Huntington's disease: the road to progress.

摘要

Most clinicians carry, in their heads, roadmaps of the time course of the disorders they frequently treat. Drawn from experience with different patients over time, these composite roadmaps are useful for educating patients, designing possible rating scales, and providing a subjective way to assess treatment results. And, like a map of a planned journey, these mental constructs of disease course can identify predictable changes, such as road elevation, versus the unpredictable, such as changes in weather. In Huntington's disease,1 for example, cognition slowly declines whereas psychiatric manifestations can flare or remit unexpectedly. But a clinician's roadmap is far from perfect; it is unsuitable for the measurements and power calculations needed to test new treatments. Furthermore, these internal maps are subject to bias, not the least of which is a human tendency to assume change is linear and equal across all domains.