Complications
Most patients with Huntington disease eventually develop weight loss.[121][122][123][124][125]
This is often a manifestation of the dysphagia that develops late in the illness, but even before that patients tend to increase their calorie intake, often without significant weight gain.
A variety of indirect evidence suggests that there is a generalized metabolic defect in Huntington disease that contributes to weight loss.[126]
Treatment consists of encouraging patients to consume foods of caloric density such as fats; care should be taken to avoid foods that exacerbate dysphagia.
Dysphagia is a late manifestation of Huntington disease that is managed by reducing portion and bite size, selecting foods that are easy for the patient to swallow, and using food-thickening agents.[121] Minimizing distractions at mealtimes can also be helpful to allow patients to focus attention on swallowing.
Family members should be instructed in the Heimlich maneuver. Johns Hopkins Medicine: Chocking and the Heimlich Maneuver Opens in new window
Feeding tubes are often declined.
Vaccination against pneumonia and yearly influenza immunization are recommended, particularly in people with dysphagia.
Falling is a late manifestation of Huntington disease and generally reflects a need for use of assist devices, such as a walker or wheelchair.
Compliance may be problematic due to cognitive impairment.
Falls may be a symptom that precipitates nursing home placement.[124]
There is a relationship between depression and suicide, and a high frequency of suicide and suicide attempts in people with Huntington disease.
Risk factors for suicide in the general population include suicide in relatives (a permission effect), recent incarceration, social isolation, access to suicidal means, concomitant illness, and stressful life events.[76][127][128][129][130][131][132]
It seems reasonable to consider these factors equally significant in people with Huntington disease.
Preventing suicide involves restriction of access to suicidal means, particularly weapons, ammunition, or medications with lethal toxicity.[133]
Strategies that minimize isolation may also be of benefit.
Antidepressant medications are effective in patients with Huntington disease, and there should be a relatively low threshold for their use. Agents of lower toxic potential are preferred.
Impulsivity is common in Huntington disease and may contribute to suicide risk.[134]
Incontinence is common in end-stage Huntington disease and is often a precipitating cause for nursing home placement.
Pharmacologic intervention rarely eradicates incontinence completely, but anticholinergic drugs may improve symptoms. Input from a specialist continence nurse is important.
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