Emotion Recognition Deficits in Huntington’s Disease: A Systematic Review and Meta-analysis Across Modalities and Disease Stages
Siyu Yan1, Golnoush Akhlaghipour2, Dorothy Nguyen2, Kunal Debroy2, Ashini Patel2, Harrison Lee2, Swanny Shi2, Yagiz Altun1
1Neurology, Albert Einstein College of Medicine, 2Neurology, Montefiore Medical Center
Objective:
To assess the magnitude and pattern of emotion-recognition deficits in Huntington’s disease (HD) across sensory modalities and emotional categories, and to identify demographic, clinical and methodological factors moderating these impairments.
Background:
HD is a neurodegenerative disorder characterized by motor, cognitive, and psychiatric disturbances. Emerging evidence suggests that impairments in social cognition are prominent across different stages of HD. However, findings amongst studies have been inconsistent, possibly due to variations in task paradigms, disease stage, and the assessed sensory domains.
Design/Methods:
A systematic search of PubMed/Medline was conducted on October 2nd, 2025, using keywords [(“Huntington’s disease” OR “Huntington”) AND (“emotion recognition” OR “emotion perception”)]. Studies were screened independently by two reviewers and were included if they are peer-reviewed human studies with validated emotion recognition tasks and reported sufficient data to compute effect sizes. Data were extracted and results were pooled using a random-effects meta-analysis model in JASP.
Results:
Our search identified 190 references. After screening, 74 studies were retained for full-text review and 24 studies ultimately met inclusion criteria. HD patients showed particularly robust deficits in negative emotion recognition (d= 1.36, 95% CI [1.12, 1.61]), particularly in anger (d= 1.61), disgust (d= 1.56), and fear (d= 1.47). In addition, HD patients show a large and significant impairment in recognizing negative emotions from facial expressions (d= 1.39, p< 0.001), while deficits in other modality recognition were nonsignificant. Interestingly, meta-regression showed that the proportion of male participants significantly moderated deficits (p< 0.001), with higher proportions of males associated with greater deficits.
Conclusions:
Our meta-analysis demonstrates that emotion-recognition deficits are a robust feature of HD. The selective vulnerability of negative emotion processing points to specific striatal-limbic circuit dysfunction. These findings support emotion recognition tasks as potential early biomarkers for disease progression monitoring.
The observed sex effect suggests potential sex-specific differences in vulnerability and neuropathology in HD.
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