Jacobs Milou, Hart Ellen P, Roos Raymund A C
From the Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands (MJ, RACR); and the Centre for Human Drug Research, Leiden, the Netherlands (EPH).
J Neuropsychiatry Clin Neurosci. 2018 Summer;30(3):188-193. doi: 10.1176/appi.neuropsych.17070144. Epub 2018 Jan 12.
Unemployment is common for those with Huntington's disease (HD), a genetic neurodegenerative disorder, and affects patients' quality of life. HD is characterized by motor disturbances, cognitive dysfunction, and psychiatric symptoms. The purpose of this article was to determine which clinical signs of HD are predictive of unemployment. Data for employed (N=114) and unemployed (N=106) HD mutation carriers were used to investigate group differences. Univariate logistic regression analyses, adjusted for age and gender, were performed to determine individual predictors of unemployment. Subsequently, a multivariate logistic regression analysis was performed, entering all significant results from the univariate analyses into one fully adjusted model to determine the strongest predictors. HD mutation carriers with lower cognitive performances and higher apathy scores were more likely to be unemployed than were HD mutation carriers with higher cognitive scores and no signs of apathy. Motor functioning was an independent predictor of unemployment but was not associated with unemployment in the fully adjusted model. Cognitive impairments, especially in the executive domain, and apathy were independent determinants of unemployment in HD mutation carriers. Motor disturbances, the clinical hallmark of HD, did not appear to be the most important predictor for work cessation. These results should be taken into consideration in clinical practice when evaluating HD patients' ability to work.
对于患有亨廷顿舞蹈症（HD）的人来说，失业很常见。HD是一种遗传性神经退行性疾病，会影响患者的生活质量。HD的特征是运动障碍、认知功能障碍和精神症状。本文的目的是确定HD的哪些临床体征可预测失业情况。利用已就业的HD突变携带者（N = 114）和未就业的HD突变携带者（N = 106）的数据来研究组间差异。进行了经年龄和性别调整的单因素逻辑回归分析，以确定失业的个体预测因素。随后，进行了多因素逻辑回归分析，将单因素分析的所有显著结果纳入一个完全调整模型，以确定最强的预测因素。与认知得分较高且无冷漠迹象的HD突变携带者相比，认知表现较低且冷漠得分较高的HD突变携带者更有可能失业。运动功能是失业的一个独立预测因素，但在完全调整模型中与失业无关。认知障碍，尤其是执行领域的障碍，以及冷漠是HD突变携带者失业的独立决定因素。运动障碍作为HD的临床标志，似乎并不是工作终止的最重要预测因素。在临床实践中评估HD患者的工作能力时，应考虑这些结果。
