Minimal Clinically Important Difference on Cognitive Measures for Huntington's Disease Using Function as an Anchor

BACKGROUND: Cognitive measures in Huntington's disease (HD) play an important role in clinical trial endpoint strategies; however, clinically meaningful change in these measures is difficult to interpret. Cognition is a key predictor of function, and measures of functional capacity can be used as anchors to determine minimally clinically important differences (MCID) on measures of cognition. OBJECTIVES: We aimed to estimate the MCID for cognitive measures commonly used in clinical research using two functional capacity measures as anchors. We also compared MCID estimates made using functional capacity as an anchor to those made using the health impairment measured on the 12-item short-form health survey. METHODS: We analyzed data from the Enroll-HD study using participants with Stage 2 and Stage 3 HD using the HD Integrated Staging System. We estimated MCID scores using linear mixed-effects regression at 12-, 24-, and 36-months using the smallest measurable change in functional capacity on each measure as anchors. RESULTS: The amount of change in cognitive measures associated with functionally meaningful decline was larger as disease progressed and time frames increased, p < 0.05. MCID estimates made using measures of function as anchors were generally comparable to those made using health impairment, although those made using health impairment were generally larger at 36 months, p < 0.05. CONCLUSIONS: MCID estimates differed between disease stages and over different time frames. Using measures of everyday function as anchors to estimate MCID thresholds on these measures will aid the interpretation of how cognitive change translates to important change in everyday life. © 2026 International Parkinson and Movement Disorder Society.