Reader Response: Timing and Impact of Psychiatric, Cognitive, and Motor Abnormalities in Huntington Disease

McAllister et al.1 made an important contribution to knowledge of Huntington disease (HD), finding that 42% of >6,000 persons with HD have onset of a psychiatric or cognitive symptom before motor symptoms, and these nonmotor symptoms can be functionally debilitating. Their conclusion that “nonmotor symptoms should not be used to make a clinical diagnosis of HD,”1 due to their common frequency in the general population, seems excessively broad and negative. Certainly, one should be cautious and not use depression as a diagnostic factor. However, our clinical experience indicates that psychiatric, behavioral, or cognitive symptoms should play a diagnostic role in patients with a positive genetic test.

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