Objective: The current study aimed to investigate the effect of educational level on the clinical characteristics of Chinese patients with Huntington’s disease (HD).

Background: Education is a crucial modifiable factor that has been validated to exert a protective effect on many neurodegenerative diseases. Preclinical studies have reported that cognitive training could improve motor and cognitive performances, slow down the atrophy of the caudate-putamen and increase survival in HD mouse models. However, no documents have been reported to clarify the impact of educational degree on clinical manifestations in Chinese HD patients to date.

Method: A total of 198 adult-onset HD patients with motor symptom onset were included in the study. Education level was assessed using International Standard Classification of Education (ISCED) categories, and patients were stratified into four education groups corresponding to primary school education or below, secondary school education, high school education, and university education or above. Motor, cognitive, psychiatric symptoms and functional capacity were measured using baseline Unified Huntington’s Disease Rating Scale (UHDRS), Mini-Mental State Exam (MMSE), the short version of Problem-Behavior Assessment (PBA-s), Beck Depression Inventory (BDI) and Hamilton Depression Scale (HAMD). Multivariate linear regressions were performed to clarify the independent association between educational level and clinical manifestations. Sensitive analyses using a 1:1 nearest-neighbor propensity score matching analysis to minimize the effect of potential confounders and validate the robustness of the results.

Results: Educational level was significantly associated with Unified Huntington’s Disease Rating Scale (UHDRS)-Cognitive scores (p<0.001), Mini-Mental State Examination (MMSE) scores (p<0.001), and Total Functional Capacity (TFC) scores (p=0.014), but not with the age of motor symptoms onset, the severity of motor symptoms or neuropsychiatric symptoms (p>0.05). Univariate regression analyses of propensity score matched groups and multivariate linear regression of years of education and clinical characteristics of HD showed a similar result to the main analyses.

Conclusion: HD patients with a higher educational level presented better cognitive performance and functional capacity, but education may not delay the onset of HD or improve motor or psychiatric symptoms in Chinese HD patients.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/education-level-and-the-onset-and-severity-of-symptoms-in-huntingtons-disease/