They may still be working and may still be able to drive. Involuntary movements are mild and infrequent, speech is still clear, and dementia, if present at all, is mild. In the middle of the course, affected patients are more disabled and need assistance with some of their activities of daily living. Falls, weight loss, and swallowing difficulties may become a problem. Dementia is more obvious to the casual observer.
Involuntary movements are more pronounced.
In the late stages, patients with Huntington's disease require almost total care and may reside in hospitals or nursing homes, although others remain at home. Patients may no longer be able to walk or speak. Rigidity may now be more of a problem than involuntary movements. Patients with late stage HD may not be able to swallow food anymore and will die if not given a feeding tube. Whether or not to place a feeding tube is an important decision which depends on many factors.