Positive Affect and Well-Being in Huntington’s Disease Moderates the Association Between Functional Impairment and HRQOL Outcomes

Article type: Research Article

Authors: Ready, Rebecca E.^a | Boileau, Nicholas R.^b | Barton, Stacey K.^c | Lai, Jin-Shei^d | McCormack, Michael K.^{e; f} | Cella, David^d | Fritz, Nora E.^g | Paulsen, Jane S.^h | Carlozzi, Noelle E.^{b; *}

Affiliations: [a] Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, MA, USA | [b] Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA | [c] Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA | [d] Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA | [e] Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, Piscataway, NJ, USA | [f] Department of Pathology, Rowan-SOM, Stratford, NJ | [g] Physical Therapy Program, Wayne State University, Detroit, MI, USA | [h] Departments of Neurology, Psychiatry, and Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA

Correspondence: [*] Correspondence to: Noelle E. Carlozzi, PhD, University of Michigan, Department of Physical Medicine and Rehabilitation, North Campus Research Complex, 2800 Plymouth Road, Building NCRC B14, Room G216, Ann Arbor, MI 48109-2800, USA. Tel.: +1 734 763 8917; Fax: +1 734 763 7186; E-mail: carlozzi@med.umich.edu.

Abstract: Background:Positive affect is associated with resiliency and beneficial health outcomes, but little is known about associations between positive affect and health-related quality of life (HRQOL) in Huntington’s disease (HD). Objective:This longitudinal study determined the association between positive affect and several HRQOL outcomes in persons with HD. Functional status was examined as a moderator of the association between positive affect and HRQOL. Methods:Participants, with premanifest (i.e., genetically at risk but no clinical diagnosis, n = 50) and manifest HD (early-stage n = 171; late-stage n = 101), completed a measure of positive affect and well-being and several HRQOL measures at baseline, 12-, and 24-month follow-ups. UHDRS Functional Assessment scale indicated functional status. Results:Positive affect was associated with better HRQOL for persons with premanifest and manifest HD over the 24-month time frame. These associations were moderated by functional status. For persons with higher functional status, positive affect was associated with better HRQOL, including less depression, lower anxiety, less anger, better social role satisfaction, better executive functions, greater upper extremity function, less dyscontrol, and less concern with death and dying. For persons with lower functional status, positive affect was not associated with HRQOL. Conclusions:Positive affect predicted better self-reported HRQOL over a 24-month period in persons with premanifest and manifest HD, particularly when participnats had better functional status. Interventions to enhance positive affect in HD may have beneficial effects on HRQOL.

Keywords: Quality of life, positive affect, functional assessment, Huntington’s disease, longitudinal

DOI: 10.3233/JHD-180341

Journal: Journal of Huntington's Disease, vol. 8, no. 2, pp. 221-232, 2019