Department of Psychiatry, Academic Unit for Psychiatry of Old Age, University of Melbourne, Melbourne (Goh, You, Perin, Lautenschlager, Chong, Ames, Chiu, Ellis); Neuropsychiatry Unit, Melbourne Neuropsychiatry Centre, Royal Melbourne Hospital, Melbourne (Goh, Loi); Department of Psychiatry, University of Melbourne, Melbourne (Goh, Lautenschlager, Clay, Ellis); NorthWestern Mental Health, Melbourne Health, Melbourne (Goh, Lautenschlager, Ellis); National Ageing Research Institute, Parkville, Australia (Goh); Department of Psychiatry, St. Vincent's Hospital, University of Melbourne, Melbourne (Chong); School of Psychological Sciences, University of Melbourne, Melbourne (Ellis); Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne (Ellis).
J Neuropsychiatry Clin Neurosci. 2020 Summer;32(3):235-243. doi: 10.1176/appi.neuropsych.19090199. Epub 2020 Feb 27.
Huntington's disease (HD) is an inherited neurodegenerative disease involving motor, cognitive, psychiatric, and behavioral impairments that eventually affect work-role functioning. There is limited research regarding predictors of workplace disability in HD. The authors examined predictors of work impairment and disability in a cross-sectional cohort of employed persons with symptomatic HD participating in the worldwide Enroll-HD study.
The study sample (N=316) comprised individuals with manifest HD and a CAG repeat length range between 39 and 60 and were currently engaged in paid full- or part-time employment. Univariate and multivariate logistic regression analyses identified predictors and the effect of all predictors in a fully adjusted model.
Of the sample, 20.3% reported missing work due to HD, 60.1% reported experiencing impairment while working due to HD, 79.1% reported having work-related activity impairment due to HD, and 60.8% reported impairment in overall work productivity due to HD. Individuals had 25% higher odds of missing work time if they had a higher level of functional impairment (odds ratio=0.76, 95% CI=0.64, 0.91) and had three times greater odds of missing work if they were current alcohol drinkers, compared with nondrinkers (odds ratio=2.86, 95% CI=1.62, 5.03). Individuals with lower self-perceived mental health were also 5% more likely to experience impairment at work due to HD. Motor impairment was not a strong predictor of workplace disability.
These findings provide important new knowledge that can inform the development of strategies or targeted intervention trials to support persons with symptomatic HD to maintain their work roles.
亨廷顿病（HD）是一种遗传性神经退行性疾病，涉及运动、认知、精神和行为障碍，最终影响工作角色功能。关于 HD 患者工作场所残疾的预测因素研究有限。作者在一项参与全球 Enroll-HD 研究的有症状 HD 患者的横断面队列研究中，研究了工作障碍和残疾的预测因素。
研究样本（N=316）包括有明显 HD 且 CAG 重复长度在 39 至 60 之间的个体，目前从事全职或兼职有偿工作。单变量和多变量逻辑回归分析确定了预测因素，并在完全调整后的模型中分析了所有预测因素的作用。
在样本中，20.3%的人因 HD 而缺勤，60.1%的人在工作时因 HD 而出现障碍，79.1%的人因 HD 而出现与工作相关的活动障碍，60.8%的人因 HD 而导致整体工作效率下降。与非饮酒者相比，功能障碍程度较高的个体（比值比=0.76，95%可信区间=0.64，0.91）缺勤的可能性高 25%，而目前饮酒者（比值比=2.86，95%可信区间=1.62，5.03）缺勤的可能性高 3 倍。自我感知心理健康水平较低的个体也更有可能因 HD 而在工作中出现障碍，可能性增加 5%。运动障碍不是工作场所残疾的有力预测因素。
这些发现提供了重要的新知识，可以为制定支持有症状 HD 患者保持工作角色的策略或针对性干预试验提供信息。
