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PubMed This is a summary of 21 peer-reviewed journal articles Updated
Neurology · Huntington's disease

What Are the First Symptoms of Huntington's Disease?

At a Glance

The first symptoms of Huntington's disease are typically psychiatric and cognitive changes, such as depression, anxiety, irritability, and apathy. These non-motor symptoms can appear 10 to 15 years before involuntary physical movements begin due to early structural changes in the brain.

In this answer

3 sections

01

The Premanifest Phase: Mood and Cognitive Changes

02

Why Do Mood Changes Happen Before Motor Symptoms?

03

Getting Support and Treatment

Yes, Huntington’s disease can—and very often does—start with mood, behavior, or cognitive changes long before any physical twitching begins. While most people think of Huntington’s as a movement disorder characterized by involuntary movements called chorea, decades of research show that psychiatric symptoms like depression, anxiety, apathy, and irritability frequently appear years or even up to decades before a motor diagnosis is made [1][2]. These non-motor symptoms are not simply emotional reactions to knowing one has the disease gene; they are a direct result of early physical changes in the brain.

The Premanifest Phase: Mood and Cognitive Changes

In what doctors call the prodromal or premanifest phase of Huntington’s disease, individuals may experience a range of psychiatric and cognitive symptoms [3][4][5]. This phase can last 10 to 15 years before the classic physical movements start.

  • Depression, Anxiety, and Safety: Depression is the most frequently reported psychiatric symptom among people carrying the Huntington’s gene [6][7]. This can manifest as persistent sadness, loss of interest in activities, or heightened anxiety. Importantly, Huntington’s disease carries an elevated risk of suicidal thoughts, particularly during this prodromal phase and around the time of diagnosis. If you or a loved one are experiencing thoughts of self-harm, please seek immediate help by calling or texting the 988 Suicide & Crisis Lifeline.
  • Irritability and Emotional Regulation: Early in the disease, people may show a lower threshold for frustration, an excessive response to provocation, or difficulty regulating emotions [8][9].
  • Apathy: Apathy—a distinct loss of motivation, “spark,” or drive—is a core feature of Huntington’s. Studies show that apathy often increases as the disease progresses closer to the onset of motor symptoms and can be a strong predictor of faster cognitive decline [10][11][5].
  • Mild Cognitive Changes: Before physical symptoms start, individuals might experience subtle difficulties with executive function (the brain’s ability to multitask, organize, and plan), working memory, and spatial memory [12][13][14].

Why Do Mood Changes Happen Before Motor Symptoms?

The reason mood and cognitive changes appear before involuntary movements lies in how the disease physically affects the brain over time. Huntington’s disease causes progressive atrophy (shrinkage) and connectivity loss in a deep brain region called the striatum, which acts as a major communication hub [15][16][17].

The striatum manages different types of information through separate circuits. Research suggests that the circuits responsible for processing emotions, behavior, and complex thought (the limbic and associative networks) often experience disrupted connectivity and damage before the networks that control physical movement (the motor circuits) [18][19]. Because these emotion and thought pathways are impacted earlier, psychiatric and cognitive symptoms emerge well before the characteristic physical twitching or chorea begins [15][20].

Getting Support and Treatment

Recognizing that depression, irritability, and apathy are direct symptoms of Huntington’s disease—not just personal failings or stress reactions—can be incredibly validating for patients and families [3]. While these symptoms can significantly impact daily life and relationships, they are highly treatable [6][21].

To manage these symptoms effectively:

  • Seek Specialized Care: Ask your neurologist for a referral to a neuropsychiatrist or a psychiatrist familiar with neurological conditions.
  • Explore Treatments: Mood changes in Huntington’s often respond well to standard psychiatric treatments, including antidepressant medications, mood stabilizers, and talk therapies like Cognitive Behavioral Therapy (CBT).
  • Track Your Symptoms: Keep a brief journal of mood and behavioral changes to share with your care team.

Common questions in this guide

Do mood changes happen before physical symptoms in Huntington's disease?
Yes, psychiatric symptoms like depression, anxiety, apathy, and irritability frequently appear years or even decades before physical movements begin. These are direct results of early physical changes in the brain, rather than just emotional reactions to the diagnosis.
What is the premanifest phase of Huntington's disease?
The premanifest or prodromal phase is the period before classic physical movements start. It can last 10 to 15 years and is often characterized by mood, behavioral, and mild cognitive changes.
Why does Huntington's disease cause early emotional and cognitive symptoms?
The disease causes progressive shrinkage and damage in the striatum, a deep brain region. The brain networks responsible for processing emotions and complex thought are often damaged before the networks that control physical movement.
Can the early mood symptoms of Huntington's disease be treated?
Yes, depression, irritability, and anxiety related to Huntington's disease are highly treatable. Standard psychiatric treatments like antidepressant medications, mood stabilizers, and cognitive behavioral therapy (CBT) are often effective.
What kind of doctor should I see for early Huntington's symptoms?
It is recommended to see a neurologist who can refer you to a neuropsychiatrist or a psychiatrist familiar with neurological conditions to help manage mood and cognitive changes.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Since depression, anxiety, and apathy can be early signs of Huntington's, what treatments or therapies do you recommend for managing these symptoms right now?
  2. 2.Can you refer me to a neuropsychiatrist or a psychiatrist who has experience with Huntington's disease or other movement disorders?
  3. 3.How can we formally track changes in my mood, behavior, and thinking over time?
  4. 4.What specific cognitive tests do you use to establish a baseline for my executive function and memory?
  5. 5.Are there any clinical trials focusing on the premanifest or prodromal phase that I might be eligible for?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

Related questions

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References

References (21)
  1. 1

    Huntington's Disease: Premotor Phase.

    Ramos ARS, Garrett C

    Neuro-degenerative diseases 2017; (17(6)):313-322 doi:10.1159/000481172.

    PMID: 29073635
  2. 2

    Neuropsychiatric Burden in Huntington's Disease.

    Paoli RA, Botturi A, Ciammola A, et al.

    Brain sciences 2017; (7(6)) doi:10.3390/brainsci7060067.

    PMID: 28621715
  3. 3

    Longitudinal Psychiatric Symptoms in Prodromal Huntington's Disease: A Decade of Data.

    Epping EA, Kim JI, Craufurd D, et al.

    The American journal of psychiatry 2016; (173(2)):184-92 doi:10.1176/appi.ajp.2015.14121551.

    PMID: 26472629
  4. 4

    Juvenile-onset Huntington's disease - Spectrum and evolution of presenting movement disorders.

    Yang K, Quiroz V, Tam A, et al.

    Annals of clinical and translational neurology 2024; (11(10)):2805-2810 doi:10.1002/acn3.52193.

    PMID: 39239850
  5. 5

    Neuropsychiatric symptoms are very common in premanifest and early stage Huntington's Disease.

    Martinez-Horta S, Perez-Perez J, van Duijn E, et al.

    Parkinsonism & related disorders 2016; (25()):58-64.

    PMID: 26898966
  6. 6

    Timing and Impact of Psychiatric, Cognitive, and Motor Abnormalities in Huntington Disease.

    McAllister B, Gusella JF, Landwehrmeyer GB, et al.

    Neurology 2021; (96(19)):e2395-e2406 doi:10.1212/WNL.0000000000011893.

    PMID: 33766994
  7. 7

    The psychopharmacology of Huntington disease.

    Petersén Å, Weydt P

    Handbook of clinical neurology 2019; (165()):179-189 doi:10.1016/B978-0-444-64012-3.00010-1.

    PMID: 31727211
  8. 8

    Excessive response to provocation rather than disinhibition mediates irritable behaviour in Huntington's disease.

    McLauchlan DJ, Linden DEJ, Rosser AE

    Frontiers in neuroscience 2022; (16()):993357 doi:10.3389/fnins.2022.993357.

    PMID: 36643017
  9. 9

    New Perspectives on Emotional Processing in People with Symptomatic Huntington's Disease: Impaired Emotion Regulation and Recognition of Emotional Body Language†.

    Zarotti N, Fletcher I, Simpson J

    Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists 2019; (34(5)):610-624 doi:10.1093/arclin/acy085.

    PMID: 30395151
  10. 10

    Apathy predicts rate of cognitive decline over 24 months in premanifest Huntington's disease.

    Andrews SC, Langbehn DR, Craufurd D, et al.

    Psychological medicine 2021; (51(8)):1338-1344 doi:10.1017/S0033291720000094.

    PMID: 32063235
  11. 11

    A Machine-Learning Derived Huntington's Disease Progression Model: Insights for Clinical Trial Design.

    Mohan A, Sun Z, Ghosh S, et al.

    Movement disorders : official journal of the Movement Disorder Society 2022; (37(3)):553-562 doi:10.1002/mds.28866.

    PMID: 34870344
  12. 12

    The effect of impulsivity and inhibitory control deficits in the saccadic behavior of premanifest Huntington's disease individuals.

    Júlio F, Caetano G, Januário C, Castelo-Branco M

    Orphanet journal of rare diseases 2019; (14(1)):246 doi:10.1186/s13023-019-1218-y.

    PMID: 31703597
  13. 13

    Characterization of visual cognition in pre-manifest, manifest and reduced penetrance Huntington's disease.

    Del Pino R, Acera MÁ, Ortiz de Echevarría A, et al.

    Scientific reports 2025; (15(1)):4707 doi:10.1038/s41598-025-88406-5.

    PMID: 39922862
  14. 14

    'Real-life' hippocampal-dependent spatial memory impairments in Huntington's disease.

    Glikmann-Johnston Y, Carmichael AM, Mercieca EC, Stout JC

    Cortex; a journal devoted to the study of the nervous system and behavior 2019; (119()):46-60 doi:10.1016/j.cortex.2019.04.006.

    PMID: 31071556
  15. 15

    Clinicopathological differences between the motor onset and psychiatric onset of Huntington's disease, focusing on the nucleus accumbens.

    Hirano M, Iritani S, Fujishiro H, et al.

    Neuropathology : official journal of the Japanese Society of Neuropathology 2019; (39(5)):331-341 doi:10.1111/neup.12578.

    PMID: 31264738
  16. 16

    Mapping Regional Brain Aging in Huntington's Disease Using Structural Magnetic Resonance Imaging and Machine Learning.

    Ghofrani-Jahromi M, Amirmoezzi Y, Abeyasinghe PM, et al.

    Movement disorders : official journal of the Movement Disorder Society 2026; (41(4)):881-888 doi:10.1002/mds.70160.

    PMID: 41439586
  17. 17

    Cognitive decline in Huntington's disease in the Digitalized Arithmetic Task (DAT).

    Lunven M, Hamet Bagnou J, Youssov K, et al.

    PloS one 2021; (16(8)):e0253064 doi:10.1371/journal.pone.0253064.

    PMID: 34424902
  18. 18

    Resting-state fMRI reveals longitudinal alterations in brain network connectivity in the zQ175DN mouse model of Huntington's disease.

    Vasilkovska T, Adhikari MH, Van Audekerke J, et al.

    Neurobiology of disease 2023; (181()):106095 doi:10.1016/j.nbd.2023.106095.

    PMID: 36963694
  19. 19

    Local synchronicity in dopamine-rich caudate nucleus influences Huntington's disease motor phenotype.

    Kasper J, Eickhoff SB, Caspers S, et al.

    Brain : a journal of neurology 2023; (146(8)):3319-3330 doi:10.1093/brain/awad043.

    PMID: 36795496
  20. 20

    Grey matter volume loss is associated with specific clinical motor signs in Huntington's disease.

    Coppen EM, Jacobs M, van den Berg-Huysmans AA, et al.

    Parkinsonism & related disorders 2018; (46()):56-61 doi:10.1016/j.parkreldis.2017.11.001.

    PMID: 29128164
  21. 21

    Apathy and Impulsivity Co-Occur in Huntington's Disease.

    Morris LA, Horne KL, Paermentier L, et al.

    Brain and behavior 2024; (14(10)):e70061 doi:10.1002/brb3.70061.

    PMID: 39344371

This page provides educational information about the early symptoms of Huntington's disease. It does not replace professional medical advice. Always consult your neurologist or neuropsychiatrist for diagnosis and treatment.

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