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Diepman M, Seery C, Rafee S, Somers R, O'Riordan S, Hutchinson M, O'Keeffe F. Social Cognition, Executive Functioning, Mood, and Disability in Cervical Dystonia. Cogn Behav Neurol 2024:00146965-990000000-00074. [PMID: 39091112 DOI: 10.1097/wnn.0000000000000374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 02/16/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Individuals with idiopathic adult-onset isolated cervical dystonia (CD) may have cognitive difficulties and increased mood challenges. Social cognition and executive functioning may be particularly affected. OBJECTIVE To explore social cognition and executive functioning performance in individuals with CD, using the Cambridge Neuropsychological Test Automated Battery (CANTAB), as previous research has used traditional, nondigital neuropsychological assessments. We sought to investigate the relationships between social cognition, executive functioning, mood, and disability in individuals with CD. METHODS We recruited 37 individuals with CD, including 26 women with an age range of 33 to 69 years (M = 56.64, SD = 8.31) from a dystonia clinic in a hospital neurology department. The individuals completed selected tasks from the CANTAB measuring social cognition and executive functioning. We compared the individuals' performance with CANTAB normative data. Depression, anxiety, disease severity, and disability were measured. RESULTS The individuals with CD had significantly lower scores than the CANTAB normative data in both social cognition and executive functioning tasks, with the largest differences evident in problem-solving, attention, and positive emotion bias tasks. Poorer emotion recognition was associated with increased difficulties in problem-solving tasks. The individuals demonstrated a bias toward identifying happiness in facial affect, which was related to a poorer recognition of emotions. Cognitive performance was not related to CD severity or disability or to current mood symptoms. CONCLUSION Difficulties with both social cognition and executive functioning were identified in the individuals with CD, and are likely important targets for clinical interventions.
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Affiliation(s)
- Madeleine Diepman
- The Department of Neurology, St Vincent's University Hospital, Dublin, Ireland
- The Department of Psychology, University College Dublin, Dublin, Ireland
| | - Christina Seery
- The Department of Neurology, St Vincent's University Hospital, Dublin, Ireland
- The Department of Psychology, University College Dublin, Dublin, Ireland
| | - Shameer Rafee
- The Department of Neurology, St Vincent's University Hospital, Dublin, Ireland
- The School of Medicine & Health Science, University College Dublin, Dublin, Ireland
| | - Rachel Somers
- The Department of Neurology, St Vincent's University Hospital, Dublin, Ireland
- The Department of Psychology, University College Dublin, Dublin, Ireland
| | - Séan O'Riordan
- The Department of Neurology, St Vincent's University Hospital, Dublin, Ireland
- The School of Medicine & Health Science, University College Dublin, Dublin, Ireland
| | - Michael Hutchinson
- The Department of Neurology, St Vincent's University Hospital, Dublin, Ireland
- The School of Medicine & Health Science, University College Dublin, Dublin, Ireland
| | - Fiadhnait O'Keeffe
- The Department of Neurology, St Vincent's University Hospital, Dublin, Ireland
- The Department of Psychology, University College Dublin, Dublin, Ireland
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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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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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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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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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Rafee S, Diepman M, McCormack D, Monaghan R, Fearon C, Hutchinson M, O'Keeffe F. A comprehensive cognitive analysis of cervical dystonia: A single centre study. Clin Park Relat Disord 2023; 9:100226. [PMID: 37881640 PMCID: PMC10594573 DOI: 10.1016/j.prdoa.2023.100226] [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: 06/26/2023] [Revised: 09/06/2023] [Accepted: 10/16/2023] [Indexed: 10/27/2023] Open
Abstract
Introduction Cervical dystonia (CD) presents as a motor disorder but has a number of non-motor features. Studies have demonstrated diverse changes in cognition in patients with CD. The rarity of this disorder, phenotypic heterogeneity, and, in particular, a lack of consistency in cognitive testing measures limits clear definition of cognitive changes in this disorder. The relationship between cognition, motor symptoms and quality of life has not been well defined. We undertook a comprehensive analysis of cognition in CD. Methods Patients with adult onset idiopathic isolated CD (AOICD) who had completed a battery of cognitive assessments- general intellectual functioning, verbal and visual memory, executive functions and social cognition measures, were included. Participants were assessed for mood symptoms, motor severity and quality of life. Results 13 patients (8 women) with AOICD were included covering 40 cognitive subtests. Mean age was 59.9 years and mean TWSTRS-2 severity was 11. Mean estimated premorbid function was in the normal range. Overall performance on most measures were within normal limits. The lowest mean z-score was observed in Florida Affect Battery (social cognition) subtests, z = -1.75 and -0.81. and in verbal recall, z = -0.82. The majority of patients (75%) scored below population mean on spatial working memory and (62%) performed below population mean on word retrieval and working memory. Conclusion We provide detailed cognitive results across a wide range of measures. Although patients tended towards average outcomes on the majority of tests, poorer performance than expected averages were noted in measures of social cognition, word retrieval, spatial working memory and, processing speed.
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Affiliation(s)
- Shameer Rafee
- Department of Neurology, St Vincent’s University Hospital, Ireland
- School of Medicine and Medical Sciences, University College Dublin, Ireland
| | | | - Derval McCormack
- Department of Psychology, St Vincent’s University Hospital, Ireland
| | - Ruth Monaghan
- Department of Psychology, St Vincent’s University Hospital, Ireland
| | - Conor Fearon
- Department of Neurology, St Vincent’s University Hospital, Ireland
- School of Medicine and Medical Sciences, University College Dublin, Ireland
| | - Michael Hutchinson
- Department of Neurology, St Vincent’s University Hospital, Ireland
- School of Medicine and Medical Sciences, University College Dublin, Ireland
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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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Hobby J, Ring D, Larson D. The mind and the hand. J Hand Surg Eur Vol 2023; 48:269-275. [PMID: 36638068 DOI: 10.1177/17531934221143502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Symptoms are determined in large part by mindsets. Feelings of distress and unhelpful thoughts (misinterpretations) of symptoms account for much of the variability in comfort and capability with the severity of the underlying pathophysiology making a more limited contribution. Incorporating this experimental evidence into the daily practice of hand surgery will help us find ways to develop healthy mindsets, to prioritize the alleviation of distress and the gentle redirection of unhelpful thoughts, to avoid unnecessary surgery, and to provide better psychological and social support for people recovering from injury and surgery.
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Affiliation(s)
- Jonathan Hobby
- Department of Trauma and Orthopaedics, North Hampshire Hospital, Basingstoke, UK
| | - David Ring
- University of Texas at Austin Dell Medical School, Austin, TX, USA
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Rafee S, Hutchinson M, Reilly R. The Collicular-Pulvinar-Amygdala Axis and Adult-Onset Idiopathic Focal Dystonias. ADVANCES IN NEUROBIOLOGY 2023; 31:195-210. [PMID: 37338703 DOI: 10.1007/978-3-031-26220-3_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Adult-onset idiopathic focal dystonias (AOIFD) are the most common type of dystonia. It has varied expression including multiple motor (depending on body part affected) and non-motor symptoms (psychiatric, cognitive and sensory). The motor symptoms are usually the main reason for presentation and are most often treated with botulinum toxin. However, non-motor symptoms are the main predictors of quality of life and should be addressed appropriately, as well as treating the motor disorder. Rather than considering AOIFD as a movement disorder, a syndromic approach should be taken, one that accommodates all the symptoms. Dysfunction of the collicular-pulvinar-amygdala axis, with the superior colliculus as a central node, can explain the diverse expression of this syndrome.
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Affiliation(s)
- Shameer Rafee
- Department of Neurology, St Vincent's University Hospital, Dublin, Ireland
| | - Michael Hutchinson
- Department of Neurology, St Vincent's University Hospital, Dublin, Ireland
| | - Richard Reilly
- Trinity Centre for Biomedical Engineering, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland.
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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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Xia K, Han Y, Zhou L, Hu S, Rao R, Shan S, Hua L. Attention impairment in patients with cervical dystonia: An attention network test study. Front Psychol 2022; 13:952567. [PMID: 35992456 PMCID: PMC9386253 DOI: 10.3389/fpsyg.2022.952567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/04/2022] [Indexed: 11/24/2022] Open
Abstract
Objective The purpose of this study was to investigate attentional network functional characteristics in patients with cervical dystonia (CD). Methods A total of 29 patients with CD and 26 healthy controls (HCs) were recruited. All subjects participated in the study and underwent the Attention Network Test (ANT), which evaluated the efficiencies of three independent attention networks (alerting, orienting, and executive control), as well as reaction time (RT) and accuracy. Results Significant differences between CD patients (9.86 ± 27.95 ms) and HCs (33.62 ± 23.41 ms) were observed in the alerting network (t = −3.40, p < 0.05). In contrast, the orienting network (t = 0.26, p = 0.79), executive control network (Z = −0.55, p = 0.58), total mean reaction time (t = −2.6, p = 0.79), and total accuracy rate (Z = −1.67, p = 0.09) showed no significant differences between the two groups. Conclusion Patients with CD showed a significant deficit in the alerting network. However, they did not show any deficits in the orienting or executive control network. In addition, the alerting, orienting, and executive control network functions of CD patients were all affected by the severity of torticollis, especially the alerting network function.
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Affiliation(s)
- Kun Xia
- Institute of Neurology, Anhui University of Chinese Medicine, Hefei, China
| | - Yongsheng Han
- Institute of Neurology, Anhui University of Chinese Medicine, Hefei, China
- Department of Neurology, Anhui Hospital of Integrated Traditional Chinese and Western Medicine, Hefei, China
- *Correspondence: Yongsheng Han,
| | - Lanlan Zhou
- Department of Neurology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Sheng Hu
- School of Medical Information Engineering, Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Rao Rao
- Institute of Neurology, Anhui University of Chinese Medicine, Hefei, China
| | - Shu Shan
- Institute of Neurology, Anhui University of Chinese Medicine, Hefei, China
| | - Lei Hua
- Institute of Neurology, Anhui University of Chinese Medicine, Hefei, China
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Rafee S, Ndukwe I, O'Riordan S, Hutchinson M. Reliability of DNMSQuest as a Screening Tool for Mood Disorders in Cervical Dystonia. Mov Disord Clin Pract 2021; 8:925-931. [PMID: 34405100 DOI: 10.1002/mdc3.13273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/25/2021] [Accepted: 06/19/2021] [Indexed: 11/06/2022] Open
Abstract
Background The high prevalence of mood disorders in cervical dystonia, often unaddressed in botulinum toxin clinics, is a major factor in impaired quality of life. There is a clear need for a brief screening method for identifying these disorders; the Dystonia non-motor symptoms questionnaire (DNMSQuest) has been proposed as such. Objective We aimed to assess the practical utility of the DNMSQuest and compare it with validated rating scales for anxiety, depression and quality of life. Methods In 88 patients with cervical dystonia, we compared results from the DNMSQuest with mood rating scales [Beck Anxiety Inventory (BAI), Beck Depression Index (BDI-II) and Hospital Anxiety and Depression Scale (HADS)], quality of life measures [European Quality of Life (EQOL) and European Quality of Life Visual Analogue Scale (EQOLVAS)] and with assessments of dystonia severity [Cervical Dystonia Impact Profile-58 (CDIP58) and Toronto Western Rating Scale for Spasmodic Torticollis (TWSTRS)]. Results Using a cut off score on the DNMSQuest of 5, we noted that DNMSQuest had a sensitivity of 85% for detecting anxiety and depression using the BAI and BDI-II, and 76% and 78% for anxiety and depression respectively using the HADS. The DNMSQuest correlated strongly with BAI (ρ = 0.715), BDI-II (ρ = 0.658), HADS-Anxiety (ρ = 0.616), HADS-Depression (ρ = 0.706), EQOL (ρ = 0.653) and CDIP-58 (ρ = 0.665). Conclusion The DNMSQuest is a brief, sensitive and non-specific instrument for identifying patients that warrant further review for anxiety and depression and can easily be implemented in a neurologist-run botulinum toxin clinic.
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Affiliation(s)
- Shameer Rafee
- Department of Neurology St Vincent's University Hospital Dublin Ireland
| | - Ihedinachi Ndukwe
- Department of Neurology St Vincent's University Hospital Dublin Ireland
| | - Sean O'Riordan
- Department of Neurology St Vincent's University Hospital Dublin Ireland
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Smit M, Albanese A, Benson M, Edwards MJ, Graessner H, Hutchinson M, Jech R, Krauss JK, Morgante F, Pérez Dueñas B, Reilly RB, Tinazzi M, Contarino MF, Tijssen MAJ. Dystonia Management: What to Expect From the Future? The Perspectives of Patients and Clinicians Within DystoniaNet Europe. Front Neurol 2021; 12:646841. [PMID: 34149592 PMCID: PMC8211212 DOI: 10.3389/fneur.2021.646841] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/19/2021] [Indexed: 01/02/2023] Open
Abstract
Improved care for people with dystonia presents a number of challenges. Major gaps in knowledge exist with regard to how to optimize the diagnostic process, how to leverage discoveries in pathophysiology into biomarkers, and how to develop an evidence base for current and novel treatments. These challenges are made greater by the realization of the wide spectrum of symptoms and difficulties faced by people with dystonia, which go well-beyond motor symptoms. A network of clinicians, scientists, and patients could provide resources to facilitate information exchange at different levels, share mutual experiences, and support each other's innovative projects. In the past, collaborative initiatives have been launched, including the American Dystonia Coalition, the European Cooperation in Science and Technology (COST-which however only existed for a limited time), and the Dutch DystonieNet project. The European Reference Network on Rare Neurological Diseases includes dystonia among other rare conditions affecting the central nervous system in a dedicated stream. Currently, we aim to broaden the scope of these initiatives to a comprehensive European level by further expanding the DystoniaNet network, in close collaboration with the ERN-RND. In line with the ERN-RND, the mission of DystoniaNet Europe is to improve care and quality of life for people with dystonia by, among other endeavors, facilitating access to specialized care, overcoming the disparity in education of medical professionals, and serving as a solid platform to foster international clinical and research collaborations. In this review, both professionals within the dystonia field and patients and caregivers representing Dystonia Europe highlight important unsolved issues and promising new strategies and the role that a European network can play in activating them.
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Affiliation(s)
- Marenka Smit
- Expertise Centre Movement Disorders Groningen, Department of Neurology, University Medical Centre Groningen, Groningen, Netherlands
| | - Alberto Albanese
- Department of Neurology, Istituto di Ricovero e Cura a Carattere Scientifico Humanitas Research Hospital, Milan, Italy
| | | | - Mark J. Edwards
- Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University of London, London, United Kingdom
| | - Holm Graessner
- Institute of Medical Genetics and Applied Genomics and Centre for Rare Diseases, University of Tübingen, Tübingen, Germany
| | - Michael Hutchinson
- Department of Neurology, St. Vincent's University Hospital, Dublin, Ireland
| | - Robert Jech
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University, Prague, Czechia
| | - Joachim K. Krauss
- Department of Neurosurgery, Medizinische Hochschule Hannover, Hanover, Germany
| | - Francesca Morgante
- Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University of London, London, United Kingdom
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Belen Pérez Dueñas
- Pediatric Neurology Research Group, Hospital Vall d'Hebron–Institut de Recerca (VHIR), Barcelona, Spain
| | - Richard B. Reilly
- School of Medicine, Trinity College, The University of Dublin, Dublin, Ireland
| | - Michele Tinazzi
- Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - Maria Fiorella Contarino
- Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands
- Department of Neurology, Haga Teaching Hospital, The Hague, Netherlands
| | - Marina A. J. Tijssen
- Expertise Centre Movement Disorders Groningen, Department of Neurology, University Medical Centre Groningen, Groningen, Netherlands
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Rafee S, O'Keeffe F, O'Riordan S, Reilly R, Hutchinson M. Adult onset dystonia: A disorder of the collicular-pulvinar-amygdala network. Cortex 2021; 143:282-289. [PMID: 34148640 DOI: 10.1016/j.cortex.2021.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/10/2021] [Accepted: 05/21/2021] [Indexed: 11/30/2022]
Abstract
Models attempting to explain the pathogenesis of adult onset idiopathic focal dystonia often fail to accommodate the entire spectrum of this disorder: the diverse motor and non-motor symptoms, psychiatric and cognitive dysfunction, as well as the sub-clinical, physiological and anatomical, abnormalities. We propose, and present the accumulating evidence, that the adult onset dystonia syndrome is due to disruption in the covert-attentional network, the unconscious sub-cortical mechanism for the detection of potentially environmentally threatening (salient) stimuli, involving the collicular-pulvinar-amygdala network. A critical consideration of this network indicates a number of hypothesis-generated research questions aimed at elucidating the pathogenesis of adult onset dystonia. Given the rarity of adult onset dystonia, international, multidisciplinary, multicentre studies are required to elucidate the prevalence of non-motor symptoms in unaffected relatives, in particular, using temporal discrimination. Research focussing on the non-motor symptoms and the collicular-pulvinar-amygdala pathway may be the key to understanding adult-onset idiopathic focal dystonias (AOIFD) pathophysiology.
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Affiliation(s)
- Shameer Rafee
- Department of Neurology, St Vincent's University Hospital, Dublin, Ireland.
| | - Fiadhnait O'Keeffe
- Department of Psychology, St Vincent's University Hospital, Dublin, Ireland
| | - Sean O'Riordan
- Department of Neurology, St Vincent's University Hospital, Dublin, Ireland
| | - Richard Reilly
- Trinity Centre for Bio-engineering, Trinity College Dublin, Dublin, Ireland
| | - Michael Hutchinson
- Department of Neurology, St Vincent's University Hospital, Dublin, Ireland
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Monaghan R, Cogley C, Burke T, McCormack D, O'Riordan S, Ndukwe I, Hutchinson M, Pender N, O'Keeffe F. Non-motor features of cervical dystonia: Cognition, social cognition, psychological distress and quality of life. Clin Park Relat Disord 2020; 4:100084. [PMID: 34316662 PMCID: PMC8299967 DOI: 10.1016/j.prdoa.2020.100084] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/29/2020] [Accepted: 11/26/2020] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Non-motor features of cervical dystonia (CD) have been identified, including depression, anxiety, and neuropsychological deficits. The aims were: to provide a clinical neuropsychological profile of CD patients with specific focus on social cognition; assess levels of psychological distress; and investigate the relationship between non-motor features of CD, including cognitive functioning, psychological distress, CD severity, pain, and health-related quality of life (HR-QoL). METHODS A multi-domain neuropsychological assessment battery was administered to 46 participants with CD, examining cognitive and social cognitive domains. Clinical data on dystonia severity, pain, psychological distress and HR-QoL were collected. RESULTS The majority of participants with CD performed within the average range across most tests of cognition. Scores were significantly lower than standardized norms in social cognition, processing speed, and aspects of memory. High levels of anxiety (Hospital Anxiety and Depression Scale [HADS-A] ≥ 11, 30%) and depression (HADS-D ≥ 11; 29%) were observed. Psychological distress, CD severity, pain and HR-QoL were not significantly associated with neuropsychological functioning after controlling for multiple comparisons. Low HR-QoL was associated with higher levels of pain and psychological distress, but not severity of motor symptoms. CONCLUSION Results indicate that psychological distress and deficits in cognitive and social cognitive functioning are likely distinct features of CD. While motor symptoms do not appear to impact HR-QoL, pain and psychological distress were associated with low HR-QoL. Findings highlight the importance of addressing non-motor symptoms in the treatment of CD.
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Affiliation(s)
| | - Clodagh Cogley
- St Vincent’s University Hospital, Dublin, Ireland
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Tom Burke
- Department of Psychology, Beaumont Hospital, Dublin 9, Ireland
- Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Sean O'Riordan
- St Vincent’s University Hospital, Dublin, Ireland
- School of Medicine & Health Science, University College Dublin, Dublin, Ireland
| | - Ihedinachi Ndukwe
- St Vincent’s University Hospital, Dublin, Ireland
- School of Medicine & Health Science, University College Dublin, Dublin, Ireland
| | - Michael Hutchinson
- St Vincent’s University Hospital, Dublin, Ireland
- School of Medicine & Health Science, University College Dublin, Dublin, Ireland
| | - Niall Pender
- Department of Psychology, Beaumont Hospital, Dublin 9, Ireland
- Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fiadhnait O'Keeffe
- St Vincent’s University Hospital, Dublin, Ireland
- School of Psychology, University College Dublin, Dublin, Ireland
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