Cognitive impairments, especially in the executive domain, and apathy were independent determinants of unemployment in Huntington disease mutation carriers, according to an article published in the Journal of Neuropsychology and Clinical Neurosciences in Advance. Surprisingly, motor disturbances did not appear to be the most important predictor for work cessation.

Milou Jacobs, MSc, from the Department of Neurology at Leiden University Medical Center in the Netherlands, and colleagues evaluated baseline data of 220 Huntington disease mutation carriers who participated in the Enroll-HD (Huntington disease) study at the Leiden University Medical Center to determine which clinical signs of Huntington Disease are predictive of unemployment.

Data from employed (n=114) and unemployed (n=106) carriers were used to investigate group differences. Univariate logistic regression analyses adjusted for age and sex were performed to determine individual predictors of unemployment. A multivariate logistic regression analysis was performed, entering all significant results from the univariate analyses into 1 fully adjusted model to determine the strongest predictors.

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Apathy was the most significant predictor; Huntington Disease mutation carriers who showed signs of apathy had 3.26 times the risk of being unemployed as Huntington Disease mutation carriers without apathy. The authors noted that apathy is very common and progressive among Huntington Disease mutation carriers, even during early stages of the disease, and has been associated with decline in general functioning.

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When the jobs of the unemployed were categorized as physically and nonphysically demanding jobs, unemployed individuals mostly worked in nonphysical jobs, suggesting that physical activity alone was not a reason to quit working. This supports the authors’ contention that cognitive impairment is more predictive of work cessation than motor function. However, the authors admitted that this job distinction is arbitrary and that the influence of different job demands on employment in this population should be further explored.

The authors concluded by arguing that in light of these findings, clinicians who evaluate a patient’s ability to work should take into account the patient’s degree of apathy and cognitive function.


Jacobs M, Hart EP, Roos RAC. Cognitive performance and apathy predict unemployment in Huntington’s disease mutation carriers [published online January 12, 2018]. JNCN Advance. doi:10.1176/appi.neuropsych.17070144