# Anosognosia and avoidant coping do not impact work in early Huntington's disease

## TL;DR

This study found that lack of awareness of impairments and avoidant coping in early Huntington's disease are not directly linked to work capacity, despite being associated with cognitive decline.

## Contribution

The study is the first to explore the relationship between anosognosia, avoidant coping, and work outcomes in early Huntington's disease.

## Key findings

- Anosognosia was strongly linked to cognitive decline but not to work capacity.
- Avoidant coping was associated with frontal behaviors but not work outcomes.
- Passive coping was the most common coping style among participants.

## Abstract

Work plays a crucial role in life, contributing to financial stability and well-being. Huntington's disease (HD), a genetic neurodegenerative disorder, can significantly affect work capacity. Anosognosia (lack of awareness of impairments) and avoidant coping are common in HD but remain unexplored in relation to work outcomes.

This study investigated the relationships between anosognosia, coping styles, and work capacity in individuals with pre-motor manifest and motor manifest HD.

Utilizing the HD-Work dataset, we analyzed motor and cognitive functioning, coping styles, work capacity, and anosognosia in participants with pre-motor manifest and motor manifest HD (n = 117). Anosognosia was operationalized through expert rating, participant - proxy, and cognitive – performance discrepancies. Work capacity was measured using the occupation item of the Total Functional Capacity scale, and coping styles were assessed with the Utrechtse Coping Lijst.

Anosognosia was strongly associated with cognitive decline, while avoidant coping was less prevalent. Both anosognosia and avoidance coping were correlated with frontal behaviors but not with work capacity. A positive association between avoidant coping and anosognosia was found. The most common coping style used was passive coping. Participants did not often seek social comfort.

The best predictor of anosognosia was cognitive decline. The positive association between avoidant coping and anosognosia suggested a potential misattribution of avoidant coping to anosognosia. This study emphasized the importance of recognizing avoidant and passive coping strategies in early-stage HD, as well as anosognosia in relation to cognitive decline, even though these factors do not directly impact work capacity.