Assessment Of Behavioral Problems Research Articles

How Early Is Too Early? Identification of Elevated, Persistent Problem Behavior in Childhood.

We inquire how early in childhood children most at risk for problematic patterns of internalizing and externalizing behaviors can be accurately classified. Yearly measures of anxiety/depressive symptoms and aggressive behaviors (ages 6-13; n = 334), respectively, are used to identify behavioral trajectories. We then assess the degree to which limited spans of yearly information allow for the correct classification into the elevated, persistent pattern of the problem behavior, identified theoretically and empirically as high-risk and most in need of intervention. The true positive rate (sensitivity) is below 70% for anxiety/depressive symptoms and aggressive behaviors using behavioral information through ages 6 and 7. Conversely, by age 9, over 90% of the high-risk individuals are correctly classified (i.e., sensitivity) for anxiety/depressive symptoms, but this threshold is not met until age 12 for aggressive behaviors. Notably, the false positive rate of classification for both high-risk problem behaviors is consistently low using each limited age span of data (< 5%). These results suggest that correct classification into highest risk groups of childhood problem behavior is limited using behavioral information observed at early ages. Prevention programming targeting those who will display persistent, elevated levels of problem behavior should be cognizant of the degree of misclassification and how this varies with the accumulation of behavioral information. Continuous assessment of problem behaviors is needed throughout childhood in order to continually identify high-risk individuals most in need of intervention as behavior patterns are sufficiently realized.

Initial Development of Multi-item Direct Behavior Rating Measures of Academic Enablers

Although there is a growing body of evidence to support the use of direct behavior rating (DBR) as a formative behavioral assessment method in school-based problem-solving models, this work has centered largely on the assessment of attending and problem behaviors and on the use of single-item DBR scales. The primary purpose of the current study was to report on the development and initial validation of teacher-completed multi-item DBR scales (DBR-MIS) designed to expand upon prior DBR research to assess three constructs representing behaviors that are widely considered to support student academic achievement (academic engagement, interpersonal skills, and study skills), only one of which (academic engagement) has been the target of DBR assessment methods. Development of the scales involved a content validity study utilizing feedback from a panel of consumers (teachers, parents, and school administrators) and a panel of researchers with expertise in school-based behavioral assessment. Results of an exploratory factor analysis of ratings of students completed by teachers in Grades K through 3 (N = 307) supported a one-factor solution for each of the aforementioned constructs. Favorable internal consistency was found for each scale.

Apathy Associated With Impaired Recognition of Happy Facial Expressions in Huntington's Disease.

Previous research has demonstrated an association between emotion recognition and apathy in several neurological conditions involving fronto-striatal pathology, including Parkinson's disease and brain injury. In line with these findings, we aimed to determine whether apathetic participants with early Huntington's disease (HD) were more impaired on an emotion recognition task compared to non-apathetic participants and healthy controls. We included 43 participants from the TRACK-HD study who reported apathy on the Problem Behaviours Assessment - short version (PBA-S), 67 participants who reported no apathy, and 107 controls matched for age, sex, and level of education. During their baseline TRACK-HD visit, participants completed a battery of cognitive and psychological tests including an emotion recognition task, the Hospital Depression and Anxiety Scale (HADS) and were assessed on the PBA-S. Compared to the non-apathetic group and the control group, the apathetic group were impaired on the recognition of happy facial expressions, after controlling for depression symptomology on the HADS and general disease progression (Unified Huntington's Disease Rating Scale total motor score). This was despite no difference between the apathetic and non-apathetic group on overall cognitive functioning assessed by a cognitive composite score. Impairment of the recognition of happy expressions may be part of the clinical picture of apathy in HD. While shared reliance on frontostriatal pathways may broadly explain associations between emotion recognition and apathy found across several patient groups, further work is needed to determine what relationships exist between recognition of specific emotions, distinct subtypes of apathy and underlying neuropathology. (JINS, 2019, 25, 453-461).

Assessment and Treatment of Problem Behavior Maintained by Termination of Interruptions

ABSTRACTPurpose: Previous research has identified termination of interruptions to repetitive behaviour as a reinforcer capable of maintaining problem behaviour. Effective treatments have included functional communication training and multiple schedules of reinforcement.Methods: In the present study, a functional analysis determined that the aggression of an eight-year-old boy with autism spectrum disorder was maintained by termination of interruptions of repetitive behaviour. An intervention was implemented consisting of differential reinforcement of other behaviour and response cost.Results: The intervention produced and maintained a reduction in aggression and increased tolerance for interruptions of systematically increasing durations.Conclusions: This case study demonstrates an alternative approach to the treatment of problem behaviours such as aggression maintained by termination of repetitive behaviour that includes teaching the individual to tolerate interruption of repetitive behavior.

Suicidal Ideation Assessment in Individuals with Premanifest and Manifest Huntington Disease.

Huntington disease (HD) is associated with increased risk of suicide. This study compares suicide ideation in HD to the general population, assesses factors associated with increased prevalence of suicidal thoughts, and compares clinician-rated to self-reported assessments of suicidal ideation. We examined 496 participants with premanifest or manifest HD. Clinician-rated suicidal ideation was measured using the Problem Behaviors Assessment - short form. Self-reported ideation was measured using two items from the HDQLIFE Concern with Death and Dying item bank. Independent sample t-tests were conducted to compare the prevalence of suicidal thoughts between our HD sample and the U.S. Logistic regression analyses were used to determine characteristics associated with higher odds of clinically significant suicidal ideation. Kappa agreement coefficients were calculated to evaluate concurrence between clinician-rated and self-reported assessments. Our sample had a significantly higher occurrence of suicidal ideation (19.76%) and suicidal plans (2.1%) than the general population (p < 0.0001). Odds of clinically significant suicidal ideation were 6.8 times higher in females (p = 0.04) on the clinician measure, and Hispanic/Latinos had 10.9 times higher odds than non-Hispanics (p = 0.025) on the self-report measure. Clinician-rated assessment had fair agreement (k = 0.2-0.4) with self-reported assessments, except in early stage HD where there was no overlap in the identification of participants with clinically significant suicidal ideation. Assessment for suicidal ideation and clinically significant suicidal thoughts in HD with a multimodal approach that includes clinician-rated and self-report measures is critical at all stages of the disease.

Initial assessment versus gradual change in early childhood behavior problems―Which better foretells the future?

AbstractLeading research argues the distinct importance of earliest detection of childhood behavior problems and the value of discovering subsequent change patterns as children transition through the early education years. This study examined the relative contributions of earliest assessments of children's problem behaviors as compared to the changes in those behaviors over time for the prediction of important later outcomes. Focusing on the representative national sample from the Head Start Impact Study (n = 3,827), classroom behavior problems were assessed across 4 years spanning prekindergarten through first grade. Individual child indices were derived in multilevel growth modeling to reflect initial assessments and subsequent change patterns. These indices were thereafter applied in multilevel logistic regression and receiver operating characteristic curve analyses to predict later academic and social difficulties. Both children's initial assessments and their transitional changes proved to be good predictors of most outcomes, where the accuracy for initial assessments and transitional changes was effectively equivocal. The evidence clarifies that initial assessment of behavior problems is sufficient to predict later outcomes; additional assessments did not augment forecasting accuracy nor did the combination of both initial assessment and information about subsequent change improve accuracy. Implications are discussed for assessment theory and practice.

Linguistic and behavioral performance of bilingual children with hearing loss

ObjectiveTo compare the English and non-English language performance of deaf or hard-of-hearing (DHH) children raised in homes where English was not the primary language to their typically hearing peers from similar language backgrounds. MethodsCase control study of bilingual DHH children with unilateral or bilateral non-fluctuating hearing loss defined as the most recent PTA between 26 and 70 dB in one or both ears. Typically hearing controls included bilingual siblings and children recruited from the General Pediatrics practice. Subjects completed the OWLS-II, a validated English language proficiency tool. The subject's parents completed the Child Behavioral Checklist, an assessment of problem behavior; the Student Oral Language Observation Matrix (SOLOM), an assessment of the child's non-English home language; and a study questionnaire on the child's medical, social, and language history. Results26 typically hearing controls, 15 children with bilateral hearing loss, and 18 children with unilateral hearing loss participated. The groups were similar in age, sex, insurance status, place of birth, age at arrival in the US, and maternal education status. Performance on the English language oral composite was significantly lower amongst the bilateral hearing loss group (BHL: 66.9, 95% CI [56.2–77.7]; UHL: 82.9, 95% CI [75.6–90.2]; NH: 84.4, 95% CI [79.5–89.3], p = 0.002). Performance on the SOLOM was significantly lower in bilateral hearing loss group. (BHL: 18.6, 95% CI [15.9–21.3]; UHL: 19.8, 95% CI [17.1–22.4]; NH: 22.3, 95% CI [20.6–24.0], p = 0.036). ConclusionsBilingual children with bilateral hearing loss are at increased risk for poor oral expressive and receptive language development. These children comprise a particularly vulnerable population who might benefit from additional focused interventions to support their language development.

The observability of problem behavior and its relation to discrepancies between adolescents' self-report and parents' proxy report on problem behavior.

This study provides evidence regarding the relatedness of multi-informant agreement and perceived observability of internalizing and externalizing problem behaviors. Based on 2 distinct but comparable samples of children/adolescents (Sample 1: 58.2% female and mean age of 12.51 years; Sample 2: 56.4% female and mean age of 12.35 years) and their mothers, cross-sectional as well as longitudinal analyses were conducted. Although often suggested in the literature, the results of the study do not indicate that-in general-internalizing behavior is less observable than externalizing behavior. Moreover, the results do not corroborate the suggestion that multi-informant agreement regarding internalizing behavior is lower than that of externalizing behavior. However, apart from the broad distinction of internalizing versus externalizing behavior, observability and multi-informant agreement are positively correlated with respect to reports on actual state (cross-sectional) as well as change (longitudinal) of problem behavior. The results are discussed in the context of research on multi-informant reports on problem behavior and with respect to practical implications for the assessment of problem behavior. (PsycINFO Database Record

Structural and metabolic brain correlates of apathy in Huntington's disease.

Apathy is the most prevalent and characteristic neuropsychiatric feature of Huntington's disease. Congruent with the main early pathological changes, apathy is primarily associated with subcortical damage in frontal-striatal circuits. However, little is known about its precise subserving mechanisms and the contribution of regions other than the basal ganglia. We aimed to define the neural correlates of apathy in Huntington's disease based on gray matter volume and PET/CT of 18 F-fluorodeoxyglucose metabolism. We rated the severity of apathy in 40 mild Huntington's disease participants using the Problem Behaviors Assessment for Huntington's disease. Voxelwise regression analysis was performed, controlling for effects of potential confounders, and PET/CT results were corrected for the effects of gray matter atrophy. Apathy was strongly associated with decreased gray matter within a spatially distributed cortico-subcortical network, with major compromise of the bilateral amygdala and temporal cortex. PET metabolism was significantly decreased in frontotemporal and parietal regions. Metabolic uptake and gray matter values in the identified clusters showed significant correlations with multiple clinical measures. Our findings indicate that apathy in Huntington's disease is not exclusively a consequence of basal ganglia and related frontal-executive alterations. It is subserved by a complex cortico-subcortical network where critical reward and emotional-related prefrontal, temporal, and limbic nodes contribute strongly to its severity. This highlights the contribution of damage in regions other than the basal ganglia to the clinical expression of Huntington's disease. © 2018 International Parkinson and Movement Disorder Society.

Patient-reported outcome measures in Huntington disease: Quality of life in neurological disorders (Neuro-QoL) social functioning measures.

Social functioning is an essential but poorly understood component of health-related quality of life (HRQOL) for people with Huntington disease (HD). We report on the psychometric properties of 2 Neuro-QoL patient-reported outcome measures to assess social functioning in HD. Persons with prodromal (n = 198) or manifest HD (n = 195 early and n = 117 late) completed Neuro-QoL Ability to Participate in Social Roles and Activities, and Satisfaction with Social Roles and Activities. Items from 2 generic HRQOL patient-reported outcome measures were used to create a social functioning composite score; items from the Unified Huntington's Disease Rating Scale and Problem Behaviors Assessment Scale were used to create a clinician-rated composite score of social function. Internal consistencies for the scores on the Neuro-QoL measures were excellent (> .88). Computer adaptive test administration had some advantages over computer-administered static Short Forms. Validity was supported by significant associations between the scores on the Neuro-QoL measures and other self- and clinician-reports of social function. Individuals with prodromal HD had better social functioning than the manifest HD groups; individuals with late-HD had less satisfaction and ability to participate in social roles and activities than the other 2 groups. Neuro-QoL provides brief, reliable scores of social functioning that measure ability to participate in, and satisfaction with, social roles and activities in persons with prodromal and manifest HD. In addition, test score interpretations of these measures support their validity in people with prodromal and manifest HD. These measurement tools add breadth to treatment outcome measures in HD and can increase understanding of the social implications of living with HD. (PsycINFO Database Record

Behavior Problems Inventory (BPI): Psychometric characteristics of an instrument for routine assessment of persons with psychoses and related disorders

This study explores the psychometric characteristics of the Behavior Problems Inventory (BPI), an instrument for routine clinical assessment of behavior problems in outpatients with psychosis based on information provided by key family informants. Six hundred and twenty-one patients diagnosed with psychosis and bipolar affective disorder (ICD-10 F20-F31) attended at Community Mental Health Units were evaluated in routine reviews using the BPI and the Social Functioning Scale (SFS). Twenty-five subjects were simultaneously administered the Social Behavior Schedule (SBS) and 28 were again administered the BPI eight weeks later. The instrument shows adequate psychometric characteristics with high internal consistency and robust temporal reliability, as well as satisfactory concurrent and construct validity. Factor analysis identified three factors: Underactivity/Social Withdrawal, Active Problems and Lack of Impulse Control, with adequate saturation of the items on each of the factors. The BPI is easy to apply, reliable and valid, takes up little of valuable clinical time, allowing routine assessment in public service contexts for persons diagnosed with psychosis and bipolar affective disorder for whom key family informants are available.

Descriptive assessment of problem behavior during transitions of children with intellectual and developmental disabilities.

Transitions from one activity to another may evoke problem behavior from individuals with intellectual disabilities. One explanation for the occurrence of problem behavior could be the change in relative densities of reinforcement between the two activities. We conducted a descriptive assessment of problem behavior with four children during transitions to and from several different contexts. We observed that, in most cases, the probability of problem behavior was greater during a transition to an activity with a lower density of reinforcement than during a transition to an activity with a higher density of reinforcement. We discuss our findings in terms of problem behavior associated with transitions in activities with different reinforcer densities, as well as the possibility that the problem behavior may be associated with shifts in motivating operations.

Evaluating cognition in individuals with Huntington disease: Neuro-QoL cognitive functioning measures.

Cognitive functioning impacts health-related quality of life (HRQOL) for individuals with Huntington disease (HD). The Neuro-QoL includes two patient-reported outcome (PRO) measures of cognition-Executive Function (EF) and General Concerns (GC). These measures have not previously been validated for use in HD. The purpose of this analysis is to evaluate the reliability and validity of the Neuro-QoL Cognitive Function measures for use in HD. Five hundred ten individuals with prodromal or manifest HD completed the Neuro-QoL Cognition measures, two other PRO measures of HRQOL (WHODAS 2.0 and EQ5D), and a depression measure (PROMIS Depression). Measures of functioning The Total Functional Capacity and behavior (Problem Behaviors Assessment) were completed by clinician interview. Objective measures of cognition were obtained using clinician-administered Symbol Digit Modalities Test and the Stroop Test (Word, Color, and Interference). Self-rated, clinician-rated, and objective composite scores were developed. We examined the Neuro-QoL measures for reliability, convergent validity, discriminant validity, and known-groups validity. Excellent reliabilities (Cronbach's alphas ≥ 0.94) were found. Convergent validity was supported, with strong relationships between self-reported measures of cognition. Discriminant validity was supported by less robust correlations between self-reported cognition and other constructs. Prodromal participants reported fewer cognitive problems than manifest groups, and early-stage HD participants reported fewer problems than late-stage HD participants. The Neuro-QoL Cognition measures provide reliable and valid assessments of self-reported cognitive functioning for individuals with HD. Findings support the utility of these measures for assessing self-reported cognition.

Autosomal dominant mannose-binding lectin deficiency is associated with worse neurodevelopmental outcomes after cardiac surgery in infants

ObjectivesThe MBL2 gene is the major genetic determinant of mannose-binding lectin (MBL)—an acute phase reactant. Low MBL levels have been associated with adverse outcomes in preterm infants. The MBL2Gly54Asp missense variant causes autosomal dominant MBL deficiency. We tested the hypothesis that MBL2Gly54Asp is associated with worse neurodevelopmental outcomes after cardiac surgery in neonates. MethodsThis is an analysis of a previously described cohort of patients with nonsyndromic congenital heart disease who underwent cardiac surgery with cardiopulmonary bypass before age 6 months (n = 295). Four-year neurodevelopment was assessed in 3 domains: Full-Scale Intellectual Quotient, the Visual Motor Integration development test, and the Child Behavior Checklist to assess behavior problems. The Child Behavior Checklist measured total behavior problems, pervasive developmental problems, and internalizing/externalizing problems. A multivariable linear regression model, adjusting for confounders, was fit. ResultsMBL2Gly54Asp was associated with a significantly increased covariate-adjusted pervasive developmental problem score (β = 3.98; P = .0025). Sensitivity analyses of the interaction between age at first surgery and MBL genotype suggested effect modification for the patients with MBL2Gly54Asp (Pinteraction = .039), with the poorest neurodevelopment outcomes occurring in children who had surgery earlier in life. ConclusionsWe report the novel finding that carriers of MBL2Gly54Asp causing autosomal dominant MBL deficiency have increased childhood pervasive developmental problems after cardiac surgery, independent of other covariates. Sensitivity analyses suggest that this effect may be larger in children who underwent surgery at earlier ages. These data support the role of nonsyndromic genetic variation in determining postsurgical neurodevelopment-related outcomes in children with congenital heart disease.

Assessment of Behavioral Problems in Children With Hearing Loss.

To compare the prevalence of disruptive behavior problems between preschool-aged children with hearing loss and normal hearing. Cross-sectional study. Tertiary academic center. Caregivers of children (2-5 yr old) with normal hearing (NH) (n = 39), hearing loss using hearing aid(s) (HA) (n = 29), or cochlear implant(s) (CI) (n = 21). Demographic information and a mental health history were obtained. Child behavior and language development were assessed. The Young Child-Diagnostic Interview Schedule for Children-IV and the MacArthur-Bates Communication Development Inventory III. Distributions of race, socioeconomic status, insurance status, and parental home situation (single versus two parent family) were similar across all groups. Parents of children with hearing loss were significantly more likely to report behavior problems (HA = 41%, CI = 38%) than parents of NH children (10%; p = 0.002). Children with hearing loss were significantly more likely to meet diagnostic criteria for oppositional defiant disorder (HA = 48%, CI = 48%) than NH children (23%; p = 0.02). More NH children (8%) than hearing impaired children (0%) had accessed mental health services (p = 0.08). NH children were found to have more advanced language development than hearing-impaired children (p < 0.01), but controlling for Communication Development Inventory III percentiles, the observed behavioral differences remained. Controlling for language development, children with hearing loss have higher prevalence of and impairment from disruptive behaviors than their NH peers. These children are less likely to receive appropriate behavioral interventions. Further research is warranted to investigate the impact of disruptive behaviors on speech and hearing rehabilitation. Methods to improve access to effective behavioral interventions in this population are needed.

Suicidal ideation and suicidal behavior according to the C-SSRS in a European cohort of Huntington's disease gene expansion carriers

BackgroundHuntington's disease (HD) gene expansion carriers are at an increased risk of suicide, but so far, no studies have investigated the full spectrum of suicidality, including suicidal ideation, suicidal behavior and self-injurious behavior. MethodsWe included 1451 HD gene expansion carriers (age 48.4 years (SD 14.0), 54.8% female) of the REGISTRY study of the European Huntington's Disease Network. Lifetime suicidal ideation and suicidal behavior were assessed with the Columbia-Suicidal Severity Rating Scale. Motor symptoms and disease stage were assessed using subscales of the Unified Huntington's Disease Rating Scale, and depressed mood and irritability were assessed by the Problem Behaviors Assessment. ResultsLifetime passive suicidal ideation was reported by 21.2%. Participants in stage II showed the highest prevalence rate of suicidal ideation, while participants in stage IV/V showed the highest prevalence of suicidal behavior. A lifetime suicide attempt was reported by 6.5% of the HD gene expansion carriers. In multivariate regression analyses, both suicidal ideation and suicidal behavior were associated with a depressed mood, and to a lesser extend to irritability. LimitationsResults may have been affected by denial or recall bias and no conclusions can be made about the temporal and causal relationships with depressed mood and irritability because of the cross-sectional analyses. ConclusionsGiven the high prevalence of suicidal ideation and suicidal behavior in all stages of HD, it is important to screen HD gene expansion carriers for suicidal ideation and suicidal behavior on a regular basis in clinical practice.

Reliability and Validity of the HD-PRO-TriadTM, a Health-Related Quality of Life Measure Designed to Assess the Symptom Triad of Huntington's Disease.

Huntington's disease (HD), is a neurodegenerative disorder that is associated with cognitive, behavioral, and motor impairments that diminish health related quality of life (HRQOL). The HD-PRO-TRIADTM is a quality of life measure that assesses health concerns specific to individuals with HD. Preliminary psychometric characterization was limited to a convenience sample of HD participants who completed measures at home so clinician-ratings were unavailable. The current study evaluates the reliability and validity of the HD-PRO-TRIADTM in a well-characterized sample of individuals with HD. Four-hundred and eighty-two individuals with HD (n = 192 prodromal, n = 193 early, and n = 97 late) completed the HD-PRO-TRIADTM questionnaire. Clinician-rated assessments from the Unified Huntington Disease Rating Scales, the short Problem Behaviors Assessment, and three generic measures of HRQOL (WHODAS 2.0, RAND-12, and EQ-5D) were also examined. Internal reliability for all domains and the total HD-PRO-TRIADTM was excellent (all Cronbach's α >0.93). Convergent and discriminant validity were supported by significant associations between the HD-PRO-TRIADTM domains, and other patient reported outcome measures as well as clinician-rated measures. Known groups validity was supported as the HD-PRO-TRIADTM differentiated between stages of the disease. Floor and ceiling effects were generally within acceptable limits. There were small effect sizes for 12-month change over time and moderate effect sizes for 24-month change over time. Findings support excellent internal reliability, convergent and discriminant validity, known groups validity, and responsiveness to change over time. The current study supports the clinical efficacy of the HD-PRO-TRIADTM. Future research is needed to assess the test-retest reliability of this measure.

Sociodemographic Characteristics, Behavioral Problems, Parental Concerns and Children’s Strengths Reported by Parents

Abstract: Parental report is essential to understand adaptive difficulties in childhood. The aim of the study was to identify concerns of parents and qualities of children reported by parents, as well as the association of these variables with sociodemographic factors and child behavior problems. Parents of 353 schoolchildren from three public schools and one private school took part in the study. Assessment of behavior problems and parental reports about concerns and children’s strengths were obtained from the Child Behavior Checklist - CBCL. We submitted parents’ answers to the open-ended questions in the CBCL to a lexical analysis with the IRAMUTEQ software. Results concerning ‘strengths’ were related to affective and social interaction, while ‘concerns’ were related to academic performance and prevention of behavior problems. We concluded that parent concerns are targets of preventive interventions in childhood, while child strengths reported by parents are skills that need to be developed, as they help in adaptive functioning.

Avaliação e tratamento de comportamentos problemas de duas pessoas com o diagnóstico de depressão

Este estudo envolveu a avaliação e tratamento de comportamentos-problema de duas pessoas com o diagnóstico de depressão em que eventos motivadores antecedentes e reforçadores consequentes para os comportamentos-problema consistiram em atenção social e fuga de demandas. As participantes eram do sexo feminino e relataram ter recebido esse diagnóstico desde a adolescência. Para avaliar os relatos de comportamentos-problema, foram empregadas estratégias de avaliação funcional por observação indireta, por observação direta e a análise funcional com quatro condições principais: atenção, fuga de demanda, sozinho e controle. As participantes exibiram altos índices de comportamentos-problema nas condições de atenção e fuga de demandas, o que evidencia o controle do responder pelos eventos motivadores antecedentes e pelos reforços consequentes. Na condição de controle foi possível observar a eficácia da densidade de reforçadores, e na condição sozinho os comportamentos-problema não ocorreram. Para tratar os relatos de comportamentos-problema, o programa de intervenção incluiu o reforço diferencial (DRA), mais a extinção (EXT), com uso do delineamento de reversão-replicação seguido por follow-up. Observou-se que o uso do DRA mais EXT diminuiu os relatos de comportamentos-problema e aumentou os relatos de comportamentos desejados de forma confiável.

Plasma Cytokine Levels in Relation to Neuropsychiatric Symptoms and Cognitive Dysfunction in Huntington’s disease

In Huntington's disease (HD) the innate immune system is activated, as reflected by increased plasma levels of different cytokines. To explore whether increased cytokine levels are associated with neuropsychiatric symptoms and cognitive dysfunction in HD mutation carriers. Plasma cytokine levels of TNF-alpha, interleukin (IL)-1ra, IL-1β, IL-5, IL-6, IL-8 and Il-10 were assessed in 124 HD mutation carriers at two time points 2 years apart (totalling 214 observations). Using multilevel regression analysis, cytokines were analysed in relation to neuropsychiatric symptoms and cognitive dysfunction. Depressed mood was assessed with the depression subscale of the Problem Behaviours Assessment (PBA), apathy with the Apathy Scale, and irritability with the Irritability Scale. Cognitive functioning was assessed using the Mini-Mental State Examination (MMSE) and a battery of executive cognitive functioning tests, aggregated into an executive cognitive functioning (ExCog) score. Inverse associations were found in adjusted models between IL-6 and ExCog score (β= -0.114; p = 0.01) and between IL-1ra and ExCog score (β= -0.110; p = 0.02). No associations between cytokine levels and any of the other neuropsychiatric symptom scores remained statistically significant in adjusted models. Higher plasma levels of IL-6 and IL-1ra are weakly associated with cognitive dysfunction in HD, but not with other neuropsychiatric symptoms.