Emotion Recognition in People with Huntington’s Disease : A Comprehensive Systematic Review

Zarotti, Nicolò and Storey, Alice and Lloyd, Sarah and Mesia Guevara, Laura and Caswell, Helen and Chen, Cliff and Simpson, Jane (2026) Emotion Recognition in People with Huntington’s Disease : A Comprehensive Systematic Review. Journal of Huntington's disease, 15 (1). pp. 20-54.

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Abstract

Background Deficits of emotion recognition have received increasing attention in people with Huntington's disease (HD) in the three decades since the discovery of the HD gene. However, the characterisation of such deficits across different disease stages, types of stimuli, and sensory modalities is currently unclear. Objective This study aimed to provide a comprehensive review of the evidence on emotion recognition deficits in HD gene carriers (both manifest and premanifest) over the three decades since definitive gene testing. Method A systematic review was carried out from January 1993 to January 2025 across MEDLINE, PsycINFO, Academic Search Complete, and CINAHL (PROSPERO registration: CRD42023398649). Results From 9735 initial citations, 59 studies were eventually included. In manifest HD, facial recognition of negative emotions such as anger, fear, disgust, and sadness was consistently impaired, whereas happiness and neutral expressions were generally spared. A few auditory studies showed consistent deficits for disgust, fear, and anger, while happiness and sadness appeared less affected. Only preliminary evidence is currently available for deficits involving body language, visual and written vignettes, videos, and olfactory and gustatory tasks. Although sparser, the evidence for premanifest HD suggests that some individuals may develop significant recognition difficulties prior to motor onset, particularly due to early frontostriatal deterioration and white matter disruption. Conclusions Impairments of facial recognition of negative emotions are reported consistently in manifest HD, while only preliminary results are available for other modalities. The evidence involving premanifest HD is much sparser. Key implications for clinical practice and future research are outlined and discussed. Plain language summary People with Huntington's disease can face psychological problems that affect their daily lives. One common issue is difficulties understanding what emotions other people feel. Scientists have studied this topic since they found the Huntington's gene in 1993, yet the full picture remains unclear. This review looked at 59 studies on emotion recognition in Huntington's disease published between January 1993 and January 2025 across four major databases. The results show that in people with manifest HD recognising angry, fearful, disgusted, and sad faces is often difficult. On the other hand, spotting happy or neutral faces is usually fine. A few experiments that used voices instead of faces showed similar weaknesses for disgust, fear, and anger in manifest HD, although happiness and sadness were less impaired. Evidence for understanding emotions from body postures, short stories, films, smells, or tastes is still limited. Some but not all people with premanifest HD also struggle with emotion recognition, probably because of early damage in frontal areas of the brains. These findings are important for researchers and people with HD alike, as they can help families, friends, caregivers, and patients respond better to daily challenges.