Dissociation between decision-making under risk and decision-making under ambiguity in premanifest and manifest Huntington's disease

- Decision-making under risk and ambiguity were assessed in individual with premanifest and manifest Huntington's disease.
- Individuals with premanifest HD were unimpaired in decision-making whatever the task.
- Individuals with manifest HD were impaired in decision-making under ambiguity, but not in decision-making under risk.
- Decision-making deficits in individuals with manifest HD correlated with cognitive scores but not with impulsivity.

We investigated decision-making under ambiguity (DM-UA) and decision making under risk (DM-UR) in individuals with premanifest and manifest Huntington's disease (HD). Twenty individuals with premanifest HD and 23 individuals with manifest HD, on one hand, and 39 healthy individuals divided into two control groups, on the other, undertook a modified version of the Iowa Gambling Task (IGT), an adaptation of a DM-UA task, and a modified version of the Game of Dice Task (GDT), an adaptation of a DM-UR task. Participants also filled in a questionnaire of impulsivity and responded to cognitive tests specifically designed to assess executive functions. Compared to controls, individuals with premanifest HD were unimpaired in performing executive tests as well as in decision-making tasks, except for the Stroop task. In contrast, individuals with manifest HD were impaired in both the IGT and executive tasks, but not in the GDT. No sign of impulsivity was observed in individuals with premanifest or manifest HD. Our results suggest that the progression of HD impairs DM-UA without affecting DM-UR, and indicate that decision-making abilities are preserved during the premanifest stage of HD.