Disordered Decision Making: A Cognitive Framework for Apathy and Impulsivity in Huntington’s Disease
Open accessAbstract
A caregiver's all-too-familiar narrative - "He doesn't think through what he does, but mostly he does nothing." Apathy and impulsivity, debilitating and poorly understood, commonly co-occur in Huntington's disease (HD). HD is a neurodegenerative disease with manifestations bridging clinical neurology and psychiatry. In addition to movement and cognitive symptoms, neurobehavioral disturbances, particularly apathy and impulsivity, are prevalent features of HD, occurring early in the disease course, often worsening with disease progression, and substantially reducing quality of life. Treatments remain limited, in part because of limited mechanistic understanding of these behavioral disturbances. However, emerging work within the field of decision-making neuroscience and beyond points to common neurobiological mechanisms underpinning these seemingly disparate problems. These insights bridge the gap between underlying disease pathology and clinical phenotype, offering new treatment strategies, novel behavioral and physiological biomarkers of HD, and deeper understanding of human behavior. In this review, we apply the neurobiological framework of cost-benefit decision making to the problems of apathy and impulsivity in HD. Through this decision-making lens, we develop a mechanistic model that elucidates the occurrence of these behavioral disturbances and points to potential treatment strategies and crucial research priorities. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson Movement Disorder Society.
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Toward a Holistic Perspective of Huntington’s Disease
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Papadopetraki, D., Cools, R., Taylor, K. I., Popp, W., Siderowf, A. D., Weintraub, D. A., & Kurniawan, I. T. (2025) · doi:10.2196/preprints.81913
Decision context and neurobehavioural disturbance in Huntington’s disease
Morris, L., Horne, K., Paermentier, L., Buchanan, C. M., Myall, D. J., Manohar, S., Apps, M. A. J., Roxburgh, R. H., Anderson, T., Masud Husain, B., et al. (2025) · Cognitive Affective & Behavioral Neuroscience · doi:10.3758/s13415-025-01359-0
Vovard, B., Baets, J. F.-D., Codron, P., Allain, P., & Cassereau, J. (2025) · Revue Neurologique · doi:10.1016/j.neurol.2025.11.003
Papadopetraki, D., Cools, R., Taylor, K. I., Popp, W., Siderowf, A. D., Weintraub, D. A., & Kurniawan, I. T. (2025) · JMIR Formative Research · doi:10.2196/81913
Michel, E., Garnier-Allain, A., Kaliuzhna, M., Bennabi, D., Servant, M., & Béreau, M. (2026) · PLoS ONE · doi:10.1371/journal.pone.0352351
Poulsen, E., Ásbjörnsdóttir, B., Hjermind, L. E., Nielsen, J. E., & Vogel, A. (2026) · Journal of Neurology · doi:10.1007/s00415-026-14214-0
- Authors
- Morris, L., O'Callaghan, C., & Le Heron, C.
- Affiliations
- New Zealand Brain Research Institute (NZ)
- Brain and Mind Centre and School of Medical Sciences, Faculty of Medicine and Health University of Sydney Sydney New South Wales Australia
- Department of Medicine University of Otago Christchurch New Zealand
- Venue
- Movement Disorders
- Publisher
- Wiley
- Published
- 2022-05-02
- Volume
- 37
- Issue
- 6
- Pages
- 1149-1163
- ISSN
- 0885-3185 (ISSN-L)
- 1531-8257
- PMC
- PMC9322688
- OpenAlex
- W4225268748
- Cited by
- 36
- References
- 148
- Citations by year
- 2026: 2 · 2025: 11 · 2024: 10 · 2023: 4 · 2022: 9
- FWCI
- 1.22
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Movement Disorders (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Genetic Neurodegenerative Diseases
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Health Sciences › Medicine › Neurology › Neurological disorders and treatments
- Keywords
- Huntington's disease, apathy, impulsivity, decision-making, cost-benefit decision making, neurobehavioral disorders, cognitive framework, biomarkers, treatment options, neurodegeneration
- MeSH terms
- Cognition, Decision Making, Humans, Huntington Disease, Impulsive Behavior, Male, Parkinson Disease, Quality of Life, Disease Progression, Neurodegenerative Diseases, Apathy
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