Irritability and irritable aggression are common symptoms of Huntington’s disease (HD). Some facts you should know:
- About 22% of patients with HD who live at home experience aggression.
- As many as 60% of people with HD living in long term care facilities become aggressive.
- Episodes may occur years before onset of motor symptoms or worsen as the disease advances.
- If left untreated, aggression may cause significant disruption of interpersonal relationships, affect work performance, risk placement in a long-term care facility, or prompt intervention by emergency responders.
Irritable aggression in HD is related to uninhibited anger or frustration. The abnormal HD protein directly damages the part of the brain responsible for control over impulses and activation of behavior. Normally, there is a “gate” in the brain that allows an impulse to become a behavior, opening when it’s appropriate to act and closing when it’s not in your best interest to act. For the person with HD, it’s like the gate is constantly open (disinhibition), constantly closed (apathy), or very inconsistent (unpredictable).
Many cognitive disabilities in HD are due to a problem with awareness. Before the individual became ill, these same cognitive abilities were also unconscious. It’s hard to imagine how frustrating HD related cognitive impairments can be when you can’t even explain to yourself or others what is wrong.
The combination of frustration and disinhibition results in irritability. Continued lack of understanding by all involved results in escalation. Only when symptoms are improved with understanding, appropriate medication and reducing environmental demands can the person with HD recognize what skills they were missing. Different terms describe different types of behaviors. And all of these behaviors fall somewhere on a spectrum of irritability.
HD Reach takes an evidence-based approach to helping patients and HD families manage HD related aggression, whether fear of aggression is the main concern or care is required after an aggressive episode has already occurred. Every person with HD can benefit from healthcare interventions, compassionate care, and support. If you want to learn more, see the topics below:
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- Definitions of Irritability
- The Spectrum of Irritability
- Being Safe
- Why do people with HD become irritable or aggressive?
- Where do I start?
- Choosing the Right Interventions