Multidisciplinary rehabilitation reduces hypothalamic grey matter volume loss in individuals with preclinical Huntington's disease: A nine-month pilot study
Danielle M. Bartlett, Edith Cowan UniversityFollow
Juan F. Dominguez D.
Alpar S. Lazar
Catarina C. Kordsachia
Tim J. Rankin
Johnny Lo, Edith Cowan UniversityFollow
Andrew D. Govus
Brian D. Power
Peter R. Eastwood
Mel R. Ziman, Edith Cowan University
Travis M. Cruickshank, Edith Cowan UniversityFollow
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
Journal of the Neurological Sciences
School of Medical and Health Sciences / School of Science / Exercise Medicine Research Institute
National Health and Medical Research Council (NHMRC).
NHMRC Number : 1136548
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.