F058 Anosognosia in HD: how early does it begin?

<h3>Background</h3> Individuals with Huntington’s disease (HD) commonly experience anosognosia, a lack of awareness of deficits. However, exactly when anosognosia begins in the course of HD remains unclear. <h3>Objective</h3> To characterize the onset of anosognosia in HD by examining its presence at various stages of disease. <h3>Methods</h3> The Anosognosia Scale (AS) consists of 8 items on which individuals rate their abilities relative to peers, with responses ranging from very impaired to excellent. The AS was given to 53 gene carriers stratified by CAG-Age- Product (CAP) and composite UHDRS (cUHDRS) score, in addition to their caregivers. Differences between caregiver and patient scores of ≥6 points were considered as evidence of anosognosia. <h3>Results</h3> 18% of individuals with CAP scores &lt;400 (mean DCL=2.64); 38% of individuals with CAP scores 400–500 (mean DCL=3.31); and 31% of individuals with CAP scores &gt;500 (mean DCL=4) showed anosognosia. Similarly, 21% (mean DCL=2.74); 26% (mean DCL=3.89); and 46% (mean DCL=4.0), respectively, of individuals stratified by cUHDRS score, showed anosognosia. AS score differences were greatest with regard to cognitive symptoms in the earliest stages of HD, but most pronounced with regard to motor/functional symptoms as the disease progressed. <h3>Conclusions</h3> Our findings suggest that anosognosia appears early in the course of HD, even prior to manifest disease onset. The lack of awareness of deficits, both cognitive and motor/functional, should dissuade against the use of self-report instruments as outcome measures in HD clinical research. Further studies will be needed to confirm and extend these findings.