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Coenen MA, Spikman JM, Smit M, Klooster J, Tijssen MAJ, Gerritsen MJJ. Moving on with (social) cognition in idiopathic cervical dystonia. J Int Neuropsychol Soc 2024; 30:464-470. [PMID: 38223955 DOI: 10.1017/s1355617723011426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
OBJECTIVE Cervical dystonia (CD) is a movement disorder characterized by involuntary muscle contractions causing sustained twisting movements and abnormal postures of the neck and head. Assumed affected neuronal regions are the cortico-striatal-thalamo-cortical circuits, which are also involved in cognitive functioning. Indeed, impairments in different cognitive domains have been found in CD patients. However, to date studies have only investigated a limited range of cognitive functions within the same sample. In particular, social cognition (SC) is often missing from study designs. Hence, we aimed to evaluate a broad range of cognitive functions including SC in CD patients. METHOD In the present study 20 idiopathic CD patients and 40 age-, gender-, and IQ-matched healthy controls (HCs) were assessed with tests for non-SC (verbal memory, psychomotor speed, and executive functions) as well as for SC (emotion recognition, Theory of Mind (ToM), and empathy). RESULTS CD patients scored on average significantly lower than HC on tests for non-SC, but did not show impairments on any of the tests for SC. CONCLUSIONS The current study showed impairments in non-SC in CD, but intact social cognitive functions. These results underline the importance of recognizing non-motor symptoms in idiopathic CD patients, but emphasize a focus on identifying strengths and weaknesses in cognitive functioning as these influence daily life activities.
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Affiliation(s)
- Maraike A Coenen
- Department of Neurology, University of Groningen, University Medical Center, Groningen, The Netherlands
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Jacoba M Spikman
- Department of Neurology, University of Groningen, University Medical Center, Groningen, The Netherlands
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Marenka Smit
- Department of Neurology, University of Groningen, University Medical Center, Groningen, The Netherlands
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Jesper Klooster
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
- Tactus Verslavingszorg, Zwolle, The Netherlands
| | - Marina A J Tijssen
- Department of Neurology, University of Groningen, University Medical Center, Groningen, The Netherlands
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Marleen J J Gerritsen
- Department of Neurology, University of Groningen, University Medical Center, Groningen, The Netherlands
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
- Department of Medical Psychology, Deventer Ziekenhuis, Deventer, The Netherlands
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2
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Defazio G, Muroni A, Taurisano P, Gigante AF, Fanzecco M, Martino D. Are Cognitive Symptoms Part of the Phenotypic Spectrum of Idiopathic Adult-Onset Dystonia? Summary of Evidence from Controlled Studies. Mov Disord Clin Pract 2024; 11:329-334. [PMID: 38314659 PMCID: PMC10982590 DOI: 10.1002/mdc3.13978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Cognitive dysfunction has been reported in idiopathic adult-onset dystonia (IAOD), but whether this is a primary or secondary component of the disorder remains uncertain. OBJECTIVE Here, we aimed to analyze the key domains of abnormal cognitive performance in IAOD and whether this is associated with motor or mood changes. METHODS Article selection for our critical review was guided by PRISMA guidelines (mesh terms "dystonia" and "cognitive," publication period: 2000-2022). Only peer-reviewed, English-language original case-control studies involving patients with IAOD who were not exposed to dopamine- or acetylcholine-modulating agents and validated cognitive assessments were included. RESULTS Abstract screening ultimately yielded 22 articles for full-text review and data extraction. A greater proportion of studies (17 of 22, 82%) reported abnormal cognitive performance in IAOD. Most of these studies focused on blepharospasm (BSP) and cervical dystonia (10 and 14, respectively). Most studies reporting cognitive impairment (11 of 17) identified multidomain impairment in cognition. Executive functions were the domain most frequently explored (14 of 22 studies), 79% of which detected worse performance in people with dystonia. Results related to other domains were inconclusive. Cognitive abnormalities were independent of motor symptoms in most studies (7 of 12) that explored this relationship and independent of mood status in all 8 that investigated this. CONCLUSIONS Within IAOD, cognitive dysfunction (in particular, executive dysfunction) has been documented mainly in BSP and cervical dystonia. More comprehensive testing is warranted to assess abnormalities in other domains and in other forms of IAOD, as well as to evaluate longitudinal progression of cognitive disturbances in this condition.
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Affiliation(s)
- Giovanni Defazio
- Department of Translational Biomedicine and Neuroscience, Aldo Moro University of Bari, Bari, Italy
| | | | - Paolo Taurisano
- Department of Translational Biomedicine and Neuroscience, Aldo Moro University of Bari, Bari, Italy
| | | | - Michela Fanzecco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Davide Martino
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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3
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O'Connor S, Hevey D, Burke T, Rafee S, Pender N, O'Keeffe F. A Systematic Review of Cognition in Cervical Dystonia. Neuropsychol Rev 2024; 34:134-154. [PMID: 36696021 PMCID: PMC10920436 DOI: 10.1007/s11065-022-09558-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 04/17/2022] [Accepted: 06/10/2022] [Indexed: 01/26/2023]
Abstract
Growing evidence points to a spectrum of non-motor symptoms, including cognitive difficulties that have a greater impact on functional outcomes and quality of life than motor symptoms in cervical dystonia (CD). Some cognitive impairments have been reported; however, findings are inconsistent, and described across mixed groups of dystonia. The current review aimed to examine the evidence for cognitive impairments in CD. MEDLINE, EMBASE, PsychINFO and Web of Science databases were searched. Studies were included if they met the following criteria (i) cross-sectional or longitudinal studies of adults with CD, (ii) where the results of standardised measures of cognitive or neuropsychological function in any form were assessed and reported, (iii) results compared to a control group or normative data, and (iv) were published in English. Results are presented in a narrative synthesis. Twenty studies were included. Subtle difficulties with general intellectual functioning, processing speed, verbal memory, visual memory, visuospatial function, executive function, and social cognition were identified while language, and attention and working memory appear to be relatively spared. Several methodological limitations were identified that should be considered when interpreting the evidence to describe a specific profile of cognitive impairment in CD. Clinical and research implications are discussed.
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Affiliation(s)
- Sarah O'Connor
- Department of Clinical Psychology, School of Psychology, Aras an Phiarsaigh, Trinity College Dublin, Dublin 2, Dublin, Ireland.
| | - David Hevey
- Department of Clinical Psychology, School of Psychology, Aras an Phiarsaigh, Trinity College Dublin, Dublin 2, Dublin, Ireland
| | - Tom Burke
- Department of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Shameer Rafee
- Department of Neurology, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine & Health Science, University College Dublin, Dublin, Ireland
| | - Niall Pender
- Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fiadhnait O'Keeffe
- Department of Clinical Psychology, School of Psychology, Aras an Phiarsaigh, Trinity College Dublin, Dublin 2, Dublin, Ireland
- Department of Psychology, St Vincent's University Hospital, Dublin, Ireland
- School of Psychology, University College Dublin, Dublin, Ireland
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4
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Rizzo G, Martino D, Avanzino L, Avenanti A, Vicario CM. Social cognition in hyperkinetic movement disorders: a systematic review. Soc Neurosci 2023; 18:331-354. [PMID: 37580305 DOI: 10.1080/17470919.2023.2248687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 07/10/2023] [Accepted: 08/09/2023] [Indexed: 08/16/2023]
Abstract
Numerous lines of research indicate that our social brain involves a network of cortical and subcortical brain regions that are responsible for sensing and controlling body movements. However, it remains unclear whether movement disorders have a systematic impact on social cognition. To address this question, we conducted a systematic review examining the influence of hyperkinetic movement disorders (including Huntington disease, Tourette syndrome, dystonia, and essential tremor) on social cognition. Following the PRISMA guidelines and registering the protocol in the PROSPERO database (CRD42022327459), we analyzed 50 published studies focusing on theory of mind (ToM), social perception, and empathy. The results from these studies provide evidence of impairments in ToM and social perception in all hyperkinetic movement disorders, particularly during the recognition of negative emotions. Additionally, individuals with Huntington's Disease and Tourette syndrome exhibit empathy disorders. These findings support the functional role of subcortical structures (such as the basal ganglia and cerebellum), which are primarily responsible for movement disorders, in deficits related to social cognition.
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Affiliation(s)
- Gaetano Rizzo
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e degli studi culturali, Università di Messina, Messina, Italy
| | - Davide Martino
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Laura Avanzino
- Department of Experimental Medicine, Section of Human Physiology, University of Genoa, Genoa, Italy
| | - Alessio Avenanti
- Centro studi e ricerche in Neuroscienze Cognitive, Dipartimento di Psicologia "Renzo Canestrari", Campus di Cesena, Alma Mater Studiorum Università di Bologna, Cesena, Italy
- Centro de Investigación en Neuropsicología y Neurociencias Cognitivas, Universidad Católica del Maule, Talca, Chile
| | - Carmelo Mario Vicario
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e degli studi culturali, Università di Messina, Messina, Italy
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5
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Mahady L, White J, Rafee S, Yap SM, O'Riordan S, Hutchinson M, Gough P, O'Keeffe F. Social cognition in cervical dystonia. Clin Park Relat Disord 2023; 9:100217. [PMID: 37711968 PMCID: PMC10497798 DOI: 10.1016/j.prdoa.2023.100217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/19/2023] [Accepted: 09/04/2023] [Indexed: 09/16/2023] Open
Abstract
Background Whilst traditionally considered a movement disorder, it is now generally accepted that cervical dystonia (CD) presents with additional non-motor symptoms which significantly impact quality of life. Our study primarily aimed to explore social cognition and levels of psychological distress in individuals with CD, in comparison to age- and sex-matched healthy controls. Methods 20 participants with CD attending a specialist movement disorders clinic were recruited. 20 age and sex matched neurologically healthy controls were recruited in parallel. Participants completed the Hospital Anxiety and Depression Scale, and two novel social cognition tasks: The Cambridge Mindreading Face-Voice Battery (CAFMB) and the Edinburgh Social Cognition Test (ESCoT). Results Participants with CD exhibited poorer complex emotion recognition abilities for visual and auditory stimuli, compared to controls on the CAFMB task. Participants with CD did not differ significantly from controls on performance on cognitive or affective Theory of Mind tasks, or interpersonal or intrapersonal understanding of social norms, as measured by the ESCoT. The proportion of depressive symptoms was significantly higher for participants with CD than controls. 40% of participants with CD reported clinically elevated depressive symptoms, and 60% reported clinically elevated anxiety. Poorer understanding of emotional facial expressions was associated with higher levels of depression in the CD group. Conclusions Significant between-group differences between participants with CD and controls suggests socio-cognitive dysfunction is an important aspect of the non-motor syndrome of CD. Findings highlight the need for assessment of and intervention for both social cognitive difficulties and psychological distress in individuals with CD.
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Affiliation(s)
- Laura Mahady
- School of Psychology, University College Dublin, Belfield, Dublin 4, Ireland
| | - Jessica White
- School of Psychology, University College Dublin, Belfield, Dublin 4, Ireland
| | - Shameer Rafee
- Department of Neurology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Siew-Mei Yap
- Department of Neurology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Sean O'Riordan
- Department of Neurology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Michael Hutchinson
- Department of Neurology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - Patricia Gough
- School of Psychology, University College Dublin, Belfield, Dublin 4, Ireland
| | - Fiadhnait O'Keeffe
- School of Psychology, University College Dublin, Belfield, Dublin 4, Ireland
- Department of Neurology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
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6
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Bailey GA, Martin E, Peall KJ. Cognitive and Neuropsychiatric Impairment in Dystonia. Curr Neurol Neurosci Rep 2022; 22:699-708. [PMID: 36201146 PMCID: PMC9633506 DOI: 10.1007/s11910-022-01233-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW To review recent literature evaluating psychiatric and cognitive symptoms in dystonia, the two non-motor symptom groups most frequently evaluated in dystonia research and recognised in clinical practice. RECENT FINDINGS Recent work has embedded clinical recognition of psychiatric symptoms in dystonia, with depressive and anxiety-related symptoms routinely observed to be the most common. Less explored symptoms, such as self-harm, suicidal ideation, and substance abuse, represent newer areas of investigation, with initial work suggesting higher rates than the background population. Investigation of cognitive function has provided less consistent results, both within individual dystonia subtypes and across the spectrum of dystonias, partly reflecting the heterogeneity in approaches to assessment. However, recent work indicates impairments of higher cognitive function, e.g. social cognition, and disrupted visual and auditory sensory processing. Dystonia demonstrates psychiatric and cognitive symptom heterogeneity, with further work needed to recognise endophenotypes and improve diagnostic accuracy, symptom recognition, and management.
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Affiliation(s)
- Grace A Bailey
- Neuroscience and Mental Health Research Institute, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, UK
| | - Eva Martin
- School of Medicine, Cardiff University, Cardiff, UK
| | - Kathryn J Peall
- Neuroscience and Mental Health Research Institute, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, UK.
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7
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Liu K, Hou Y, Ou R, Yang T, Yang J, Song W, Zhao B, Shang H. Cognitive impairment in Chinese patients with cervical dystonia. Front Neurol 2022; 13:961563. [PMID: 36188384 PMCID: PMC9523424 DOI: 10.3389/fneur.2022.961563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 08/29/2022] [Indexed: 11/21/2022] Open
Abstract
Objective Cognitive impairment (CI) in patients with cervical dystonia (CD) has been reported in many studies but with inconsistent findings. We investigated the prevalence, characteristics, and clinical factors related to CI in Chinese patients with CD. Methods Sixty-eight patients with CD and 68 healthy controls (HCs) were included in the study. Demographic and clinical data were investigated. A logistic regression analysis was conducted to discriminate the clinical factors associated with CI in patients with CD. A cluster analysis was performed to explore the different characteristics within the group of CD patients with CI. Results We found that 42 (61.76%) patients with CD had CI. The most frequent CI domain was visuospatial function (39.71%), followed by memory (38.24%), attention/working memory (29.41%), language (25.00%), and executive function (23.53%). CD patients with CI were older, less educated, had an older age of onset, more severe motor symptoms and disability, and experienced more pain than CD patients without CI. The presence of CI in patients with CD was associated with less education (OR = 0.802, p = 0.034) and a higher Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) severity subscore (OR = 1.305, p = 0.001). The cluster analysis identified two different subgroups of patients, one with relatively mild cognitive impairment and the other with relatively severe cognitive impairment. Conclusion CI is relatively common in Chinese patients with CD, with the most common CI domain of the visuospatial function. In the present study, CI in patients with CD was associated with less education and more severe motor symptoms, and patients with CI may be further divided into two subgroups based on different extent and domain of cognitive decline.
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8
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Aita SL, Del Bene VA, Marotta DA, Pizer JH, Hawley NA, Niccolai L, Walker HC, Gerstenecker A, Martin RC, Clay OJ, Crowe M, Triebel KL, Hill BD. Neuropsychological Functioning in Primary Dystonia: Updated and Expanded Multidomain Meta-Analysis. Mov Disord 2022; 37:1483-1494. [PMID: 35385165 DOI: 10.1002/mds.29022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Primary dystonia is conventionally considered as a motor disorder, though an emerging literature reports associated cognitive dysfunction. OBJECTIVES Here, we conducted meta-analyses on studies comparing clinical measures of cognition in persons with primary dystonia and healthy controls (HCs). METHODS We searched PubMed, Embase, Cochrane Library, Scopus, and PsycINFO (January 2000-October 2020). Analyses were modeled under random effects. We used Hedge's g as a bias-corrected estimate of effect size, where negative values indicate lower performance in dystonia versus controls. Between-study heterogeneity and bias were primarily assessed with Cochran's Q, I2 , and Egger's regression. RESULTS From 866 initial results, 20 studies met criteria for analysis (dystonia n = 739, controls n = 643; 254 effect sizes extracted). Meta-analysis showed a significant combined effect size of primary dystonia across all studies (g = -0.56, P < 0.001), with low heterogeneity (Q = 25.26, P = 0.15, I2 = 24.78). Within-domain effects of primary dystonia were motor speed = -0.84, nonmotor speed = -0.83, global cognition = -0.65, language = -0.54, executive functioning = -0.53, learning/memory = -0.46, visuospatial/construction = -0.44, and simple/complex attention = -0.37 (P-values <0.01). High heterogeneity was observed in the motor/nonmotor speed and learning/memory domains. There was no evidence of publication bias. Moderator analyses were mostly negative but possibly underpowered. Blepharospasm samples showed worse performance than other focal/cervical dystonias. Those with inherited (ie, genetic) disease etiology demonstrated worse performance than acquired. CONCLUSIONS Dystonia patients consistently demonstrated lower performances on neuropsychological tests versus HCs. Effect sizes were generally moderate in strength, clustering around -0.50 SD units. Within the speed domain, results suggested cognitive slowing beyond effects from motor symptoms. Overall, findings indicate dystonia patients experience multidomain cognitive difficulties, as detected by neuropsychological tests. © 2022 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Stephen L Aita
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA.,Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Victor A Del Bene
- Department of Neurology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Dario A Marotta
- Department of Neurology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA.,Alabama College of Osteopathic Medicine, Dothan, Alabama, USA
| | - Jasmin H Pizer
- Department of Psychology, University of South Alabama, Mobile, Alabama, USA
| | - Nanako A Hawley
- Department of Psychology, University of South Alabama, Mobile, Alabama, USA
| | - Lindsay Niccolai
- Supportive Care Medicine, Moffitt Cancer Center, Tampa, Florida, USA
| | - Harrison C Walker
- Department of Neurology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Adam Gerstenecker
- Department of Neurology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Roy C Martin
- Department of Neurology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Olivio J Clay
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Michael Crowe
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kristen L Triebel
- Department of Neurology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Benjamin D Hill
- Department of Psychology, University of South Alabama, Mobile, Alabama, USA
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9
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Beuriat PA, Cohen-Zimerman S, Smith GNL, Krueger F, Gordon B, Grafman J. Evidence of the role of the cerebellum in cognitive theory of mind using voxel-based lesion mapping. Sci Rep 2022; 12:4999. [PMID: 35322157 PMCID: PMC8943209 DOI: 10.1038/s41598-022-09104-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 03/17/2022] [Indexed: 12/11/2022] Open
Abstract
Theory of Mind (ToM) is a social-cognitive skill that allows the understanding of the intentions, beliefs, and desires of others. There is a distinction between affective and cognitive ToM, with evidence showing that these processes rely on partially distinct neural networks. The role of the cerebellum in social cognition has only been rarely explored. In this study, we tested whether the cerebellum is necessary for cognitive and affective ToM performance. We investigated adults with traumatic brain injury (n = 193) and healthy controls (n = 52) using voxel-based lesion-symptom mapping (VLSM) and by measuring the impact on functional connectivity. First, we observed that damage to the cerebellum affected pure Cognitive ToM processing. Further, we found a lateralization effect for the role of the cerebellum in cognitive ToM with participants with left cerebellar injury performing worse than those with right cerebellar injury. Both VLSM and standard statistical analysis provided evidence that left cerebellar Crus I and lobule VI contributed to ToM processing. Lastly, we found that disconnection of the left thalamic projection and the left fronto-striatal fasciculus was associated with poor cognitive ToM performance. Our study is the first to reveal direct causal neuropsychological evidence for a role of the cerebellum in some but not all types of ToM, processing. It reinforces the idea that social cognition relies on a complex network functionally connected through white matter pathways that include the cerebellum. It supports evidence that the neural networks underpinning the different types of ToM can be differentiated.
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Affiliation(s)
- Pierre-Aurélien Beuriat
- Cognitive Neuroscience Laboratory, Brain Injury Research, Shirley Ryan AbilityLab, Chicago, IL, USA. .,Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. .,Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France. .,Rockfeller School of Medicine, Claude Bernard University, Lyon, France.
| | - Shira Cohen-Zimerman
- Cognitive Neuroscience Laboratory, Brain Injury Research, Shirley Ryan AbilityLab, Chicago, IL, USA.,Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Gretchen N L Smith
- Cognitive Neuroscience Laboratory, Brain Injury Research, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Frank Krueger
- School of Systems Biology, George Mason University, Fairfax, VA, USA.,Department of Psychology, University of Mannheim, Mannheim, Germany
| | - Barry Gordon
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, USA
| | - Jordan Grafman
- Cognitive Neuroscience Laboratory, Brain Injury Research, Shirley Ryan AbilityLab, Chicago, IL, USA.,Departments of Neurology, Psychiatry and Cognitive Neurology and Alzheimer's Disease, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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10
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Junker J, Berman BD, Hall J, Wahba DW, Brandt V, Perlmutter JS, Jankovic J, Malaty IA, Wagle Shukla A, Reich SG, Espay AJ, Duque KR, Patel N, Roze E, Vidailhet M, Jinnah HA, Brüggemann N. Quality of life in isolated dystonia: non-motor manifestations matter. J Neurol Neurosurg Psychiatry 2021; 92:jnnp-2020-325193. [PMID: 33563813 PMCID: PMC8356023 DOI: 10.1136/jnnp-2020-325193] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 12/23/2020] [Accepted: 12/29/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To evaluate the relationship between health-related quality of life (HR-QoL) and both physical and psychiatric factors in a large, international, multicentre cohort of patients with isolated dystonia, the Dystonia Coalition. METHODS Natural history data from 603 patients with isolated dystonia (median age 57 years (IQR: 48 to 64 years), 67.0% women) were prospectively acquired and analysed. HR-QoL (RAND 36-Item Health Survey), severity of depressive symptoms, generalised anxiety (Hospital Anxiety and Depression Scale) and social anxiety (Liebowitz Social Anxiety Scale) were assessed. Dystonia severity (Burke-Fahn-Marsden Dystonia Rating Scale) and dystonic tremor were examined. Statistical predictors of HR-QoL were calculated using saturated path analysis. RESULTS Reduced HR-QoL was strongly associated with the degree of depressive symptoms and generalised and social anxiety (8/8 RAND 36 subscales, p≤0.001). Increased dystonia severity was associated with worse physical functioning, physical and emotional role functioning and social functioning (all p≤0.001). The presence of tremor correlated with worse physical functioning and pain (all p≤0.006). Younger age was associated with reduced emotional well-being and vitality (all p≤0.006). There were no HR-QoL differences between sexes. CONCLUSION HR-QoL in isolated dystonia is strongly associated with psychiatric and physical features. While current standard of care focus on motor aspects of dystonia, comprehensive care should address both physical and mental aspects of health.
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Affiliation(s)
- Johanna Junker
- Department of Neurology, University of Luebeck, Luebeck, Germany
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | - Brian D Berman
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
| | - James Hall
- Southampton Education School, University of Southampton, Southampton, UK
| | - Deena W Wahba
- BayCare Laboratories, BayCare Health Systems, Tampa, FL, USA
| | - Valerie Brandt
- School of Psychology, Centre for Innovation in Mental Health, University of Southampton, Southampton, UK
| | - Joel S Perlmutter
- Departments of Neurology, Radiology, Neuroscience, Physical Therapy & Occupational Therapy, Washington University in St. Louis, St. Louis, MO, USA
| | - Joseph Jankovic
- Parkinsons' Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Irene A Malaty
- Department of Neurology, Fixel Institute for Neurologic Disorders, University of Florida, Gainesville, Florida, USA
| | - Aparna Wagle Shukla
- Department of Neurology, Fixel Institute for Neurologic Disorders, University of Florida, Gainesville, Florida, USA
| | - Stephen G Reich
- Department of Neurology, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Alberto J Espay
- Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Kevin R Duque
- Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Neepa Patel
- Department of Neurology, Henry Ford Hospital West Bloomfield, West Bloomfield, MI, USA
| | - Emmanuel Roze
- Departement de Neurologie, AP-HP, Hopital de la Pitie-Salpetriere, Paris, France
- Institut du Cerveau_Paris Brain Institute-ICM, INSERM 1127, CNRS 7225, Sorbonne Universités, Paris, France
| | - Marie Vidailhet
- Departement de Neurologie, AP-HP, Hopital de la Pitie-Salpetriere, Paris, France
- Institut du Cerveau_Paris Brain Institute-ICM, INSERM 1127, CNRS 7225, Sorbonne Universités, Paris, France
| | - H A Jinnah
- Department of Neurology and Human Genetics, Emory University, Atlanta, GA, USA
| | - Norbert Brüggemann
- Department of Neurology, University of Luebeck, Luebeck, Germany
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
- Center of Brain, Behavior and Metabolism, University of Luebeck, Luebeck, Germany
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