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Huntington's disease leads to degeneration in frontostriatal circuits, which drives progressive impairment of higher-order thinking. The characteristic cognitive change is a decline in intellectual function, especially in executive tasks such as planning, organizing, problem-solving, and processing speed. As the disease advances, this can progress to global cognitive decline or dementia.

Psychiatric symptoms, including emotional lability, are common but represent non-cognitive features. Seizures are not typical of Huntington's disease, and while psychosis can occur, it is not the defining cognitive change. Therefore, intellectual decline best captures the core cognitive impairment associated with Huntington's disease.