Predictors of nursing home placement in Huntington disease

Vicki L. Wheelock, T. Tempkin, Karen Marder, Martha Nance, R. H. Myers, H. Zhao, Elise Kayson, C. Orme, Ira Shoulson, Phillipa Hedges, Elizabeth McCusker, Samantha Pearce, Ronald Trent, David Abwender, Peter Como, Irenita Gardiner, Charlyne Hickey, Karl Kieburtz, Frederick Marshall, Nancy PearsonCarol Zimmerman, Elan Louis, Carol Moskowitz, Carmen Polanco, Naomi Zubin, Catherine Brown, Jill Burkeholder, Mark Guttman, Sandra Russell, Dwight Stewart, Jackie Thomson, Daniel S. Sax, Marie Saint-Hilaire, Jackie Gray, Cindy Hunter, Nanette Mercado, Eric Siemers, Joanne Wojeieszek, Ted Dawson, Elizabeth Leritz, Adam Rosenblatt, Meeia Sherr, Candace Young, Tetsuo Ashizawa, Jenny Beach, Joseph Jankovic, Jeana Jaglin, Kathleen Shannon, Anders Lundin, Kathleen Francis, Kim Lane, Alexander Auchus, J. Timothy Greenamyre, Steven Hersch, Randi Jones, David Olson, Jang Ho John Cha, Merit Cudkowicz, Walter Koroshetz, John Penney, Greg Rudolf, Paula Sexton, Anne B. Young, Roger Albin, Kristine Wernette, Donald S. Higgins, Carson Reider, Vicki Hunt, Francis Walker, Robert Hauscr, Juan Sanchez-Ramos, Audrey Walker, Carol Pantello, Gina Rohs, Oksana Suchowersky, Kerry Duncan, Lauren Seeberger, Jody Corey-Bloom, Jane Paulsen, Michael Swenson, Neal Swerdlow, Wayne Martin, Marguerite Wieler, Alicia Facca, Gustavo Rey, William Weiner, Charles Adler, John Caviness, Cindy Lied, Stephanie Newman, Andrew Feigin, Jennifer Mazurkiewicz, Karen Caplan, Janet Cellar, Kenneth Marck, Michael Hayden, Lynn Raymond, Leon S. Dure, Jane Lane

Research output: Contribution to journalArticlepeer-review

116 Scopus citations


Objective: To determine whether motor, behavioral, or psychiatric symptoms in Huntington disease (HD) predict skilled nursing facility (SNF) placement. Methods: Subjects were participants in the Huntington Study Group's Unified Huntington Disease Rating Scale Database (Rochester, NY) between January 1994 and September 1999. Specific motor, psychiatric, and behavioral variables in subjects residing at home and in SNF were analyzed using X2 and Student's t-tests. For a subset of subjects for whom longitudinal data existed, a Cox proportional hazards model controlling for age, sex, and disease duration was used. Results: Among 4,809 subjects enrolled, 3,070 had clinically definite HD. Of these, 228 (7.4%) resided in SNF. The SNF residents' average age was 52 years, average disease duration was 8.6 years, and they were predominantly women (63%). The SNF residents had worse motor function (chorea, bradykinesia, gait abnormality, and imbalance, p < 0.0001); were more likely to have obsessions, compulsions, delusions, and auditory hallucinations; and had more aggressive, disruptive (p < 0.0001), and irritable behaviors (p = 0.0012). For 1,559 subjects, longitudinal data existed (average length of follow-up, 1.9 years), and 87 (5%) moved from home to SNF. In the Cox model, bradykinesia (HR 1.965, 95% CI 1.083 to 3.564), impaired gait (HR 3.004, 95% CI 1.353 to 6.668), and impaired tandem walking (HR 2.546, 95% CI 1.460 to 4.439) were predictive of SNF placement. Conclusions: Institutionalized patients with HD are more motorically, psychiatrically, and behaviorally impaired than their counterparts living at home. However, motor variables alone predicted institutionalization. Treatment strategies that delay the progression of motor dysfunction in HD may postpone the need for institutionalization.

Original languageEnglish (US)
Pages (from-to)998-1001
Number of pages4
Issue number6
StatePublished - Mar 25 2003

ASJC Scopus subject areas

  • Clinical Neurology


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