As the disease progresses, frontal lobe deficits become prominent including impaired judgment, concentration, planning, and sequencing abilities. Dysarthric speech is common. As the disease progresses the movements become more pronounced and affect the entire body including the trunk. The gait is characterized by writhing and lurching movements. Involuntary movements become slower and blend together in an athetotic appearance.
Dystonic postures occur.
Dysphagia is common, and may lead to frequent aspirations. Terminally, the patient is rigid and mute. In a patient with the typical clinical features of personality disorder, dementia, and chorea as well as apositive family history, the diagnosis of HD is not difficult. Occasionally, however, patients are encountered who have chorea but lack a family history for the disease. In addition to HD there are more than 150 neurologic disorders in which chorea is a feature.3 The more common disorders are listed in Table 1.