Huntington’s: The Diagnosis That Changes Everything—Here’s What to Expect

Huntington’s disease (HD) is a progressive neurological disorder that causes the degeneration of nerve cells in the brain. It profoundly impacts movement, cognitive abilities, and mental health. While the disease is incurable, early diagnosis and comprehensive care can significantly improve quality of life and help patients and families manage its progression.

This article explores how Huntington’s disease is diagnosed, what treatments are available, and how patients and caregivers can navigate its complex challenges.

Diagnosis of Huntington’s Disease

Diagnosing Huntington’s disease involves a multifaceted approach combining medical history, neurological exams, mental health assessments, imaging, and genetic testing.

1. Initial Clinical Assessment

A preliminary diagnosis begins with:

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• A detailed review of personal and family medical history.

• A physical examination.

• Interviews about symptoms and changes in mental or emotional states.

2. Neurological Exam

A neurologist evaluates:

• Motor function – reflexes, muscle tone, coordination, and balance.

• Sensory abilities – touch, vision, and hearing.

• Mental and psychiatric symptoms – mood, alertness, and thought patterns.

3. Neuropsychological Testing

Standardized tests assess:

• Memory and learning capacity.

• Problem-solving and reasoning.

• Language and spatial awareness.
  In-depth testing may be conducted by a licensed psychologist if needed.

4. Mental Health Evaluation

A psychiatrist may evaluate:

• Emotional well-being.

• Behavioral patterns and impulse control.

• Judgment and coping skills.

• Substance abuse indicators or signs of psychosis.

5. Imaging Tests

MRI and CT scans are used to:

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• Identify changes in brain structure.

• Rule out other conditions mimicking Huntington’s symptoms.
  Note: Imaging may not detect early-stage HD.

6. Genetic Testing

A genetic test can confirm the presence of the faulty HTT gene responsible for HD. This is crucial for diagnosis when:

• There is no clear family history.

• Other conditions need to be excluded.

Predictive Genetic Testing

For people with a family history but no symptoms, predictive testing offers clarity. However, this test:

• Cannot determine the age of onset.

• Requires pre-test counseling to weigh emotional and legal risks.

Treatment of Huntington’s Disease

Although no treatment can reverse the course of HD, many therapies can reduce symptoms and improve function.

Medications for Movement Disorders

• Tetrabenazine (Xenazine), Deutetrabenazine (Austedo), Valbenazine (Ingrezza):

  • Suppress involuntary movements (chorea).

  • May cause drowsiness, depression, or anxiety.

• Antipsychotics (Haloperidol, Olanzapine, Aripiprazole):

  • Help control aggression and hallucinations.

  • Can worsen stiffness or cause movement issues.

• Other Drugs (Amantadine, Levetiracetam, Clonazepam):

  • Mild benefit for chorea with tolerability issues.

Medications for Mental Health Symptoms

• Antidepressants (SSRIs such as Prozac, Lexapro):

  • Alleviate depression and obsessive thoughts.

• Mood stabilizers (Depakote, Lamictal):

  • Used for bipolar symptoms.

• Antipsychotics (Seroquel, Zyprexa):

  • Manage agitation and mood swings.

Therapies and Interventions

Psychotherapy

Helps patients and families:

• Cope emotionally.

• Communicate better.

• Plan for disease progression.

Speech Therapy

Focuses on:

• Improving speech clarity.

• Managing swallowing difficulties.

• Introducing communication aids.

Physical Therapy

• Builds strength, balance, and coordination.

• Reduces fall risk and delays mobility loss.

• Guides use of assistive devices like walkers or wheelchairs.

Occupational Therapy

• Assists with daily tasks using adaptive tools.

• Recommends home modifications for safety and independence.

Lifestyle Adjustments and Home Care

Nutrition

• Increased caloric needs due to muscle activity and metabolic changes.

• Soft or blended foods to reduce choking risks.

• Use of adaptive utensils and feeding aids.

Mental Health and Cognitive Strategies

• Structured routines.

• Task breakdown into smaller steps.

• Calm, organized environments.

• Educational support for school-age patients.

Planning for Long-Term and End-of-Life Care

Early planning is essential. Consider:

• Living wills and advance directives to guide future medical care.

• Residential care or hospice services for late-stage needs.

• Legal and financial preparations to protect the patient and reduce family stress.

Support and Resources

Support networks are vital. Access:

• Nonprofit organizations like the Huntington’s Disease Society of America.

• Community resources for respite care, support groups, and financial aid.

• Educational programs for caregivers and family members.

Preparing for Your Appointment

Before visiting your neurologist:

• Document symptoms, life changes, and current medications.

• List family members with neurological or psychiatric histories.

• Bring a trusted friend or family member for support.

Expect questions about mood, behavior, family history, and everyday functioning. Answering openly helps ensure an accurate diagnosis and timely intervention.

Conclusion

While Huntington’s disease is a life-altering diagnosis, comprehensive care—from early diagnosis to personalized therapies—can improve day-to-day living. Through medical support, planning, and community resources, patients and families can navigate the journey with more control and compassion.