Figure 1
Consort Diagram for HD Psychosis Analysis Group Selection. Inclusion & exclusion criteria and breakdown of participant group included in analyses of psychosis in HD. In addition to non-manifest/motor-manifest HD participants being excluded, those with an HD onset age < 18 or a CAG repeat length > 70 were also omitted. Among the 7988 manifest/motor-manifest HD participants remaining, 10 participants were excluded due to missing data on psychosis status, and 12 participants were excluded due to childhood onset of psychosis. Our final analysis group included 7966 manifest/motor-manifest HD participants, of which 1021 had psychosis and 6945 did not.
Table 1
Bivariate Analysis of Baseline Characteristics Associated with HD Psychosis.
| Characteristic | Psychosis – NO | Psychosis – YES | Logistic Regression | |
|---|---|---|---|---|
| Mean (SD)/Median (Q1,Q3) or N (%) | Mean (SD)/Median (Q1,Q3) or N (%) | OR (95% CI) | P-value | |
| Male Sex | 3376 (48.61) | 491 (48.09) | 0.98 (0.86,1.12) | 0.76 |
| ‘Caucasian’ Ethnicity | 6542 (94.24) | 953 (93.43) | 0.87 (0.67,1.15) | 0.31 |
| Previous Suicidal Ideation/Attempt | 1887 (27.2) | 463 (45.62) | 2.24 (1.96,2.57) | <0.01* |
| Positive Family History of HD | 5792 (83.4) | 907 (88.83) | 1.58 (1.30,1.95) | <0.01* |
| Marital Status | ||||
| Married/Partnership | 4371 (63.02) | 584 (57.25) | reference | |
| Other | 1313 (18.93) | 207 (20.29) | 1.18 (0.99,1.40) | 0.06 |
| Single | 1252 (18.05) | 229 (22.45) | 1.37 (1.16,1.61) | <0.01* |
| ISCED Education Level 1 of 4,5,6 | 3037 (43.94) | 323 (31.92) | 0.60 (0.52,0.69) | <0.01* |
| Unemployed | 5389 (77.81) | 929 (91.17) | 2.94 (2.37,3.71) | <0.01* |
| Initial Major Symptom Noted By Participant | ||||
| Motor | 4051 (61.91) | 429 (46.48) | reference | |
| Cognitive | 739 (11.29) | 77 (8.34) | 0.98 (0.76,1.26) | 0.90 |
| Psychiatric | 1038 (15.86) | 295 (31.96) | 2.68 (2.28,3.16) | <0.01* |
| Other/Mixed | 715 (10.93) | 122 (13.22) | 1.61 (1.29,1.99) | <0.01* |
| Rater’s Judgment of Initial Major Symptom | ||||
| Motor | 3761 (54.71) | 342 (34.58) | reference | |
| Cognitive | 586 (8.52) | 60 (6.07) | 1.13 (0.84,1.49) | 0.42 |
| Psychiatric | 1260 (18.33) | 365 (36.91) | 3.19 (2.71,3.74) | <0.01* |
| Other/Mixed | 1267 (18.43) | 222 (22.45) | 1.93 (1.61,2.31) | <0.01* |
| Positive History of Depression | 4877 (70.24) | 868 (85.27) | 2.45 (2.05,2.95) | <0.01* |
| Positive History of Irritability | 4548 (65.50) | 864 (84.87) | 2.95 (2.48,3.54) | <0.01* |
| Positive History of Violent/Aggressive Behavior | 2372 (34.16) | 677 (66.57) | 3.84 (3.34,4.42) | <0.01* |
| Positive History of Apathy | 4202 (60.51) | 842 (82.71) | 3.12 (2.64,3.71) | <0.01* |
| Positive History of Perseverative/Obsessive Behavior | 3454 (49.75) | 764 (75.35) | 3.09 (2.66,3.59) | <0.01* |
| History of Significant Cognitive Impairment/Dementia | 3948 (56.90) | 811 (79.51) | 2.94 (2.51,3.45) | <0.01* |
| History of Alcohol Abuse | 635 (9.17) | 163 (16.06) | 1.90 (1.57,2.28) | <0.01* |
| History of Drug Abuse | 615 (8.88) | 121 (11.93) | 1.39 (1.13,1.70) | <0.01* |
| Number of Pack-years smoked in Participant’s History | 16.8 [7.0,30.0] | 18.0 [8.0,31.5] | 1.01 (1.00,1.01) | 0.02* |
| Age of Motor Symptom Onset | 46.33 (11.96) | 44.84 (11.92) | 0.99 (0.98,1.00) | <0.01* |
| Age of Clinical HD Diagnosis | 48.97 (12.38) | 47.69 (12.41) | 0.99 (0.99,1.00) | <0.01* |
[i] Bivariate analysis of baseline characteristics showed a range of demographic (positive family history of HD, single marital status, ISCED education level, unemployed), psychiatric history (previous suicidal ideation/attempt, drug/alcohol abuse, depression, irritability, aggression, perseverative/obsessive behavior, apathy, anxiety) and clinical history (age of motor symptom onset, age of clinical HD diagnosis, and initial major symptom noted by participant and rater) variables all associated with the presence of psychosis in manifest/motor-manifest HD. * for p-value means remaining significant after Benjamini-Hochberg procedure.
Table 2
Bivariate Analysis of Clinical Assessment Scores Associated with HD Psychosis.
| Characteristic | Psychosis – NO | Psychosis – YES | Logistic Regression | ||
|---|---|---|---|---|---|
| Mean (SD)/Median (Q1,Q3) or N (%) | Mean (SD)/Median (Q1,Q3) or N (%) | OR (95% CI) | P-value | ||
| BMI | 24.92 (4.97) | 25.15 (5.51) | 1.01 (1.00,1.02) | 0.18 | |
| Total Motor Score | 37.36 (21.14) | 48.15 (25.13) | 1.02 (1.02,1.02) | <0.01* | |
| TUG Test1- Total Time | 10.00 [8.00,12.00] | 11.00 [8.22,15.00] | 1.03 (1.02,1.04) | <0.01* | |
| TFC Score2 | 9 [6,11] | 5 [2,8] | 0.83 (0.81,0.84) | <0.01* | |
| Functional Assessment Score | 20 [15,24] | 14 [7,19] | 0.91 (0.90,0.92) | <0.01* | |
| SDMT Test3- Total Correct | 23.49 (13.01) | 16.20 (12.53) | 0.95 (0.95,0.96) | <0.01* | |
| Verbal Fluency- Total Correct 1 min | 12.23 (5.84) | 9.40 (6.01) | 0.91 (0.90,0.93) | <0.01* | |
| Stroop Color Naming Test- Total Correct | 42.34 (17.82) | 32.36 (18.91) | 0.97 (0.97,0.97) | <0.01* | |
| MMSE4 Score | 26 [23,28] | 24 [19,27] | 0.90 (0.89,0.92) | <0.01* | |
| Depression PBA5 Score | 3 [0,8] | 5 [1,12] | 1.04 (1.03,1.05) | <0.01* | |
| Irritability Aggression PBA Score | 1 [0,4] | 2 [0,8] | 1.06 (1.05,1.07) | <0.01* | |
| Apathy PBA Score | 1 [0,6] | 4 [0,9] | 1.10 (1.09,1.12) | <0.01* | |
| Executive Function PBA Score | 0 [0,5] | 4 [0,11] | 1.09 (1.08,1.10) | <0.01* | |
| Anxiety HADS-SIS6 Subscore | 5 [3,9] | 6 [3,10] | 1.06 (1.03,1.08) | <0.01* | |
| Depression HADS-SIS Subscore | 6 [3,9] | 7 [3,10] | 1.06 (1.04,1.09) | <0.01* | |
| Irritability HADS-SIS Subscore | 5.00 [2.00,9.00] | 6.00 [2.75,10.00] | 1.03 (1.01,1.05) | 0.01* | |
| Outward Irritability HADS-SIS Subscore | 3 [1,6] | 4 [1,6] | 1.03 (1.00,1.06) | 0.09 | |
| Inward Irritability HADS-SIS Subscore | 2 [0,4] | 2 [0,4] | 1.05 (1.01,1.09) | 0.01* | |
| Larger Research CAG Allele Determined from DNA | 43.94 (3.73) | 44.16 (3.92) | 1.02 (1.00,1.03) | 0.08 | |
[i] Bivariate analysis of clinical assessment scores showed a range of cognitive (SDMT, Verbal Fluency, Stroop Color Naming Test, MMSE Score), psychiatric (Depression PBA score, Irritability/aggression PBA score, Apathy PBA score, Executive function PBA score, Anxiety HADS-SIS Subscore, Depression HADS-SIS Subscore, Irritability HADS-SIS Subscore, Inward Irritablity HADS-SIS Subscore) and functional variables (Total Motor Score, TUG Test, TFC Score, Functional Assessment Score) all associated with presence of psychosis in manifest/motor-manifest HD. * Abbreviations: 1 Timed Up and Go Test; 2 Total Functional Capacity; 3 Symbol Digit Modality Test; 4 Mini Mental Status Exam; 5 Problem Behavior Assessment; 6 Hospital Anxiety and Depression Scale & Snaith Irritability Scale. * for p-value means remaining significant after Benjamini-Hochberg procedure.