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The clinical features of Huntington's disease can include psychiatric problems and difficulties with behaviour, feeding, communication and abnormal movements.
People can start to show the features of Huntington's disease at almost any age, but most will develop problems between the ages of 35 and 55.
The condition usually progresses and gets worse for around 10-25 years, until the person eventually dies. Signs and symptoms may vary between individuals and there's no typical pattern.
Early features, such as personality changes, mood swings and unusual behaviour, are often overlooked at first and attributed to something else.
Some people with Huntington's disease may not recognise that they have any problems.
Behavioural changes
Behavioural changes are often the first features to appear in Huntington's disease and can be the most distressing. These changes often include:
a lack of emotions and not recognising the needs of others in the family
alternating periods of aggression, excitement, depression, apathy, antisocial behaviour and anger
difficulty concentrating on more than one task and handling complex situations
irritability and impulsiveness
A person with Huntington's disease may appear to have a lack of drive, initiative and concentration, making them seem lazy. However, this isn't the case – it's just the way the condition affects the brain. As part of this, they may also develop a lack of interest in hygiene and self care.
The Huntington's Disease Association has more information about the behavioural problems (PDF, 219kb) associated with the condition.
Psychiatric problems
Many people with Huntington's disease have depression. This occurs as part of the condition, not just as a response to the diagnosis. Symptoms of depression include continuous low mood, low self-esteem, a lack of motivation or interest in things, and feelings of hopelessness.
A few people may also develop obsessive behaviours and schizophrenic-like problems, although this is relatively rare.
Studies have shown that people with Huntington's disease are more likely to consider suicide, particularly near the time of diagnosis when the condition is becoming apparent, and when they start to lose their independence.
Movement problems
Huntington's disease affects movement. Early features include slight, uncontrollable movements of the face, and jerking, flicking or fidgety movements of the limbs and body. These move from one area of the body to another and can cause the person to lurch and stumble.
These features are often first seen when the person is walking or resting (sitting in a chair or lying in bed).
As the condition progresses, the uncontrollable movements will become more frequent and extreme. However, over time this may change and in the advanced stages of the condition a person's movements may become slow and their muscles more rigid.
Feeding problems
People with Huntington's disease tend to lose weight, despite having a good appetite. They can find eating tiring, frustrating and messy because the mouth and throat muscles don't work properly, due to the loss of motor control. In some cases, this can lead to choking and recurrent chest infections.
Loss of coordination can lead to spilling or dropping food. Swallowing is a problem, so choking on food and drink, particularly thin drinks such as water, can be a common problem.
A referral to a dietitian or a speech and language therapist may be necessary if there are difficulties with swallowing. In some cases, a feeding tube can be inserted.
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