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Sensitivity of gait analysis to detect motor phenotype in pre-manifest and manifest Huntington's disease – cross-sectional results from the TRACK-HD Study
Conference proceeding   Peer reviewed

Sensitivity of gait analysis to detect motor phenotype in pre-manifest and manifest Huntington's disease – cross-sectional results from the TRACK-HD Study

S Rohm, N Bechtel, H Beckmann, A Sturrock, S van den Bogaard, M Say, C Jauffret, J A Mills, T P Archarya, D R Langbehn, …
Aktuelle Neurologie, Vol.36(S 02)
Abstracts Freier Vorträge und Poster der Jahrestagung der DGN 2009, 2009 (Nürnberg)
10/07/2009
DOI: 10.1055/s-0029-1238520

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Abstract

Background: Deficits in postural control and gait are well established symptoms of Huntington's Disease (HD), which contribute to falls and loss of independence. Gait impairment is currently being assessed by the Unified Huntington's Disease Rating Scale Total Motor Score (UHDRS-TMS). Previous studies have shown that the use of the GAITRite mat (www.GAITRite.com) provides additional objective and quantitative information: e.g., correlations with predicted years to onset and years since onset (Rao et al. 2008), and differences in gait measures for fallers vs. non-fallers and controls (Grimbergen et al. 2008). Objective: To investigate whether objective gait assessment can provide a sensitive, objective and quantitative measure to differentiate between control, pre-manifest and symptomatic HD groups in large cohorts as part of a multicenter blinded study. Subjects and methods: 123 controls, 120 pre-manifest gene carriers (UHDRS-TMS≤5) and 123 HD patients were assessed at 4 study sites. The assessment comprised two conditions of walking at normal speed and fast speed. Subjects walked 3 times back and forth on the GAITRite mat for both conditions. Data evaluation was performed blinded. Results: Coefficients of variation of stride length, and logarithmized (log) CoVs for stance time, step time and stride length were calculated. All measures distinguished gene-expanded subjects from controls (p<0.0001) and HD from pre-manifest subjects (p<0.0001 except for fast: log stance time p=0.0025). Log stance time distinguished premanifest gene carriers from controls (p<0.01). Correlations were found with estimated onset within 5 years (p<0.001 except for log stance time fast condition) and with the coefficient of striatal to intracranial volume (p<0.001; except for stride length normal: p=0.006, fast: p=0.0094, log stride length fast: p=0.003). Conclusion: The first signs of gait impairment can be detected even in the premanifest phase of disease and the full spectrum of gait disturbances is quantitatively assessable in manifest stages. Interestingly, these impairments seem to be more pronounced in the normal than in the fast walking condition. We will further investigate whether objective gait analysis qualifies as a sensitive marker for tracking the disease and serves as a prospective surrogate marker in follow-up assessments. Acknowledgements: TRACK-HD is supported by the CHDI and High Q Foundation, a not for profit organization dedicated to finding treatments for HD.

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