Exploring the predictors of financial impairment in Huntington’s disease using the Enroll-HD dataset

Kate L Harris,Roger A Barker,Sarah L Mason

doi:10.1007/s00415-021-10929-4

Abstract

ObjectivesHuntington’s disease (HD) is a neurodegenerative disease in which cognitive and behavioural symptoms impair the performance of instrumental activities of daily living, including the handling of finances. We sought to determine the prevalence of financial dysfunction in HD, and the demographic and clinical predictors of such impairments.MethodsWe analysed longitudinal data for pre-manifest gene carriers and HD patients from the Enroll-HD dataset. Financial dysfunction was determined by finance-related items in the Total Functional Capacity (TFC) and Functional Assessment (FA) scales. A binary logistical regression model was used to investigate the predictive value of demographic and clinical factors for the development of financial dysfunction.ResultsFinancial impairment was found to be common in HD gene carriers, and over half required financial assistance within 5 years from diagnosis. Cognitive impairment, apathy, unemployment and disease severity predicted financial dysfunction in manifest patients. For pre-manifest patients, the predictors were proximity to disease onset and depression.ConclusionsLoss of financial autonomy is common in HD, and cognitive and psychiatric factors are important in its development. Clinicians must be vigilant to identify patients that may be vulnerable to financial exploitation.

Highlights

Huntington’s disease is a neurodegenerative disease characterised by varying degrees of motor, cognitive and psychiatric dysfunction which together impact an individual’s functional capacity, including instrumental activities of daily living such as housekeeping, driving, and managing medications
One important instrumental activities of daily living (iADL) that has been relatively understudied in Huntington’s disease (HD) is financial capacity, which refers to the ability to independently manage one’s financial affairs in a manner consistent with one’s personal self-interest [1]
There is a large body of evidence to indicate that financial capacity is diminished in neurodegenerative diseases such as MCI [3,4,5] and Alzheimer’s Disease (AD) [2, 6], Parkinson’s Disease (PD) [7,8,9], and frontotemporal dementia (FTD) [10]

Summary

Introduction

Huntington’s disease is a neurodegenerative disease characterised by varying degrees of motor, cognitive and psychiatric dysfunction which together impact an individual’s functional capacity, including instrumental activities of daily living (iADL) such as housekeeping, driving, and managing medications. One important iADL that has been relatively understudied in HD is financial capacity, which refers to the ability to independently manage one’s financial affairs in a manner consistent with one’s personal self-interest [1]. Financial capacity is instrumental for independent living and encompasses a variety of domains including practical skills (e.g., counting coins, making purchases), knowledge of facts (e.g., bank account details) and conceptual understanding (e.g., when making investments and exercising financial judgement). Impairments in these abilities renders an individual at risk for financial insecurity and exploitation [2]. Depression contributes to financial capacity in a non-demented older adult population [17], the role of depression in financial impairments associated with neurodegeneration is unclear, with some studies showing an association [8, 15, 18], and others not [19,20,21]

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