An electrophysiological analysis of altered cognitive functions in Huntington disease

T. F. Munte, M. E. Ridao-Alonso, J. Preinfalk, A. Jung, B. M. Wieringa, M. Matzke, R. Dengler and S. Johannes
Department of Neurology Medical School of Hannover, Germany.

BACKGROUND: Neuropsychological deficits are a main feature of Huntington disease (HD) with previous data suggesting involvement of memory functions and visual processing. OBJECTIVE: To increase the knowledge about cognitive malfunction in HD in the domains of visual processing and memory by the use of modern electrophysiological techniques (event-related potentials [ERPs]). DESIGN: A case-control design was used. Three ERP paradigms were used; a parallel visual search paradigm allowed for the simultaneous processing of a multi-element visual array in search of a target stimulus, while a serial search paradigm with varied numbers of distractor items necessitated a serial one by one scanning of the arrays. The third experiment was a word-recognition memory task. SETTING: The measurements were obtained in a neurophysiological laboratory of a university hospital. PATIENTS AND CONTROLS: Nine patients with HD and 9 control subjects matched for age, sex, and education were studied. MAIN OUTCOME MEASURES: Components of averaged ERPs were quantified by latency and amplitude measures and subjected to statistical analysis. Behavioral measures (search time, hit rate, and recognition accuracy) were assessed as well. RESULTS: The early visual components showed a significant latency shift (delay of about 50 milliseconds) in HD. In the search paradigms the P3 components differentiating target and standard stimuli were virtually absent in HD as was the ERP effect indexing word recognition. This was accompanied by a marked delay in search times and lower hit rates in the search tasks and a grossly reduced recognition accuracy in the memory task. CONCLUSIONS: The results suggest marked impairments of patients with HD in early visual sensory processing (early components). Deficits in visual search might be attributed to an impairment to deploy attentional resources across the visual field and/or an inability to control eye movements. The ERPs in the memory task differed grossly from similar data obtained by others in patients with Alzheimer disease, suggesting a different neural basis for the amnesia in HD.