradiso, 2004).
memory lapses. depression – including low mood, a lack of interest in things, and feelings of hopelessness. stumbling and clumsiness. mood swings, such as irritability or aggressive behaviour.
Psychological & Emotional Symptoms
Individuals with Huntington's disease can experience specific personality and behavioural changes characterized by apathy, irritability, impulsivity, and obsession. These changes can initially be subtle and become more prominent as the disease progresses.
Huntington's disease impairs the functioning of the brain, which can result in apathy, trouble organizing, impulsivity, irritability and anger, unawareness, disinhibition, preservation, and other psychiatric symptoms. These emotional and behavioral symptoms can further complicate the caregiver's role.
As the disease progresses, a variety of motor, emotional/behavioral, and cognitive symptoms are experienced, including unsteadiness, trouble holding onto things, trouble walking, changes in sleeping patterns, delusions and hallucinations, intellectual decline, and memory loss.
Noticeable changes in personality. Involuntary movements (chorea) and unsteady gait. Slurred speech. Difficulty swallowing and significant weight loss.
Other changes may include trouble with driving, prioritizing (deciding which things are more important to do and which are less important), and difficulty organizing, learning new things, remembering a fact, putting thoughts into words, or answering a question.
Categorizing Psychiatric Issues in HD
The first consists of mental illnesses which are common in the general population and are readily recognized by physicians, especially major depression, which has been estimated to affect 40% of people with HD at some point during their illness.
Weight loss can make symptoms worse and weaken the patient's immune system, making them more vulnerable to infections and other complications. Huntington's disease itself is not usually fatal, but it can lead to choking, pneumonia, or other infections that can lead to death.
Huntington's disease also causes a decline in thinking and reasoning skills, including memory, concentration, judgment, and ability to plan and organize. Huntington's disease brain changes lead to alterations in mood, especially depression, anxiety, and uncharacteristic anger and irritability.
People with Huntington's disease may sometimes seem uncaring and thoughtless. Their apparent disregard for the emotional needs of a partner can be hurtful, especially when it contrasts with a formerly loving relationship; the natural tendency is for the partner to feel slighted.
People with Huntington's may also be less able to control their emotions, possibly leading to outbursts of screaming, swearing, slamming doors, hitting walls, or the like. Patterns of behavior can change as the disease progresses.
Although not directly related to HD, stress is nevertheless related to the progression of the disease because it adds to the neurodegeneration that is already taking place. Chronic stress can alter nerve cells, brain structure, and brain function.
Several recent studies have described neuropsychiatric symptoms including depressed mood, mania, irritability, anxiety, apathy, obsessions-compulsions, and psychosis.
Patient caregivers were administered the neuropsychiatric inventory. RESULTS Ninety eight per cent of the patients exhibited neuropsychiatric symptoms, the most prevalent being dysphoria, agitation, irritability, apathy, and anxiety. Symptoms ranged from mild to severe and were unrelated to dementia and chorea.
Impaired social functioning is a key feature of Huntington's disease (HD). In addition to motor limitations that prevent social participation (e.g., fall risk, driving cessation), personality changes caused by cognitive and psychiatric decline alter social functioning capacity in people with HD.
Some patients may experience hallucinations and delusions that can severely affect their day-to-day interactions. Living with Huntington's can induce feelings of anxiety, depression, apathy, and frustration.
Pneumonia and heart disease are the two leading causes of death for people with HD.
Stage IV: (9 - 21 years from illness onset)
Requires major assistance in financial affairs, domestic responsibilities, and most activities of daily living. For instance, comprehension of the nature and purpose of procedures may be intact, but major assistance is required to act on them.
People can start to show the symptoms of Huntington's disease at almost any age. Most will develop problems between the ages of 30 and 50. The condition gradually gets worse for around 10-25 years, until the person dies.
Early signs and symptoms can include irritability, depression, small involuntary movements, poor coordination, and trouble learning new information or making decisions. Many people with Huntington disease develop involuntary jerking or twitching movements known as chorea.