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February 17, 1984

Huntington's Chorea and Reality Orientation

Author Affiliations

Veterans Administration Medical Center Knoxville, Iowa

JAMA. 1984;251(7):891-892. doi:10.1001/jama.1984.03340310013009

To the Editor.—  Huntington's chorea is a progressive neurological disease transmitted by a dominant autosomal gene. The neuropathological findings as well as the symptom course are thoroughly discussed in the scientific literature. It seems, however, that some of the understanding of the cognitive aspects of this disorder may be without sufficient data base. For example, it is a frequently held clinical assertion that although a dementing process may occur in these patients, basic reality orientation may be maintained at least until terminal stages,1,2 while any apparent disorientation perhaps is the result of loss of ability to communicate effectively and consistently.Based on our clinical experience, the assumption of reality orientation maintenance did not seem to be fully warranted. Thus, we set out to test the assumption systematically. We hypothesized that if the neurological impairment of patients with Huntington's chorea resulted in an actual loss of reality orientation, the pattern