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Huntington's disease

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Huntington's disease (HD) is a fatal neurodegenerative condition. This means it causes the progressive breakdown of nerve cells in the brain. It is a complex disorder that affects three main areas: movement, thinking, and emotions.

Huntington
Huntington

These three areas are often called a triad of symptoms. Because it damages the brain over time, the symptoms get worse as the disease advances. It is a serious condition that requires full-time care in its later stages.

The disease is caused by a specific error in the huntingtin gene, known as HTT. This gene provides the instructions for making the huntingtin protein. Inside this gene, there is a section of DNA called a trinucleotide repeat. This section consists of a three-letter code, CAG, that repeats many times.

Huntington's disease (5880985560)
Huntington's disease (5880985560)

In most people, this CAG sequence repeats a normal number of times. However, in people with HD, this section undergoes a trinucleotide repeat expansion. This means the CAG sequence repeats far more than it should.

This expansion leads to the production of a mutant huntingtin protein, or mHTT. This abnormal protein is toxic to brain cells. It causes damage through several possible biological mechanisms. One major effect is the degeneration of medium spiny neurons. These specific cells are located in the basal ganglia, a region of the brain that controls movement.

Basal ganglia and related structures (2)
Basal ganglia and related structures (2)

As these neurons die, the brain loses its ability to coordinate bodily functions.

Neuron with mHTT inclusion zoomed
Neuron with mHTT inclusion zoomed

Huntington's disease follows an autosomal dominant pattern of inheritance. This means a person only needs one copy of the mutated gene to develop the disease. If one parent has the mutation, each child has a 50% chance of inheriting it.

Autosomal Dominant Pedigree Chart2
Autosomal Dominant Pedigree Chart2

This probability is the same for both males and females. While most cases are inherited from a parent, up to 10% of cases result from a new mutation. This occurs when the mutation happens spontaneously without being passed down.

The symptoms of HD are often categorized into stages. In the early stages, people may experience subtle changes. These might include mood swings, irritability, or slight problems with thinking. These psychiatric symptoms can appear many years before physical movement problems. As the disease progresses into middle and late stages, the physical symptoms become much more obvious. One characteristic movement is chorea, which refers to involuntary, jerky, or "dance-like" body movements.

Another symptom is dystonia, which causes repetitive twisting or muscle rigidity.

Cognitive decline is also a major part of the disease. Patients often experience problems with executive functions. This includes difficulty planning, focusing on tasks, or controlling impulses. Memory deficits can also develop, affecting short-term, long-term, and working memory. Psychiatric symptoms can also include anxiety, depression, and even hallucinations. These mental health challenges are often the most distressing parts for families. Some people may also experience weight loss or difficulty swallowing.

History shows how much we have learned about this condition. The first description of the disease was recorded by Charles Oscar Waters in 1841. In 1872, George Huntington provided a much more detailed description of the symptoms.

On Chorea with photo
On Chorea with photo

It took much longer to find the cause. An international group led by the Hereditary Disease Foundation discovered the genetic basis in 1993. Today, researchers are studying stem-cell therapy to try and replace lost neurons. They are also testing new medications to slow the progression of the disease.

Statistics help us understand how common the disease is. HD affects about 4 to 15 people in every 100,000 of European descent. It is much rarer among Japanese and Finnish populations. Most people begin showing symptoms around age 40. However, about 8% of cases are known as juvenile HD, which starts before age 20.

Woody Guthrie NYWTS
Woody Guthrie NYWTS

In these younger cases, patients often show rigidity rather than chorea. Death usually occurs 15 to 20 years after the first symptoms appear. Common causes of death include heart disease or pneumonia.

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🖼️ Images & Media (9)
File:Huntington's disease (5880985560).jpg
Huntington's disease (5880985560).jpg
File:Autosomal Dominant Pedigree Chart2.svg
Autosomal Dominant Pedigree Chart2.svg
File:Neuron with mHTT inclusion zoomed.jpg
Neuron with mHTT inclusion zoomed.jpg
File:Basal_ganglia_and_related_structures_(2).svg
Basal_ganglia_and_related_structures_(2).svg
File:Huntington.jpg
Huntington.jpg
Report (IA report00comm 6).pdf
File:Tetrabenazine structure.svg
Tetrabenazine structure.svg
File:On Chorea with photo.jpg
On Chorea with photo.jpg
File:Woody Guthrie NYWTS.jpg
Woody Guthrie NYWTS.jpg
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