Multidisciplinary rehabilitation reduces hypothalamic grey matter volume loss in individuals with preclinical Huntington's disease: A nine-month pilot study

Author Identifier

Danielle Bartlett Orcid: https://orcid.org/0000-0002-6096-3760

Johnny Lo Orcid: https://orcid.org/0000-0003-1913-5354

Mel Ziman Orcid: https://orcid.org/0000-0001-7527-3538

Travis Cruickshank Orcid: https://orcid.org/0000-0001-8673-191X

Document Type

Journal Article

Publication Title

Journal of the Neurological Sciences




School of Medical and Health Sciences / School of Science / Exercise Medicine Research Institute





Wellcome trust.

National Health and Medical Research Council (NHMRC).

Grant Number

NHMRC Number : 1136548


Bartlett, D. M., Lazar, A. S., Kordsachia, C. C., Rankin, T. J., Lo, J., Govus, A. D., ... & Cruickshank, T. M. (2020). Multidisciplinary rehabilitation reduces hypothalamic grey matter volume loss in individuals with preclinical Huntington's disease: A nine-month pilot study. Journal of the Neurological Sciences, 408, Article 116522. https://doi.org/10.1016/j.jns.2019.116522


Background: Hypothalamic pathology is a well-documented feature of Huntington's disease (HD) and is believed to contribute to circadian rhythm and habitual sleep disturbances. Currently, no therapies exist to combat hypothalamic changes, nor circadian rhythm and habitual sleep disturbances in HD. Objective: To evaluate the effects of multidisciplinary rehabilitation on hypothalamic volume, brain-derived neurotrophic factor (BDNF), circadian rhythm and habitual sleep in individuals with preclinical HD. Methods: Eighteen individuals with HD (ten premanifest and eight prodromal) undertook a nine-month multidisciplinary rehabilitation intervention (intervention group), which included exercise, cognitive and dual task training and social events, and were compared to a community sample of eleven individuals with premanifest HD receiving no intervention (control group). Hypothalamic volume, serum BDNF, salivary cortisol and melatonin concentrations, subjective sleep quality, daytime somnolence, habitual sleep-wake patterns, stress and anxiety and depression symptomatology were evaluated. Results: Hypothalamus grey matter volume loss was significantly attenuated in the intervention group compared to the control group after controlling for age, gender, Unified Huntington's Disease Rating Scale-Total Motor Score and number of cytosine-adenine-guanine repeats. Serum BDNF levels were maintained in the intervention group, but decreased in the control group following the study period. Both groups exhibited decreases in cortisol and melatonin concentrations. No changes were observed in sleep or mood outcomes. Conclusions: This exploratory study provides evidence that multidisciplinary rehabilitation can reduce hypothalamic volume loss and maintain peripheral BDNF levels in individuals with preclinical HD but may not impact on circadian rhythm. Larger, randomised controlled trials are required to confirm these findings.