Functional Consequences of Major or Mild 
Neurocognitive Disorder Du e to Huntington’s Disease
In the prodromal phase of illness and at early diagnosis, occupational decline is most com-
mon, with most individuals repo rting some loss of ability to engage in their typical work.
The emotional, behavioral, and cognitive aspects of Huntington’s disease, such as disin-
hibition and personality changes, are highly associated with functional decline. Cognitive
deficits that contribute most to functional decline may incl ude speed of processing, initi-
ation, and attention rather th an memory impairment. Given that Huntington’s disease on-
set occurs in productive years of life, it may have a very disruptive effect on performance
in the work setting as well as social and fam ily life. As the disease progresses, disability
from problems such as impair ed gait, dysarthria, and impulsive or irritable behaviors may
substantially add to the level of impairment and daily care needs, over and above the care
needs attributable to the cognitive decline.  Severe choreic moveme nts may substantially
interfere with provision of care such  as bathing, dressing, and toileting.
Differential Diagnosis
Other mental disorders. Early symptoms of Huntington’s disease may include instabil-
ity of mood, irritability, or compulsive behaviors that may suggest another mental disor-
der. However, genetic testing or the develo pment of motor symptoms  will distinguish the
presence of Huntington’s disease.
Other neurocognitive disorders. The early symptoms of Huntington’s disease, particu-
larly symptoms of executive dysfunction an d impaired psychomotor speed, may resemble
other neurocognitive disorders (NCDs), such as major or mild vascular NCD.