Objective: To investigate the utility of Instrumented Timed Up and Go (TUG) test to estimate disease severity in people with Huntington Disease (PwHD).

Background: Huntington disease (HD) is a progressive neurodegenerative disease with motor, cognitive, and behavioral impairments.[1] Only a few measures of balance and mobility are available that can estimate disease severity and determine treatment effectiveness in PwHD.[2], [3] TUG and cognitive dual-task TUG (TUG-Cog) are clinical performance measures that have shown potential for monitoring the progression of similar neurodegenerative diseases.[4] This study aimed to (1) compare TUG and TUG-Cog performance among PwHDs and non-HD peers and (2) examine the association of TUG and TUG-Cog parameters with disease severity in PwHD.

Method: 50 PwHD across early and middle disease stages (53.8 ± 11.6 yrs; 28 males, Total Functional Capacity score= 9.58 ± 2.25) and 35 non-HD peers (50.3 ± 12.8 yrs; 15 males) completed TUG and TUG-Cog wearing IMU sensors in a single session. The Unified Huntington Disease Rating Scale-Total Motor Score (TMS) was collected from PwHD.[5] We used two-way ANOVA to compare the total duration required to complete TUG and TUG-Cog by both groups. We ran regression analyses to identify TUG and TUG-Cog parameters that can predict disease severity as measured by TMS. TUG and TUG-Cog parameters included in analyses were total duration, sit-to-stand duration, sit-to-stand lean angle, turn-angle degrees, turn duration, turn-turn velocity, along with age and sex.

Results: Both groups’ performance deteriorated while completing TUG-Cog compared to TUG (p = 0.002), with PwHD taking longer than non-HD peers to complete both tests (p ≤ 0.001). TUG parameters explained only 11.2% of the variance in TMS (p > 0.05), whereas TUG-Cog parameters explained 44% of the variance in TMS (p < 0.001). The coefficients of sex (1.74), sit-to-stand duration (3.43), and turn duration (-3.78) during TUG-Cog indicated their potential to be predictors for HD severity.

Conclusion: The differences between PwHD and non-HD peers on TUG and TUG-Cog indicate that both tests are sensitive clinical performance measures for HD status. TUG-Cog parameters showed a stronger association with disease severity among PwHD than TUG, indicating that TUG-Cog can be used to identify complex motor–cognitive impairments and to estimate disease severity among PwHD.[6]

References: The above abstract was submitted for the APTA CSM 2024 conference, and a poster was presented at the APTA CSM conference on February 16, 2024.

[1]L. Quinn and M. Busse, “The role of rehabilitation therapy in Huntington disease,” Handbook of Clinical Neurology, vol. 144, pp. 151–165, 2017.
[2]L. Quinn et al., “Reliability and minimal detectable change of physical performance measures in individuals with pre-manifest and manifest Huntington disease,” Physical therapy, vol. 93, no. 7, pp. 942–956, 2013.
[3]L. Quinn, D. Kegelmeyer, A. Kloos, A. K. Rao, M. Busse, and N. E. Fritz, “Clinical recommendations to guide physical therapy practice for Huntington disease,” Neurology, vol. 94, no. 5, pp. 217–228, 2020.
[4]A. Christopher, E. Kraft, H. Olenick, R. Kiesling, and A. Doty, “The reliability and validity of the Timed Up and Go as a clinical tool in individuals with and without disabilities across a lifespan: A systematic review: Psychometric properties of the Timed Up and Go,” Disability and rehabilitation, vol. 43, no. 13, pp. 1799–1813, 2021.
[5]T. A. Mestre et al., “Rating scales for motor symptoms and signs in Huntington’s disease: critique and recommendations,” Movement disorders clinical practice, vol. 5, no. 2, pp. 111–117, 2018.
[6]L. M. Muratori, L. Quinn, X. Li, G. Youdan, M. Busse, and N. E. Fritz, “Measures of postural control and mobility during dual-tasking as candidate markers of instability in Huntington’s disease,” Human Movement Science, vol. 80, p. 102881, 2021.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/utility-of-instrumented-timed-up-and-go-test-to-estimate-disease-severity-in-huntington-disease/