F065 Evaluating the clinical, cognitive and neuroimaging associations of impaired insight into behavioural symptoms of Huntington’s disease

<h3>Background</h3> Insight into behavioural symptoms of Huntington’s disease (HD) is frequently impaired and associated with poorer quality of life and higher caregiver burden. Here, we aim to evaluate clinical, cognitive and neuroimaging associations of impaired insight into behavioural problems in HD. <h3>Methods</h3> We used data from 133 participants with pre- and early-manifest HD from the TRACK-ON study. Insight was measured as the discrepancy between participant and companion ratings on the Frontal Systems Behaviour Scale. Multivariable regression models established associations of motor severity, CAG repeat length, psychiatric symptoms, and cognitive function with impaired insight. Neuroimaging (structural T1 and resting state fMRI) analysis will also be completed with insight impairment as the outcome. <h3>Results</h3> Impaired insight was associated with lower self-reported depressive symptoms (<b>β</b> -1.85, p&lt;0.01) and anxiety (<b>β</b> -2.10, p&lt;0.001). Lack of insight - particularly into disinhibited behaviours - was associated with an increased risk of previous suicide attempt (<b>β</b> 6.51, p &lt;0.05). Performance on executive, visuospatial tasks and complex attention were negatively predictive of impaired insight (<b>β</b> -2.78, p&lt;0.05 Stroop task; beta -6.53, p &lt; 0.05 Mental Rotation Task; <b>β</b> -1.02, p&lt;0.05 Circle Tracing Task), adjusted for age, sex, CAG length and motor severity. There was no association between impaired insight and motor severity, or CAG repeat length. <h3>Conclusion</h3> Impaired insight into behavioural symptoms in pre- and early-manifest HD is associated with prior suicidality and poorer cognitive (including executive) function. This may have clinical implications and underlines the need for early identification of impaired insights in people with HD.