Higher educational attainment in Huntington disease families: evidence from the Enroll-HD study.

BACKGROUND: Huntington disease (HD) is an inherited neurodegenerative disorder that impairs motor, cognitive, and psychiatric function. Offspring of individuals with HD may experience early caregiving responsibilities, potentially disrupting their educational outcomes. We evaluated the associations between parental age at HD symptom onset, genetic-expansion, sociodemographic, and regional factors with offspring educational attainment outcomes in adulthood. METHODS: We estimated odds ratios using logistic regression to evaluate associations between higher educational attainment in offspring and parental age at symptom onset, genetic-expansion, race, and region among adults ([Formula: see text]18 years) in the Enroll-HD study. To assess the relative importance of exposures in predicting educational outcomes, we fit a random forest model and ranked these based on mean decrease in accuracy. RESULTS: In our explorative analysis, participants whose parents had an earlier age at HD symptom onset were associated with lower odds of attaining a higher education. We also identified a nonlinear, inverted-U association between genetic-expansion and the probability of higher educational attainment–a pattern that has been observed in prior studies of neurocognitive function in children. Marked differences were also observed by race and region: Black, Hispanic/Latino, and Native American participants were associated with lower odds of higher education compared with White participants, and those residing outside Northern America were associated with lower odds of higher educational attainment. DISCUSSION: Earlier parental HD onset was associated with lower educational attainment in offspring and disparities were observed across genetic-expansion, sociodemographic, and regional groups. Our exploratory findings may inform future studies aimed at better understanding educational inequities among families affected by HD and related neurodegenerative disorders.