HD-DRUM rhythmic training in Huntington’s disease: feasibility, motor, and brain microstructural pilot signals

ABSTRACT Background Rhythmic movement training may benefit cognitive and motor functions in Huntington’s disease (HD). HD-DRUM is a tablet-based 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 randomised 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 (recruitment, retention, adherence, acceptability) rates 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 randomised into either HD-DRUM (n = 32, 1 excluded) or usual-activity control (n = 23) groups. Participants underwent Quantitative-Motor, executive function and mood assessments and diffusion-weighted MRI at baseline and 8 weeks follow-up. Recruitment, retention, and adherence (frequency and duration of HD-DRUM engagement) rates were recorded, and HD-DRUM acceptability was assessed with a self-report questionnaire. Group differences of changes in behavioural 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 signalled benefits from HD-DRUM and were associated with each other. Conclusions Acceptability feasibility of HD-DRUM and a future effectiveness RCT in people with HD was established. HD-DRUM-induced brain plasticity may underpin motor performance benefits. HD-DRUM may provide an accessible home-based intervention for maintenance of movements and brain microstructure in HD. Trial registration number ISRCTN11906973 (Protocol version 1.7, 01/11/2023)