F34 Anosognosia of motor deficits in Huntington’s disease

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Background Anosognosia (unawareness) of choreic movements is relatively common in Huntington’s disease (HD) although its origin is unclear. Aims We investigated anosognosia of motor deficits in HD. Methods Seventy-one outpatients with stage I or II HD participated. The motor section of UHDRS, the total functional capacity, a short battery of cognitive tests, the SANS and SAPS scales for negative and positive psychiatric symptoms, and the Hamilton scales for depression and anxiety were administered. A semi-structured four-point questionnaire was also administered to assess extent of motor anosognosia in daily life. Results The patients were divided into 27 (38%) (group 1) aware of their motor symptoms (score zero on questionnaire), and 44 (62%) (group 2) with various degrees of unawareness: 29 (66%) group 2 patients scored 1, 11 (25%) scored 2, and 4 (9%) scored 3. The two groups were compared. Group 2 patients performed worse on visual search test (p = 0.04) and SANS (p = 0.02). Anosognosia correlated directly with UHDRS (r=0.32; p=0.04) and indirectly with anxiety (r=−0.33; p=0.03). When shown their motor impairments, the 4 patients with score 3 retained the delusional belief they had no impairment. Conclusions Two thirds of our patients had motor anosognosia, with higher SANS score, indicating more severe apathetic syndrome, and worse visual search test, indicating slower cognitive processing, than non-anosognosic patients. The finding of delusional belief in patients with severe anosognosia suggests that psychiatric changes play a role in generating anosognosia in HD. HD anosognosia appears to have varied origins.

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