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Cogn Behav Neurol. 2005 Dec;18(4):215-22.

Nature and development of Huntington disease in a nursing home population: The Behavior Observation Scale Huntington (BOSH).

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Leiden University Medical Center, Department of Neurology, Leiden, The Netherlands.



The Behavior Observation Scale Huntington (BOSH) was developed to obtain a detailed description of the manifestation of Huntington disease (HD) in the final stages.


The Unified Huntington's Disease Rating Scale (UHDRS), developed to assess Huntington patients' clinical capacities, does not differentiate adequately in later stages of the disease. A scale easy to administer by nursing personnel for progression of the disease in later stages was needed.


Two pilot questionnaires preceded the final version of the BOSH. Observers administered the final version twice independently on 91 patients in 4 nursing homes.


The BOSH contains 32 items in 3 subscales: 1) activities of daily living (ADL), 2) social-cognitive functioning, and 3) mental rigidity and aggression. Internal and interrater reliabilities were between 0.83 and 0.95. Rigidity and aggression become more frequent as the disease progresses; later on, this behavior diminishes. Social-cognitive capabilities deteriorate more rapidly in later stages.


This study sought to develop a scale for assessing behaviors and individual differences in later stages of HD. The findings support the use of the BOSH in identifying these behaviors and differences.

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