Feasibility of HD-DRUM, a rhythmic movement training, in Huntington's Disease: A randomised controlled pilot trial exploring changes in paced motor function and brain microstructure

Background: Rhythmic movement training offers promise as a cognitive and motor
intervention tool in Huntington’s disease (HD). HD-DRUM is a tablet-based application for
the training of paced movements. Feasibility of 8 weeks of remote HD-DRUM compared
with usual-activity control was assessed in a two-arm, randomised controlled trial (RCT) in
people with HD. HD-DRUM related changes in quantitative motor and cognitive functions,
mood, and brain microstructure were explored.
Objectives: To assess acceptability of HD-DRUM and feasibility (recruitment, retention,
adherence) of an effectiveness RCT. To gain estimates of HD-DRUM-related effect sizes on
cognition, motor functions, mood and to explore training mechanism and impact on brain
microstructure.
Methods: Fifty-four individuals with HD, confirmed by genetic testing and/or clinical
diagnosis (age, sex, TFC, HD-ISS), were randomised into either HD-DRUM (n = 31) or usualactivity control (n = 23) groups. Participants underwent quantitative motor (q-Motor) and
working memory/executive function assessments and diffusion-weighted MRI imaging
before and after the 8 weeks period. Group differences of changes in motor and cognitive
performance were explored with 95% confidence intervals and those in whole brain
microstructure with Tract-Based-Spatial-Statistics of diffusion MRI data.
Results: Acceptability of HD-DRUM, retention, and adherence rates averages were high
(>80%) and target recruitment was exceeded. HD-DRUM-related improvements in paced
tapping and in brain microstructure, suggestive of a slowing of white matter decline, were
observed.
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perpetuity.
preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in
medRxiv preprint doi: https://doi.org/10.64898/2026.01.26.26344842; this version posted January 27, 2026. The copyright holder for this
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Conclusions: HD-DRUM, a remote rhythmic movement app, was feasible and acceptable in
people with HD. HD-DRUM holds the potential for a low cost, accessible intervention for
maintenance of movements and brain microstructure in HD.