Feasibility of HD-DRUM, a rhythmic movement training, in Huntington’s Disease: a randomised controlled pilot trial exploring changes in paced motor function and brain microstructure

ABSTRACT Background Rhythmic movement training offers promise as a cognitive and motor intervention tool in Huntington’s disease (HD). HD-DRUM is a tablet-based application for the training of paced movements. Feasibility of 8 weeks of remote HD-DRUM compared with usual-activity control was assessed in a two-arm, randomised controlled trial (RCT) in people with HD. HD-DRUM related changes in quantitative motor and cognitive functions, mood, and brain microstructure were explored. Objectives To assess acceptability of HD-DRUM and feasibility (recruitment, retention, adherence) of an effectiveness RCT. To gain estimates of HD-DRUM-related effect sizes on cognition, motor functions, mood and to explore training mechanism and impact on brain microstructure. Methods Fifty-four individuals with HD, confirmed by genetic testing and/or clinical diagnosis (age, sex, TFC, HD-ISS), were randomised into either HD-DRUM (n = 31) or usual-activity control (n = 23) groups. Participants underwent quantitative motor (q-Motor) and working memory/executive function assessments and diffusion-weighted MRI imaging before and after the 8 weeks period. Group differences of changes in motor and cognitive performance were explored with 95% confidence intervals and those in whole brain microstructure with Tract-Based-Spatial-Statistics of diffusion MRI data. Results Acceptability of HD-DRUM, retention, and adherence rates averages were high (>80%) and target recruitment was exceeded. HD-DRUM-related improvements in paced tapping and in brain microstructure, suggestive of a slowing of white matter decline, were observed. Conclusions HD-DRUM, a remote rhythmic movement app, was feasible and acceptable in people with HD. HD-DRUM holds the potential for a low cost, accessible intervention for maintenance of movements and brain microstructure in HD.