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The primary determinant of age at onset in Huntington's disease is CAG repeat length, but in recent years there have been advances in identifying and characterising genetic modifiers which influence age at onset. This has led to the question of whether these data may be applied clinically to improve clinical practice. Here, on behalf of the European Huntington\u2019s Disease Network (EHDN) Genetic Testing and EHDN Genetic Modifiers Working Groups, we review the current state of genetic testing for Huntington's disease and consider the personal impact that pre-symptomatic genetic testing has on those that undertake it. We then discuss how genetic information could be used to improve onset prediction clinically, and whether it could be applied in clinical trials stratification. We conclude by proposing short, medium and long-term recommendations to improve the use of genetic data to in clinical practice and clinical trials.<\/jats:p>","DOI":"10.1177\/18796397251391953","type":"journal-article","created":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T15:24:36Z","timestamp":1766503476000},"page":"167-178","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Genetic testing for Huntington's disease: Past, present and future. How could genetic data be used to improve clinical practice?"],"prefix":"10.1177","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2467-0917","authenticated-orcid":false,"given":"Davina J","family":"Hensman Moss","sequence":"first","affiliation":[{"name":"University College London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rhiannon","family":"Ireland","sequence":"additional","affiliation":[{"name":"Independent Patient or Public Partner, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guy","family":"Chapman","sequence":"additional","affiliation":[{"name":"Independent Patient or Public Partner, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rhona","family":"MacLeod","sequence":"additional","affiliation":[{"name":"Manchester Centre for Genomic Medicine"},{"name":"School of Biological Sciences, Division of Evolution, Infection and Genomics, University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robyn","family":"Labrum","sequence":"additional","affiliation":[{"name":"Neurogenetics Unit, Rare &amp; Inherited Disease Laboratory, London North Genomic Laboratory Hub, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James M","family":"Polke","sequence":"additional","affiliation":[{"name":"Neurogenetics Unit, Rare &amp; Inherited Disease Laboratory, London North Genomic Laboratory Hub, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8298-8264","authenticated-orcid":false,"given":"Darren G","family":"Monckton","sequence":"additional","affiliation":[{"name":"University of Glasgow"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0870-9412","authenticated-orcid":false,"given":"Peter","family":"Holmans","sequence":"additional","affiliation":[{"name":"Cardiff University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"EHDN Genetic Modifiers Working group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"EHDN Genetic Counselling and Testing Working Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9804-2131","authenticated-orcid":false,"given":"Tom H","family":"Massey","sequence":"additional","affiliation":[{"name":"Cardiff University"},{"name":"UK Dementia Research Institute at Cardiff University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6260-7700","authenticated-orcid":false,"given":"Nayana","family":"Lahiri","sequence":"additional","affiliation":[{"name":"St George's University Hospital"},{"name":"Cardiovascular and Genomics Institute, City, St George's University of London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,12,23]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)60974-9"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1159\/000443738"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/mds.25717"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-0004.2004.00241.x"},{"key":"e_1_3_4_6_2","first-page":"1202","article-title":"The likelihood of being affected with Huntington disease by a particular age, for a specific CAG size","volume":"60","author":"Brinkman RR","year":"1997","unstructured":"Brinkman RR, Mezei MM, Theilmann J, et al. 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