Patients with Huntington disease (HD) are at high risk of experiencing reduced productivity due to impairment or missing work, particularly for those who reported alcohol consumption, according to the results of a study published in The Journal of Neuropsychiatry and Clinical Neurosciences. For individuals with HD, employment has important implications for financial security, social activity, personal satisfaction, and self-esteem, and evidence suggests that there are major health benefits for those with mild cognitive impairment who continue to work.
Anita M.Y. Goh, DPsych, of the department of psychiatry, Academic Unit for Psychiatry of Old Age, University of Melbourne, Australia, and colleagues studied 316 patients (mean age, 44.5±3.4 years; 52.5% men) with manifest HD and a 39- to 60-CAG repeat length range who were currently working in paid full- or part-time employment. They sought to identify factors associated with work impairment and disability. Patients were selected from Enroll-HD, a global clinical research platform designed to facilitate studies of HD. The investigators hypothesized that more CAG repeats, motor symptoms, and impairments would be associated with greater work-related impairment.
Nearly one-fifth of patients with HD reported missing work due to the disease, with 60.1% experiencing impairment while working due to HD. Furthermore, 79.1% of patients reported having work-related activity impairment due to HD, and 60.8% reported HD-related impairment in productivity.
A higher level of functional impairment (odds ratio [OR], 0.76; 95% CI, 0.64-0.91) and current alcohol consumption (OR, 2.86; 95% CI, 1.62-5.03) were significantly correlated with missing work in multivariate logistic regression analyses. Patients with lower perceived mental health were at increased risk of experiencing impairment at work (OR, 0.95; 95% CI, 0.897-0.995). However, neither motor impairment nor the number of CAG repeats was a strong predictor of workplace impairment.
The researchers suggested that reasonable adjustments can be made for people with cognitive impairment and dementia. “Appropriate workplace support and modifications for persons with HD would engender inclusivity and diversity of employees, retain experienced works, and keep persons with HD functioning within society for longer,” they noted.
The study was limited by the use of a database that could not be explored for other potential significant factors associated with workplace disability, such as job-related stress and type of occupation. Furthermore, Enroll-HD involves self-reported data for most outcomes, and the quality of the data reported could have been impacted by the participant’s disability.
“Drinking alcohol maybe a coping strategy, as having a neurodegenerative illness, particularly one such as HD that is strongly genetically transmitted and typically affects multiple members of one family, can cause anxiety about the future,” the investigators concluded.
Goh AMY, You E, Perin S, et al. Alcohol use, mental health, and functional capacity as predictors of workplace disability in a cohort with manifest Huntington’s disease. JNCN Advance. 2020. doi: 10.1176/appi.neuropsych.19090199.