Predictors of nursing home placement in Huntington disease

Vicki L. Wheelock, T. Tempkin, Karen Marder, Martha Nance, R. H. Myers, H. Zhao, Elise Kayson, C. Orme, Ira Shoulson, Phillipa Hedges, Elizabeth McCusker, Samantha Pearce, Ronald Trent, David Abwender, Peter Como, Irenita Gardiner, Charlyne Hickey, Karl Kieburtz, Frederick Marshall, Nancy Pearson & 79 others Carol Zimmerman, Elan Louis, Carol Moskowitz, Carmen Polanco, Naomi Zubin, Catherine Brown, Jill Burkeholder, Mark Guttman, Sandra Russell, Dwight Stewart, Jackie Thomson, Daniel S. Sax, Marie Saint-Hilaire, Jackie Gray, Cindy Hunter, Nanette Mercado, Eric Siemers, Joanne Wojeieszek, Ted M Dawson, Elizabeth Leritz, Adam Rosenblatt, Meeia Sherr, Candace Young, Tetsuo Ashizawa, Jenny Beach, Joseph Jankovic, Jeana Jaglin, Kathleen Shannon, Anders Lundin, Kathleen Francis, Kim Lane, Alexander Auchus, J. Timothy Greenamyre, Steven Hersch, Randi Jones, David Olson, Jang Ho John Cha, Merit Cudkowicz, Walter Koroshetz, John Penney, Greg Rudolf, Paula Sexton, Anne B. Young, Roger Albin, Kristine Wernette, Donald S. Higgins, Carson Reider, Vicki Hunt, Francis Walker, Robert Hauscr, Juan Sanchez-Ramos, Audrey Walker, Carol Pantello, Gina Rohs, Oksana Suchowersky, Kerry Duncan, Lauren Seeberger, Jody Corey-Bloom, Jane Paulsen, Michael Swenson, Neal Swerdlow, Wayne Martin, Marguerite Wieler, Alicia Facca, Gustavo Rey, William Weiner, Charles Adler, John Caviness, Cindy Lied, Stephanie Newman, Andrew Feigin, Jennifer Mazurkiewicz, Karen Caplan, Janet Cellar, Kenneth Marck, Michael Hayden, Lynn Raymond, Leon S. Dure, Jane Lane

Research output: Contribution to journalArticle

Abstract

Objective: To determine whether motor, behavioral, or psychiatric symptoms in Huntington disease (HD) predict skilled nursing facility (SNF) placement. Methods: Subjects were participants in the Huntington Study Group's Unified Huntington Disease Rating Scale Database (Rochester, NY) between January 1994 and September 1999. Specific motor, psychiatric, and behavioral variables in subjects residing at home and in SNF were analyzed using X2 and Student's t-tests. For a subset of subjects for whom longitudinal data existed, a Cox proportional hazards model controlling for age, sex, and disease duration was used. Results: Among 4,809 subjects enrolled, 3,070 had clinically definite HD. Of these, 228 (7.4%) resided in SNF. The SNF residents' average age was 52 years, average disease duration was 8.6 years, and they were predominantly women (63%). The SNF residents had worse motor function (chorea, bradykinesia, gait abnormality, and imbalance, p <0.0001); were more likely to have obsessions, compulsions, delusions, and auditory hallucinations; and had more aggressive, disruptive (p <0.0001), and irritable behaviors (p = 0.0012). For 1,559 subjects, longitudinal data existed (average length of follow-up, 1.9 years), and 87 (5%) moved from home to SNF. In the Cox model, bradykinesia (HR 1.965, 95% CI 1.083 to 3.564), impaired gait (HR 3.004, 95% CI 1.353 to 6.668), and impaired tandem walking (HR 2.546, 95% CI 1.460 to 4.439) were predictive of SNF placement. Conclusions: Institutionalized patients with HD are more motorically, psychiatrically, and behaviorally impaired than their counterparts living at home. However, motor variables alone predicted institutionalization. Treatment strategies that delay the progression of motor dysfunction in HD may postpone the need for institutionalization.

Original languageEnglish (US)
Pages (from-to)998-1001
Number of pages4
JournalNeurology
Volume60
Issue number6
StatePublished - Mar 25 2003

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Skilled Nursing Facilities
Huntington Disease
Nursing Homes
Institutionalization
Hypokinesia
Gait
Proportional Hazards Models
Psychiatry
Obsessive Behavior
Chorea
Delusions
Hallucinations
Walking
Databases
Students

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

Wheelock, V. L., Tempkin, T., Marder, K., Nance, M., Myers, R. H., Zhao, H., ... Lane, J. (2003). Predictors of nursing home placement in Huntington disease. Neurology, 60(6), 998-1001.

Predictors of nursing home placement in Huntington disease. / Wheelock, Vicki L.; Tempkin, T.; Marder, Karen; Nance, Martha; Myers, R. H.; Zhao, H.; Kayson, Elise; Orme, C.; Shoulson, Ira; Hedges, Phillipa; McCusker, Elizabeth; Pearce, Samantha; Trent, Ronald; Abwender, David; Como, Peter; Gardiner, Irenita; Hickey, Charlyne; Kieburtz, Karl; Marshall, Frederick; Pearson, Nancy; Zimmerman, Carol; Louis, Elan; Moskowitz, Carol; Polanco, Carmen; Zubin, Naomi; Brown, Catherine; Burkeholder, Jill; Guttman, Mark; Russell, Sandra; Stewart, Dwight; Thomson, Jackie; Sax, Daniel S.; Saint-Hilaire, Marie; Gray, Jackie; Hunter, Cindy; Mercado, Nanette; Siemers, Eric; Wojeieszek, Joanne; Dawson, Ted M; Leritz, Elizabeth; Rosenblatt, Adam; Sherr, Meeia; Young, Candace; Ashizawa, Tetsuo; Beach, Jenny; Jankovic, Joseph; Jaglin, Jeana; Shannon, Kathleen; Lundin, Anders; Francis, Kathleen; Lane, Kim; Auchus, Alexander; Greenamyre, J. Timothy; Hersch, Steven; Jones, Randi; Olson, David; Cha, Jang Ho John; Cudkowicz, Merit; Koroshetz, Walter; Penney, John; Rudolf, Greg; Sexton, Paula; Young, Anne B.; Albin, Roger; Wernette, Kristine; Higgins, Donald S.; Reider, Carson; Hunt, Vicki; Walker, Francis; Hauscr, Robert; Sanchez-Ramos, Juan; Walker, Audrey; Pantello, Carol; Rohs, Gina; Suchowersky, Oksana; Duncan, Kerry; Seeberger, Lauren; Corey-Bloom, Jody; Paulsen, Jane; Swenson, Michael; Swerdlow, Neal; Martin, Wayne; Wieler, Marguerite; Facca, Alicia; Rey, Gustavo; Weiner, William; Adler, Charles; Caviness, John; Lied, Cindy; Newman, Stephanie; Feigin, Andrew; Mazurkiewicz, Jennifer; Caplan, Karen; Cellar, Janet; Marck, Kenneth; Hayden, Michael; Raymond, Lynn; Dure, Leon S.; Lane, Jane.

In: Neurology, Vol. 60, No. 6, 25.03.2003, p. 998-1001.

Research output: Contribution to journalArticle

Wheelock, VL, Tempkin, T, Marder, K, Nance, M, Myers, RH, Zhao, H, Kayson, E, Orme, C, Shoulson, I, Hedges, P, McCusker, E, Pearce, S, Trent, R, Abwender, D, Como, P, Gardiner, I, Hickey, C, Kieburtz, K, Marshall, F, Pearson, N, Zimmerman, C, Louis, E, Moskowitz, C, Polanco, C, Zubin, N, Brown, C, Burkeholder, J, Guttman, M, Russell, S, Stewart, D, Thomson, J, Sax, DS, Saint-Hilaire, M, Gray, J, Hunter, C, Mercado, N, Siemers, E, Wojeieszek, J, Dawson, TM, Leritz, E, Rosenblatt, A, Sherr, M, Young, C, Ashizawa, T, Beach, J, Jankovic, J, Jaglin, J, Shannon, K, Lundin, A, Francis, K, Lane, K, Auchus, A, Greenamyre, JT, Hersch, S, Jones, R, Olson, D, Cha, JHJ, Cudkowicz, M, Koroshetz, W, Penney, J, Rudolf, G, Sexton, P, Young, AB, Albin, R, Wernette, K, Higgins, DS, Reider, C, Hunt, V, Walker, F, Hauscr, R, Sanchez-Ramos, J, Walker, A, Pantello, C, Rohs, G, Suchowersky, O, Duncan, K, Seeberger, L, Corey-Bloom, J, Paulsen, J, Swenson, M, Swerdlow, N, Martin, W, Wieler, M, Facca, A, Rey, G, Weiner, W, Adler, C, Caviness, J, Lied, C, Newman, S, Feigin, A, Mazurkiewicz, J, Caplan, K, Cellar, J, Marck, K, Hayden, M, Raymond, L, Dure, LS & Lane, J 2003, 'Predictors of nursing home placement in Huntington disease', Neurology, vol. 60, no. 6, pp. 998-1001.
Wheelock VL, Tempkin T, Marder K, Nance M, Myers RH, Zhao H et al. Predictors of nursing home placement in Huntington disease. Neurology. 2003 Mar 25;60(6):998-1001.
Wheelock, Vicki L. ; Tempkin, T. ; Marder, Karen ; Nance, Martha ; Myers, R. H. ; Zhao, H. ; Kayson, Elise ; Orme, C. ; Shoulson, Ira ; Hedges, Phillipa ; McCusker, Elizabeth ; Pearce, Samantha ; Trent, Ronald ; Abwender, David ; Como, Peter ; Gardiner, Irenita ; Hickey, Charlyne ; Kieburtz, Karl ; Marshall, Frederick ; Pearson, Nancy ; Zimmerman, Carol ; Louis, Elan ; Moskowitz, Carol ; Polanco, Carmen ; Zubin, Naomi ; Brown, Catherine ; Burkeholder, Jill ; Guttman, Mark ; Russell, Sandra ; Stewart, Dwight ; Thomson, Jackie ; Sax, Daniel S. ; Saint-Hilaire, Marie ; Gray, Jackie ; Hunter, Cindy ; Mercado, Nanette ; Siemers, Eric ; Wojeieszek, Joanne ; Dawson, Ted M ; Leritz, Elizabeth ; Rosenblatt, Adam ; Sherr, Meeia ; Young, Candace ; Ashizawa, Tetsuo ; Beach, Jenny ; Jankovic, Joseph ; Jaglin, Jeana ; Shannon, Kathleen ; Lundin, Anders ; Francis, Kathleen ; Lane, Kim ; Auchus, Alexander ; Greenamyre, J. Timothy ; Hersch, Steven ; Jones, Randi ; Olson, David ; Cha, Jang Ho John ; Cudkowicz, Merit ; Koroshetz, Walter ; Penney, John ; Rudolf, Greg ; Sexton, Paula ; Young, Anne B. ; Albin, Roger ; Wernette, Kristine ; Higgins, Donald S. ; Reider, Carson ; Hunt, Vicki ; Walker, Francis ; Hauscr, Robert ; Sanchez-Ramos, Juan ; Walker, Audrey ; Pantello, Carol ; Rohs, Gina ; Suchowersky, Oksana ; Duncan, Kerry ; Seeberger, Lauren ; Corey-Bloom, Jody ; Paulsen, Jane ; Swenson, Michael ; Swerdlow, Neal ; Martin, Wayne ; Wieler, Marguerite ; Facca, Alicia ; Rey, Gustavo ; Weiner, William ; Adler, Charles ; Caviness, John ; Lied, Cindy ; Newman, Stephanie ; Feigin, Andrew ; Mazurkiewicz, Jennifer ; Caplan, Karen ; Cellar, Janet ; Marck, Kenneth ; Hayden, Michael ; Raymond, Lynn ; Dure, Leon S. ; Lane, Jane. / Predictors of nursing home placement in Huntington disease. In: Neurology. 2003 ; Vol. 60, No. 6. pp. 998-1001.
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title = "Predictors of nursing home placement in Huntington disease",
abstract = "Objective: To determine whether motor, behavioral, or psychiatric symptoms in Huntington disease (HD) predict skilled nursing facility (SNF) placement. Methods: Subjects were participants in the Huntington Study Group's Unified Huntington Disease Rating Scale Database (Rochester, NY) between January 1994 and September 1999. Specific motor, psychiatric, and behavioral variables in subjects residing at home and in SNF were analyzed using X2 and Student's t-tests. For a subset of subjects for whom longitudinal data existed, a Cox proportional hazards model controlling for age, sex, and disease duration was used. Results: Among 4,809 subjects enrolled, 3,070 had clinically definite HD. Of these, 228 (7.4{\%}) resided in SNF. The SNF residents' average age was 52 years, average disease duration was 8.6 years, and they were predominantly women (63{\%}). The SNF residents had worse motor function (chorea, bradykinesia, gait abnormality, and imbalance, p <0.0001); were more likely to have obsessions, compulsions, delusions, and auditory hallucinations; and had more aggressive, disruptive (p <0.0001), and irritable behaviors (p = 0.0012). For 1,559 subjects, longitudinal data existed (average length of follow-up, 1.9 years), and 87 (5{\%}) moved from home to SNF. In the Cox model, bradykinesia (HR 1.965, 95{\%} CI 1.083 to 3.564), impaired gait (HR 3.004, 95{\%} CI 1.353 to 6.668), and impaired tandem walking (HR 2.546, 95{\%} CI 1.460 to 4.439) were predictive of SNF placement. Conclusions: Institutionalized patients with HD are more motorically, psychiatrically, and behaviorally impaired than their counterparts living at home. However, motor variables alone predicted institutionalization. Treatment strategies that delay the progression of motor dysfunction in HD may postpone the need for institutionalization.",
author = "Wheelock, {Vicki L.} and T. Tempkin and Karen Marder and Martha Nance and Myers, {R. H.} and H. Zhao and Elise Kayson and C. Orme and Ira Shoulson and Phillipa Hedges and Elizabeth McCusker and Samantha Pearce and Ronald Trent and David Abwender and Peter Como and Irenita Gardiner and Charlyne Hickey and Karl Kieburtz and Frederick Marshall and Nancy Pearson and Carol Zimmerman and Elan Louis and Carol Moskowitz and Carmen Polanco and Naomi Zubin and Catherine Brown and Jill Burkeholder and Mark Guttman and Sandra Russell and Dwight Stewart and Jackie Thomson and Sax, {Daniel S.} and Marie Saint-Hilaire and Jackie Gray and Cindy Hunter and Nanette Mercado and Eric Siemers and Joanne Wojeieszek and Dawson, {Ted M} and Elizabeth Leritz and Adam Rosenblatt and Meeia Sherr and Candace Young and Tetsuo Ashizawa and Jenny Beach and Joseph Jankovic and Jeana Jaglin and Kathleen Shannon and Anders Lundin and Kathleen Francis and Kim Lane and Alexander Auchus and Greenamyre, {J. Timothy} and Steven Hersch and Randi Jones and David Olson and Cha, {Jang Ho John} and Merit Cudkowicz and Walter Koroshetz and John Penney and Greg Rudolf and Paula Sexton and Young, {Anne B.} and Roger Albin and Kristine Wernette and Higgins, {Donald S.} and Carson Reider and Vicki Hunt and Francis Walker and Robert Hauscr and Juan Sanchez-Ramos and Audrey Walker and Carol Pantello and Gina Rohs and Oksana Suchowersky and Kerry Duncan and Lauren Seeberger and Jody Corey-Bloom and Jane Paulsen and Michael Swenson and Neal Swerdlow and Wayne Martin and Marguerite Wieler and Alicia Facca and Gustavo Rey and William Weiner and Charles Adler and John Caviness and Cindy Lied and Stephanie Newman and Andrew Feigin and Jennifer Mazurkiewicz and Karen Caplan and Janet Cellar and Kenneth Marck and Michael Hayden and Lynn Raymond and Dure, {Leon S.} and Jane Lane",
year = "2003",
month = "3",
day = "25",
language = "English (US)",
volume = "60",
pages = "998--1001",
journal = "Neurology",
issn = "0028-3878",
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TY - JOUR

T1 - Predictors of nursing home placement in Huntington disease

AU - Wheelock, Vicki L.

AU - Tempkin, T.

AU - Marder, Karen

AU - Nance, Martha

AU - Myers, R. H.

AU - Zhao, H.

AU - Kayson, Elise

AU - Orme, C.

AU - Shoulson, Ira

AU - Hedges, Phillipa

AU - McCusker, Elizabeth

AU - Pearce, Samantha

AU - Trent, Ronald

AU - Abwender, David

AU - Como, Peter

AU - Gardiner, Irenita

AU - Hickey, Charlyne

AU - Kieburtz, Karl

AU - Marshall, Frederick

AU - Pearson, Nancy

AU - Zimmerman, Carol

AU - Louis, Elan

AU - Moskowitz, Carol

AU - Polanco, Carmen

AU - Zubin, Naomi

AU - Brown, Catherine

AU - Burkeholder, Jill

AU - Guttman, Mark

AU - Russell, Sandra

AU - Stewart, Dwight

AU - Thomson, Jackie

AU - Sax, Daniel S.

AU - Saint-Hilaire, Marie

AU - Gray, Jackie

AU - Hunter, Cindy

AU - Mercado, Nanette

AU - Siemers, Eric

AU - Wojeieszek, Joanne

AU - Dawson, Ted M

AU - Leritz, Elizabeth

AU - Rosenblatt, Adam

AU - Sherr, Meeia

AU - Young, Candace

AU - Ashizawa, Tetsuo

AU - Beach, Jenny

AU - Jankovic, Joseph

AU - Jaglin, Jeana

AU - Shannon, Kathleen

AU - Lundin, Anders

AU - Francis, Kathleen

AU - Lane, Kim

AU - Auchus, Alexander

AU - Greenamyre, J. Timothy

AU - Hersch, Steven

AU - Jones, Randi

AU - Olson, David

AU - Cha, Jang Ho John

AU - Cudkowicz, Merit

AU - Koroshetz, Walter

AU - Penney, John

AU - Rudolf, Greg

AU - Sexton, Paula

AU - Young, Anne B.

AU - Albin, Roger

AU - Wernette, Kristine

AU - Higgins, Donald S.

AU - Reider, Carson

AU - Hunt, Vicki

AU - Walker, Francis

AU - Hauscr, Robert

AU - Sanchez-Ramos, Juan

AU - Walker, Audrey

AU - Pantello, Carol

AU - Rohs, Gina

AU - Suchowersky, Oksana

AU - Duncan, Kerry

AU - Seeberger, Lauren

AU - Corey-Bloom, Jody

AU - Paulsen, Jane

AU - Swenson, Michael

AU - Swerdlow, Neal

AU - Martin, Wayne

AU - Wieler, Marguerite

AU - Facca, Alicia

AU - Rey, Gustavo

AU - Weiner, William

AU - Adler, Charles

AU - Caviness, John

AU - Lied, Cindy

AU - Newman, Stephanie

AU - Feigin, Andrew

AU - Mazurkiewicz, Jennifer

AU - Caplan, Karen

AU - Cellar, Janet

AU - Marck, Kenneth

AU - Hayden, Michael

AU - Raymond, Lynn

AU - Dure, Leon S.

AU - Lane, Jane

PY - 2003/3/25

Y1 - 2003/3/25

N2 - Objective: To determine whether motor, behavioral, or psychiatric symptoms in Huntington disease (HD) predict skilled nursing facility (SNF) placement. Methods: Subjects were participants in the Huntington Study Group's Unified Huntington Disease Rating Scale Database (Rochester, NY) between January 1994 and September 1999. Specific motor, psychiatric, and behavioral variables in subjects residing at home and in SNF were analyzed using X2 and Student's t-tests. For a subset of subjects for whom longitudinal data existed, a Cox proportional hazards model controlling for age, sex, and disease duration was used. Results: Among 4,809 subjects enrolled, 3,070 had clinically definite HD. Of these, 228 (7.4%) resided in SNF. The SNF residents' average age was 52 years, average disease duration was 8.6 years, and they were predominantly women (63%). The SNF residents had worse motor function (chorea, bradykinesia, gait abnormality, and imbalance, p <0.0001); were more likely to have obsessions, compulsions, delusions, and auditory hallucinations; and had more aggressive, disruptive (p <0.0001), and irritable behaviors (p = 0.0012). For 1,559 subjects, longitudinal data existed (average length of follow-up, 1.9 years), and 87 (5%) moved from home to SNF. In the Cox model, bradykinesia (HR 1.965, 95% CI 1.083 to 3.564), impaired gait (HR 3.004, 95% CI 1.353 to 6.668), and impaired tandem walking (HR 2.546, 95% CI 1.460 to 4.439) were predictive of SNF placement. Conclusions: Institutionalized patients with HD are more motorically, psychiatrically, and behaviorally impaired than their counterparts living at home. However, motor variables alone predicted institutionalization. Treatment strategies that delay the progression of motor dysfunction in HD may postpone the need for institutionalization.

AB - Objective: To determine whether motor, behavioral, or psychiatric symptoms in Huntington disease (HD) predict skilled nursing facility (SNF) placement. Methods: Subjects were participants in the Huntington Study Group's Unified Huntington Disease Rating Scale Database (Rochester, NY) between January 1994 and September 1999. Specific motor, psychiatric, and behavioral variables in subjects residing at home and in SNF were analyzed using X2 and Student's t-tests. For a subset of subjects for whom longitudinal data existed, a Cox proportional hazards model controlling for age, sex, and disease duration was used. Results: Among 4,809 subjects enrolled, 3,070 had clinically definite HD. Of these, 228 (7.4%) resided in SNF. The SNF residents' average age was 52 years, average disease duration was 8.6 years, and they were predominantly women (63%). The SNF residents had worse motor function (chorea, bradykinesia, gait abnormality, and imbalance, p <0.0001); were more likely to have obsessions, compulsions, delusions, and auditory hallucinations; and had more aggressive, disruptive (p <0.0001), and irritable behaviors (p = 0.0012). For 1,559 subjects, longitudinal data existed (average length of follow-up, 1.9 years), and 87 (5%) moved from home to SNF. In the Cox model, bradykinesia (HR 1.965, 95% CI 1.083 to 3.564), impaired gait (HR 3.004, 95% CI 1.353 to 6.668), and impaired tandem walking (HR 2.546, 95% CI 1.460 to 4.439) were predictive of SNF placement. Conclusions: Institutionalized patients with HD are more motorically, psychiatrically, and behaviorally impaired than their counterparts living at home. However, motor variables alone predicted institutionalization. Treatment strategies that delay the progression of motor dysfunction in HD may postpone the need for institutionalization.

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JF - Neurology

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