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Physicians Guide to the Management of Huntington's Disease
The Cognitive Disorder (CHAPTER 4 & 5)
Disorganization
Chapter 5:
The cognitive disorder in HD is considered a "subcortical" syndrome and usually lacks features such as aphasia, amnesia, or agnosia that are associated with dementia of the Aizheimer's type.
 
The most prominent cognitive impairments in HD involve the so-called "executive functions" abilities such as organization, regulation and perception.
 
These fundamental abilities can affect performance in many cognitive areas, including speed, reasoning, planning, judgment, decision making, emotional engagement, perseveration, impulse control, temper control, perception, awareness, attention, language, learning, memory and timing.
 
Chapter 4 -Disorganization

Difficulties in planning, organization, sequencing and prioritizing can affect responsibilities at home and at work.

Daily tasks, such as attempts to follow a recipe, to maintain a daily planner, to complete a list of household errands, to develop a meeting agenda, or to apply for social security benefits, become daunting.

Many early-stage HD patients complain of problems with organization and report that they just "can't get things done." There are several ways to compensate for poor organization, which can be instituted early in the disease.

Routines should be established at work or in the home so that the environment can provide structure and organization.

A central location could be established for posting a daily schedule. Persons who never before used daily planners or computer calendars may need to start.

A centralized message center can be used to make lists and organize tasks to be accomplished each day.

Activities should be organized so that each day is basically the same. For example,

7:00 shower
7:30 breakfast
8:00 take bus to work
8:30 check mail
9:30 dictate letters,
10:00 coffee
10:30 staff meeting
12:00 lunch
1:00 return phone calls
2:30 review accounting
4:00 open meeting to schedule with customers
5:00 take bus home
6:00 dinner
7:00 family time with kids
8:30 time with spouse
9:30 read
10:00 lights out.

 

Additional strategies for dealing with poor organization are offered in Table 6.

 
TABLE 6: COPING STRATEGIES FOR PLANNING
AND DECISION MAKING

Rely on routines, which can be easier to initiate or continue without guidance.

Make lists which help organize tasks needed to do an activity.

Prompt each step of an activity with external cues (routine, lists, familiar verbal cues).

Offer limited choices and avoid open ended questions.

Use short sentences with 1-2 pieces of information