“People with HD show a wide range of symptoms at the onset of the disease. While most people with HD develop the motor symptoms in their forties and fifties, subtle changes may arise much earlier. Knowledge of the typical age of onset sometimes leads physicians to miss the diagnosis, mistakenly believing the person to be too old or too young to develop HD. About 10% have onset of motor symptoms after age 60 and 10% have Juvenile onset HD, where symptoms manifest before age 20.”

Huntington’s Disease Society of American (Age of Onset – Huntington’s Disease Society of America)

Diagnosis

A preliminary diagnosis of Huntington’s disease is based primarily on your answers to questions, a general physical exam, a review of your family medical history, and neurological and psychiatric examinations.

Neurological examination

The neurologist will ask you questions and conduct relatively simple tests of your:

• Motor symptoms, such as reflexes, muscle strength and balance
• Sensory symptoms, including sense of touch, vision and hearing
• Psychiatric symptoms, such as mood and mental status

Neuropsychological testing

The neurologist may also perform standardized tests to check your:

• Memory
• Reasoning
• Mental agility
• Language skills
• Spatial reasoning

Psychiatric evaluation

You’ll likely be referred to a psychiatrist for an examination to look for a number of factors that could contribute to your diagnosis, including:

• Emotional state
• Patterns of behaviors
• Quality of judgment
• Coping skills
• Signs of disordered thinking
• Evidence of substance abuse

Brain imaging and function

Your doctor may order brain-imaging tests for assessing the structure or function of the brain. The imaging technologies may include MRI or CT scans that show detailed images of the brain.

These images may reveal changes in the brain in areas affected by Huntington’s disease. These changes may not show up early in the course of the disease. These tests can also be used to rule out other conditions that may be causing symptoms.

Genetic counseling and testing

If symptoms strongly suggest Huntington’s disease, your doctor may recommend a genetic test for the defective gene.

This test can confirm the diagnosis. It may also be valuable if there’s no known family history of Huntington’s disease or if no other family member’s diagnosis was confirmed with a genetic test. But the test won’t provide information that might help determinine a treatment plan.

Before having such a test, the genetic counselor will explain the benefits and drawbacks of learning test results. The genetic counselor can also answer questions about the inheritance patterns of Huntington’s disease.

Predictive genetic test

A genetic test can be given if you have a family history of the disease but don’t have symptoms. This is called predictive testing. The test can’t tell you when the disease will begin or what symptoms will appear first.

Some people may have the test because they find not knowing to be more stressful. Others may want to take the test before having children.

“More than 30,000 Americans are living with HD.  Everyone has two Huntington (HTT) genes, one from each parent.  Huntington disease develops when one of those genes carries the mutation. In some families, appearance of symptoms happens early and earlier with each generation. The symptoms usually appear between the ages of 30-50.”

Honestly HD (https://www.honestlyhd.com/hd-overview?gclid=bc1d72d4cc7f10a028831af07b0f59e8&gclsrc=3p.ds&msclkid=bc1d72d4cc7f10a028831af07b0f59e8&utm_source=bing&utm_medium=cpc&utm_campaign=USA_MA_SEM_NB_PH_HonestlyHD-DTC-Research-Info-All-All-NANBA.All&utm_term=prevalence%20of%20huntingtons%20disease%20in%20the%20us&utm_content=Core)

Causes:

Huntington’s disease is caused by an inherited defect in a single gene. Huntington’s disease is an autosomal dominant disorder, which means that a person needs only one copy of the defective gene to develop the disorder.

With the exception of genes on the sex chromosomes, a person inherits two copies of every gene — one copy from each parent. A parent with a defective gene could pass along the defective copy of the gene or the healthy copy. Each child in the family, therefore, has a 50 percent chance of inheriting the gene that causes the genetic disorder.

Complications:

After the start of Huntington’s disease, a person’s functional abilities gradually worsen over time. The rate of disease progression and duration varies. The time from disease emergence to death is often about 10 to 30 years. Juvenile Huntington’s disease usually results in death within 10 years after symptoms develop.

The clinical depression associated with Huntington’s disease may increase the risk of suicide. Some research suggests that the greater risk of suicide occurs before a diagnosis is made and in the middle stages of the disease when a person has begun to lose independence.

Eventually, a person with Huntington’s disease requires help with all activities of daily living and care. Late in the disease, he or she will likely be confined to a bed and unable to speak. However, he or she is generally able to understand language and has an awareness of family and friends.

Common causes of death include:

• Pneumonia or other infections
• Injuries related to falls
• Complications related to the inability to swallow

Prevention:

People with a known family history of Huntington’s disease are understandably concerned about whether they may pass the Huntington gene on to their children. These people may consider genetic testing and family planning options.

If an at-risk parent is considering genetic testing, it can be helpful to meet with a genetic counselor. A genetic counselor will discuss the potential risks of a positive test result, which would indicate the parent will develop the disease. Also, couples will need to make additional choices about whether to have children or to consider alternatives, such as prenatal testing for the gene or in vitro fertilization with donor sperm or eggs.

Another option for couples is in vitro fertilization and preimplantation genetic diagnosis. In this process, eggs are removed from the ovaries and fertilized with the father’s sperm in a laboratory. The embryos are tested for presence of the Huntington gene, and only those testing negative for the Huntington gene are implanted in the mother’s uterus.

“Huntington´s Disease (HD) is a rare, hereditary, neurodegenerative illness that affects people of all races worldwide. The disease was named after Dr. George Huntington, a physician from Long Island, United States of America, who first published a description of “hereditary chorea” in 1872.

Huntington´s Disease is a hereditary disorder.  Each child of a parent who has HD has a 50% chance of inheriting it.  HD occurs in all races.  Males and females are equally at risk.  Carriers of the HD gene will eventually develop the disease should they live long enough.

According to Dr. Ira Shoulson, the progress of HD can be divided into five stages that are flexible after diagnosed.

Globally, there is estimated to be between 3.6 and 5.7 people with HD for every 100,000 of population.”

Huntington’s disease is an inherited disease that causes the progressive breakdown (degeneration) of nerve cells in the brain. Huntington’s disease has a broad impact on a person’s functional abilities and usually results in movement, thinking (cognitive) and psychiatric disorders.

Most people with Huntington’s disease develop signs and symptoms in their 30s or 40s. But the disease may emerge earlier or later in life.

When the disease develops before age 20, the condition is called juvenile Huntington’s disease. An earlier emergence of the disease often results in a somewhat different set of symptoms and faster disease progression.

Medications are available to help manage the symptoms of Huntington’s disease, but treatments can’t prevent the physical, mental and behavioral decline associated with the condition.

Symptoms

Huntington’s disease usually causes movement, cognitive and psychiatric disorders with a wide spectrum of signs and symptoms. Which symptoms appear first varies greatly among affected people. During the course of the disease, some disorders appear to be more dominant or have a greater effect on functional ability.

Movement disorders

The movement disorders associated with Huntington’s disease can include both involuntary movement problems and impairments in voluntary movements, such as:

• Involuntary jerking or writhing movements (chorea)
• Muscle problems, such as rigidity or muscle contracture (dystonia)
• Slow or abnormal eye movements
• Impaired gait, posture and balance
• Difficulty with the physical production of speech or swallowing

Impairments in voluntary movements — rather than the involuntary movements — may have a greater impact on a person’s ability to work, perform daily activities, communicate and remain independent.

Cognitive disorders

Cognitive impairments often associated with Huntington’s disease include:

• Difficulty organizing, prioritizing or focusing on tasks
• Lack of flexibility or the tendency to get stuck on a thought, behavior or action (perseveration)
• Lack of impulse control that can result in outbursts, acting without thinking and sexual promiscuity
• Lack of awareness of one’s own behaviors and abilities
• Slowness in processing thoughts or ”finding” words
• Difficulty in learning new information

Psychiatric disorders

The most common psychiatric disorder associated with Huntington’s disease is depression. This isn’t simply a reaction to receiving a diagnosis of Huntington’s disease. Instead, depression appears to occur because of injury to the brain and subsequent changes in brain function. Signs and symptoms may include:

• Feelings of irritability, sadness or apathy
• Social withdrawal
• Insomnia
• Fatigue and loss of energy
• Frequent thoughts of death, dying or suicide

Other common psychiatric disorders include:

• Obsessive-compulsive disorder — a condition marked by recurrent, intrusive thoughts and repetitive behaviors
• Mania, which can cause elevated mood, overactivity, impulsive behavior and inflated self-esteem
• Bipolar disorder — a condition with alternating episodes of depression and mania

In addition to the above symptoms, weight loss is common in people with Huntington’s disease, especially as the disease progresses.

Symptoms of juvenile Huntington’s disease

The start and progression of Huntington’s disease in younger people may be slightly different from that in adults. Problems that often present themselves early in the course of the disease include:

Behavioral changes

• Loss of previously learned academic or physical skills
• Rapid, significant drop in overall school performance
• Behavioral problems

Physical changes

• Contracted and rigid muscles that affect gait (especially in young children)
• Changes in fine motor skills that might be noticeable in skills such as handwriting
• Tremors or slight involuntary movements
• Seizures

“Substance Abuse Statistics:

Among Americans aged 12 years and older, 37.309 million were current illegal drug users (used within the last 30 days) as of 2020.

• 13.5% of Americans 12 and over used drugs in the last month, a 3.8% increase year-over-year (YoY).
• 59.277 million or 21.4% of people 12 and over have used illegal drugs or misused prescription drugs within the last year.
• 138.543 million or 50.0% of people aged 12 and over have illicitly used drugs in their lifetime.
• Usership among people aged 12 and over is down 0.4% YoY.
• 138.522 million Americans 12 and over drink alcohol.
• 28.320 million or 20.4% of them have an alcohol use disorder.
• 57.277 million people use tobacco or nicotine products (vape).
• 25.4% of illegal drug users have a drug disorder.
• 24.7% of those with drug disorders have an opioid disorder; this includes prescription pain relievers or “pain killers” and heroin).

National Center for Drug Abuse NCDAS (NCDAS: Substance Abuse and Addiction Statistics [2023])

“What Is the Worst Drug? introduces viewers to the dangers of fentanyl and the staggering mortality rates of nicotine and alcohol use.

For starters, that is a very complicated question because like, it depends on what kind of worst are you thinking about. And alcohol and nicotine are the most pervasive used drugs and because of that they also are accountable for a lot of deaths and also health issues because of prolonged use of these drugs or binge-like use of alcohol. And right now, in the US we have a very dangerous drug that is fentanyl that is a synthetic opioid that has been mixed into other drugs and is contaminating meth, coke, heroin and fentanyl is very potent and it can cause death.

1. Fentanyl is 50x more potent than heroin and when misused the consequences can be fatal.  Know this is commonly used in OR where there is cardiac rhythm monitors and a RN watching the pt closely with maybe 3 more patients; possible less.   That is how dangerous the drug is!  Fentanyl earns the top spot on this list due to it being the most addictive, most powerful, and most deadly. This fully synthetic opioid is approximately 100 times more potent than morphine and is currently the number one cause of overdose fatality in the United States. Because of its strength, even a minuscule amount of fentanyl can cause a fatal overdose in an individual who has built up opioid tolerance. One kilogram of fentanyl has the potential to kill 500,000 people.

Drugs like methamphetamine and fentanyl are extremely dangerous for an individual who’s using them, but other substances are more dangerous for the population at large because so many people use these substances, and they can have dangerous effects. So, one example of that is nicotine. Smoking causes nearly 500, 000 related deaths a year which is a pretty staggering mortality rate. Alcohol is also used by many people and it can result in health problems, it can result in overdose death, it can also cause people to be in hazardous situations, to get into car accidents as a result of impaired driving. So, at a population level, since it’s much more used it is one of the worst substances.

2. Heroin is a central nervous system depressant and semi-synthetic opiate made from the drug morphine. When used, heroin suppresses breathing and reduces heart rate to dangerously low levels. As a depressant, this opioid is the source of many fatal overdoses and has largely contributed to the ongoing opioid epidemic.

As one of the most dangerous drugs on the planet, heroin may cause breathing cessation, heart infection, liver disease, collapsed veins, and death.The National Institute on Drug Abuse reports drug overdose deaths involving heroin rose from 1,960 in 1999 to 15,469 in 2016.

Any medication you take illegal and for a high especially through your vein is addictive!

3.  Cocaineis a highly addictive stimulant that comes in powder form. When abused, the drug negatively impacts central nervous system functions and can cause stroke, cardiac arrhythmia, cardiac arrest, convulsions, and death. In 2017, drug overdose deaths involving cocaine increased by more than 34%, with almost 14,000 Americans dying from an overdose involving cocaine.

B. Crack cocaine is a form of powdered cocaine that has been chemically manipulated and hardened into a crystalline rock. Being a cheaper alternative to cocaine, crack is widely abused and extremely addictive. In 2016, there were an estimated 432,000 current crack users in the United States alone. The substance acts as a stimulant and causes irreversible bodily damage when abused.

Regardless of how much of the drug is used or how frequently, crack cocaine raises the danger of a heart attack, stroke, seizure, or respiratory failure, all of which can result in sudden death. In addition to the standard risks associated with cocaine use, crack users may experience serious respiratory troubles, including coughing, shortness of breath, lung damage, and bleeding. The heart, liver, and kidneys of long-term users of crack cocaine are severely harmed and users are more likely to be afflicted with infectious illnesses.

4. Methamphetamine  is typically referred to as “meth”, this stimulant ranks within the top five most addictive, illicit drugs in the world. When used, meth produces a rush of euphoria, increased alertness, increased energy, and feelings of invincibility. Long-term meth use can lead to high blood pressure, heart attack, and stroke, in addition to harming your liver and kidneys. Meth can also cause your brain to permanently lose dopamine, which impairs memory, speech, and other mental functions.

Psychotic problems such as mood swings, paranoia, delusions, hallucinations, and violent and aggressive behavior are also likely to arise with prolonged meth use. Even after you have stopped using meth, you may continue to experience memory loss, confusion, and insomnia for months or years. According to the United States Drug Enforcement Administration, methamphetamine was the second-largest contributor to overdose deaths in the United States between May 2019 and May 2020.

5. Oxycodone is an extremely potent opioid prescription drug. It is often available in combination with other analgesics such as aspirin or acetaminophen. Due to it being twice as potent as morphine, oxycodone is highly addictive and life-threatening when abused. As stated in the CDC’s National Vital Statistics Report, oxycodone use ranked first in overdose deaths in 2011 with 5,587 overdose fatalities that year.   It is legal by prescription only.

Oxycodone is commonly used in the hospital for pain.

6. Benzodiazepines  They are a class of prescription drugs used to treat various anxiety and sleep disorders. According to data collected by the National Institute on Drug Abuse, the number of adults filling a benzodiazepine prescription increased 67%, from 8.1 million to 13.5 million between 1996 and 2013. Due to the sedative quality of benzos, they are at high risk for abuse and addiction. Although overdose fatalities from benzodiazepines are not common, the prescription drug is very dangerous when combined with other addictive substances such as alcohol or opioids.

The Rise of Drug Use for Adults Ages 26-49

While young adults ages 18-25 have the highest rates of drug use across the board, drug use among adults ages 26-49 is on the rise:

• The percentage of adults age 26 and older using marijuana daily or almost daily has nearly doubled since 2015.
• Cocaine use and death rates have risen; cocaine-involved overdose rates in the U.S. have risen annually since 2012.
• Meth use is on the rise and overdose death rates climbed more than five-fold for those ages 25 to 54 between 2011 and 2018.
• The nation remains in a prescription and illicit opioids crisis, as 81,230 drug overdose deaths occurred in the U.S.—the highest single year ever reported—in the 12 months ending in May 2020; most of the overdose deaths involved a prescription or illicit opioid.”

Center for Disease Control and Prevention – CDC/March 07, 2025

(Cannabis Facts and Stats | Cannabis and Public Health | CDC)

Key Statistics at a Glance with Alcohol misuse:

• 40–60% of individuals treated for substance use disorders will relapse at least once.
• Over 93% of people with a past-year substance use disorder did not receive specialty treatment.
• The cost of alcohol misuse in the U.S. is about $249 billion annually – one of the highest among all substances.
• American Indian/Alaska Native communities experience a 27.6% past-year substance use disorder rate – significantly above the national average.

Age-Stratified Usage Rates

Understanding the distribution of substance use by age helps target prevention and early intervention efforts where they can be most effective.

• Teens (12–17)
  • Alcohol use in the past month is relatively low, at roughly 9–10%.
  • Marijuana use during the past year hovers near 10%.
  • Inhalant misuse remains one of the earliest experiments, with average first use around age 13.
• Young Adults (18–25)
  • Over 50% report alcohol use in the past month – this group has the highest binge drinking rates.
  • About 34–39% have used illicit drugs in the past year, including marijuana, prescription misuse, cocaine, or hallucinogens.
  • Tobacco or nicotine product use often spikes here (24–25% in some surveys).
• Adults (26+)
  • Alcohol use remains substantial (around half of adults drink monthly), though binge and heavy drinking rates drop relative to the 18–25 cohort.
  • Illicit drug use, outside of marijuana, tends to decrease with age.

“Lupus is a disease that occurs when your body’s immune system attacks your own tissues and organs (autoimmune disease). Inflammation caused by lupus can affect many different body systems — including your joints, skin, kidneys, blood cells, brain, heart and lungs.

Lupus can be difficult to diagnose because its signs and symptoms often mimic those of other ailments. The most distinctive sign of lupus — a facial rash that resembles the wings of a butterfly unfolding across both cheeks — occurs in many but not all cases of lupus.

Some people are born with a tendency toward developing lupus, which may be triggered by infections, certain drugs or even sunlight.”

MAYO Clinic (Lupus – Symptoms & causes – Mayo Clinic)

Diagnosing Lupus:

Diagnosing lupus is difficult because signs and symptoms vary considerably from person to person. Signs and symptoms of lupus may vary over time and overlap with those of many other disorders. No one test can diagnose lupus. The combination of blood and urine tests, signs and symptoms, and physical examination findings leads to the diagnosis.  Tests the MD will order:

Laboratory tests

Blood and urine tests may include:

• Complete blood count. This test measures the number of red blood cells, white blood cells and platelets as well as the amount of hemoglobin, a protein in red blood cells. Results may indicate you have anemia, which commonly occurs in lupus. A low white blood cell or platelet count may occur in lupus as well.
• Erythrocyte sedimentation rate. This blood test determines the rate at which red blood cells settle to the bottom of a tube in an hour. A faster than normal rate may indicate a systemic disease, such as lupus. The sedimentation rate isn’t specific for any one disease. It may be elevated if you have lupus, another inflammatory condition, cancer or an infection.
• Kidney and liver assessment. Blood tests can assess how well your kidneys and liver are functioning. Lupus can affect these organs.
• Urinalysis. An examination of a sample of your urine may show an increased protein level or red blood cells in the urine, which may occur if lupus has affected your kidneys.
• Antinuclear antibody (ANA) test. A positive test for the presence of these antibodies — produced by your immune system — indicates a stimulated immune system. While most people with lupus have a positive ANA test, most people with a positive ANA do not have lupus. If you test positive for ANA, your doctor may advise more-specific antibody testing.If your doctor suspects that lupus is affecting your lungs or heart, he or she may suggest:
  

• Chest X-ray. An image of your chest may reveal abnormal shadows that suggest fluid or inflammation in your lungs.

• Ultrasound maybe used in where a M.D. orders a Echocardiogram. It’s a a noninvasive ultrasound test that evaluates heart function.This test uses sound waves to produce real-time images of your beating heart. It can check for problems with your valves and other portions of your heart.Lupus can harm your kidneys in many different ways, and treatments can vary, depending on the type of damage that occurs. In some cases, it’s necessary to test a small sample of kidney tissue to determine what the best treatment might be. The sample can be obtained with a needle or through a small incision.
• First see a specialist for Lupus who is more out in knowing what to look for (just like a cardiologist for cardiac problems or endocrinologist for diabetes, etc…) So set up an appointment with a doctor to be examined!

Treatments for Lupus:

1. Biopsy

2. The M. D. will do a physical and determine whether your signs and symptoms your experiencing.  Treatment for lupus depends on your signs and symptoms and the cause for it so treatment varies. The symptoms should be treated as lupus and what medications to use requires a careful discussion of the benefits and risks with your doctor. As your signs and symptoms flare and subside, you and your doctor may find that you’ll need to change medications or dosages.

3.Medications, this could include the following:

a. Nonsteroidal anti-inflammatory drugs (NSAIDs).  This could include, over-the-counter NSAIDs, such as naproxen sodium (Aleve) and ibuprofen (Advil, Motrin IB, others), may be used to treat pain, swelling and fever associated with lupus. Stronger NSAIDs are available by prescription. Side effects of NSAIDs include stomach bleeding, kidney problems and an increased risk of heart problems.

b. Antimalarial drugs.  Medications commonly used to treat malaria, such as hydroxychloroquine (Plaquenil), also can help control lupus. Side effects can include stomach upset and, very rarely, damage to the retina of the eye.

c. Corticosteroids  This could include Prednisone and other types of corticosteroids can counter the inflammation of lupus but often produce long-term side effects — including weight gain, easy bruising, thinning bones (osteoporosis), high blood pressure, diabetes and increased risk of infection. The risk of side effects increases with higher doses and longer term therapy.

d. Immunosuppressants.  These drugs suppress the immune system which may be helpful in serious cases of lupus. Examples include azathioprine (Imuran, Azasan), mycophenolate (CellCept), leflunomide (Arava) and methotrexate (Trexall). Potential side effects may include an increased risk of infection, liver damage, decreased fertility and an increased risk of cancer. A newer medication, belimumab (Benlysta), also reduces lupus symptoms in some people. Side effects include nausea, diarrhea and fever.Take steps to care for your body if you have lupus. Simple measures can help you prevent lupus flares and, should they occur, better cope with the signs and symptoms you experience.

4. Other treatments could include:

• See your doctor regularly. Having regular checkups instead of only seeing your doctor when your symptoms worsen may help your doctor prevent flare-ups, and can be useful in addressing routine health concerns, such as stress, diet and exercise that can be helpful in preventing lupus complications.
• Get adequate rest. People with lupus often experience persistent fatigue that’s different from normal tiredness and that isn’t necessarily relieved by rest. For that reason, it can be hard to judge when you need to slow down. Get plenty of sleep at night and naps or breaks during the day as needed.
• Be sun smart. Because ultraviolet light can trigger a flare, wear protective clothing — such as a hat, long-sleeved shirt and long pants — and use sunscreens with a sun protection factor (SPF) of at least 55 every time you go outside.
• Get regular exercise. Exercise can help you recover from a flare, reduce your risk of heart attack, help fight depression and promote general well-being.
• Don’t smoke. Smoking increases your risk of cardiovascular disease and can worsen the effects of lupus on your heart and blood vessels.
• Eat a healthy diet. A healthy diet emphasizes fruits, vegetables and whole grains. Sometimes you may have dietary restrictions, especially if you have high blood pressure, kidney damage or gastrointestinal problems.

Possible complications to Lupus:

• Kidneys. Lupus can cause serious kidney damage, and kidney failure is one of the leading causes of death among people with lupus. Signs and symptoms of kidney problems may include generalized itching, chest pain, nausea, vomiting and leg swelling (edema).
• Brain and central nervous system. If your brain is affected by lupus, you may experience headaches, dizziness, behavior changes, hallucinations, and even strokes or seizures. Many people with lupus experience memory problems and may have difficulty expressing their thoughts.
• Blood and blood vessels. Lupus may lead to blood problems, including anemia and increased risk of bleeding or blood clotting. It can also cause inflammation of the blood vessels (vasculitis).
• Lungs. Having lupus increases your chances of developing an inflammation of the chest cavity lining (pleurisy), which can make breathing painful. You may also be more susceptible to pneumonia.
• Heart. Lupus can cause inflammation of your heart muscle, your arteries or heart membrane (pericarditis). The risk of cardiovascular disease and heart attacks increases greatly.  Other areas of the body that can be effected by lupus causing problems include:  Infection, Cancer, Bone Tissue Death (avascular necrosis), and Pregnancy complications.