HD ‐ DRUM Rhythmic Training in Huntington's Disease: Feasibility, Motor, and Brain Microstructural Pilot Signals

Background Rhythmic cuing may benefit motor functions in Huntington's disease (HD) by compensating for the loss of predictive timing associated with basal ganglia degeneration. To our knowledge no remote rhythmic training application has been developed or evaluated that seeks to improve function in HD. HD‐DRUM is a tablet‐based rhythmic cuing application for the training of paced movements. Feasibility of 8 weeks at‐home HD‐DRUM compared with usual‐activity control was assessed in a two‐arm, pilot randomized controlled trial (RCT) in people with HD. HD‐DRUM‐related changes in motor and cognitive functions, mood, and brain microstructure were explored. Objectives Primary outcomes were feasibility rates (recruitment, retention, adherence, acceptability) for an effectiveness RCT. Secondary outcomes were estimates of HD‐DRUM‐related effect sizes on motor functions, cognition, mood, and brain microstructure to explore training mechanisms. Methods Fifty‐five individuals with HD were randomized into either HD‐DRUM (n = 32, 1 excluded) or control (n = 23) groups. Participants underwent Quantitative‐Motor, cognitive and mood assessments and diffusion‐weighted MRI at baseline and follow‐up. Recruitment, retention, and adherence rates were recorded, and HD‐DRUM acceptability was assessed with a self‐report questionnaire. Group differences of changes in behavioral and brain microstructural measures were reported with 95% confidence intervals. Results Acceptability of HD‐DRUM, retention, and adherence rates averages were high (>80%) and target recruitment was reached. Performance in paced tapping and brain microstructure in motor networks signaled training benefits and were associated with each other. Conclusions HD‐DRUM may provide an accessible intervention that can aid maintenance of motor function and brain microstructure in HD.