Do I misconstrue? Sarcasm detection, emotion recognition, and theory of mind in Huntington disease.

OBJECTIVE Emotion recognition has been widely studied in Huntington disease (HD), but only a few studies have investigated more complex social cognition and, when so, exclusively in manifest HD. The present study sought to investigate social-cognitive functions in a large, consecutive cohort of premanifest and manifest HD gene expansion carriers using tests assessing sarcasm detection, theory of mind (ToM), and emotion recognition. METHOD Fifty manifest, 50 premanifest HD gene expansion carriers, and 39 at risk gene expansion negative healthy controls were included. All participants were tested with sarcasm detection, ToM, and emotion recognition tasks. Between-group comparisons of test performances and correlation analyses of test performances and disease burden scores were made. RESULTS Group comparisons showed significant differences in performances on the social-cognitive tests between manifest HD gene expansion carriers and healthy controls, but differences in performances between premanifest HD gene expansion carriers and healthy controls were not statistically significant. Correlation analysis showed that the worse test performances were associated with higher disease burden scores in all HD gene expansion carriers. CONCLUSION Our findings support a theory of impaired social-cognitive functions in the early stages of HD. Test performances decreased with increasing disease burden in all HD gene expansion carriers, suggesting that social-cognitive tests may be useful for tracking disease progression. Simple emotion recognition tasks are just as sensitive for measuring social-cognitive deficits as more complex measures, but knowledge of the quality of social-cognitive impairments in HD can be of great importance to both patients and caregivers.