Background Reduced self-awareness of neuropsychiatric symptoms is common in HD, but it is not clear how this awareness differs across disease stage, and the relative associations of clinical or cognitive correlates.

Aims We examined self-awareness of neuropsychiatric symptoms (executive function, apathy and disinhibition) in pre-manifest and early manifest HD, and assessed the extent to which awareness was associated with motor, cognitive and mood symptoms.

Methods 132 gene-positive participants (60 pre-manifest and 72 early diagnosed) were included from the multicentre TRACK-HD study. Participants and their informants completed self- and informant-versions of the Frontal Systems Behaviour Scale (FrSBe), and the discrepancy between self- and informant-reports was compared across pre-manifest and early HD groups as a measure of self-awareness. Participants’ motor scores, Hospital Anxiety and Depression Scale scores, and performance on a composite of executive tasks (Trailmaking Test, Spot the Change Test, Symbol Digit Modalities Test) were assessed as predictors of self-awareness.

Results On the FrSBe, pre-manifest participants reported more executive dysfunction, apathy and disinhibition compared to their informants, whereas early HD participants reported less executive dysfunction and apathy than their informants, suggesting that self-awareness reduces as the disease progresses. Better performance on the executive composite was associated with higher self-awareness of executive dysfunction and apathy, and more self-reported anxiety was associated with self-awareness of apathy.

Conclusions Self-awareness of neuropsychiatric symptoms in HD is related to executive task performance and self-reported anxiety, rather than general disease progression, at least for pre-manifest and early diagnosed individuals. Clinicians should consider the impact that cognitive impairment and anxiety have on patients’ awareness of their own neuropsychiatric symptoms.