Modifying Neuropsychiatric and Motor Trajectories in Huntington’s Disease Through an Integrated Neurobehavioral Clinic Model

Shakaib Khan,1 Luis Velez Figueroa,1 Chindhuri Selvadurai,2 Ajit Rajendra Deshpande,1 Fatemeh Najmivarzaneh,2 Cutter A Lindbergh1 1Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, USA; 2Department of Neurology, University of Connecticut Health Center, Farmington, CT, USACorrespondence: Shakaib Khan, Department of Psychiatry, University of Connecticut Health Center, 263 Farmington Ave., Farmington, CT, 06030, USA, Tel +1-860-679-3265, Email [email protected]: Huntington’s disease (HD) is a progressive neurodegenerative disorder characterized by worsening motor dysfunction, cognitive decline, and psychiatric symptoms. Psychiatric symptoms in HD arise from progressive frontostriatal circuit dysfunction and often precede motor manifestations, contributing significantly to disability and functional decline. In the absence of disease-modifying therapies, clinical care focuses on symptom management and functional preservation.Methods: This was a retrospective pre-post chart review comparing longitudinal clinical outcomes before and after implementation of a multidisciplinary clinic model in HD patients (N = 56) using an observational study design. Differences were analyzed using paired-samples t-tests, with effect sizes reported as Cohen’s d. Depressive and anxiety symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), respectively. Motor symptoms were assessed using the Unified Huntington’s Disease Rating Scale (UHDRS) motor subscale. Cognitive symptoms were measured using the Montreal Cognitive Assessment (MoCA).Results: Anxiety and depression symptom trajectories showed increased stability after initiation of the multidisciplinary clinic (ds = − 0.008 and 0.133, respectively) compared to worsening trajectories prior to initiation (ds = 0.309 and 0.366, respectively). About 64– 67% of patients were responders post-clinic relative to only 33– 43% pre-clinic. Motor symptom severity significantly decreased following integrated clinic model implementation (d = − 0.341), representing deviation from the expected progressive trajectory of manifest HD. Cognitive performance remained stable across follow-up intervals.Discussion: Our findings suggest that multidisciplinary integrated care may favorably influence motor and psychiatric symptom trajectories in HD, supporting the value of a coordinated, team-based approach to managing this complex disorder. While observed effects were not particularly large, in the context of a progressive neurodegenerative condition, modest improvement or even stabilization in symptoms represents a clinically meaningful deviation from the expected course of decline. However, conclusions and generalizability are limited by the modest sample size and retrospective observational design.Plain Language Summary: Huntington’s disease is a progressive inherited brain disorder that causes worsening movement difficulties, cognitive decline, and severe emotional and behavioral symptoms. There are currently no treatments that can stop or slow the underlying disease process, which means care focuses on managing symptoms and preserving independence. Although multidisciplinary care bringing together neurology, mental health, and social support within a coordinated clinic visit is widely recommended, there is little quantitative evidence showing whether this approach meaningfully alters how symptoms evolve over time.In this study, we evaluated patients with Huntington’s disease before and after the implementation of an integrated clinic model that combined neurological, psychiatric, and social care in a single structured visit. We examined changes in movement, mood, anxiety, and cognitive functioning over extended follow-up periods. After the integrated model was introduced, movement symptoms improved and emotional symptoms stabilized, contrasting with worsening patterns observed before the clinic redesign. Cognitive performance remained stable.While observational in design, these findings suggest that coordinated, team-based care may do more than simply support patients; it may influence measurable symptom trajectories in a progressive brain disorder. This work provides important evidence that system-level changes in care delivery can have meaningful clinical impact in Huntington’s disease.Keywords: Huntington’s disease, integrated care models, neurodegenerative disorders, anxiety, depression