The impact of non-motor disorders on the quality of life of patients with cervical muscular dystonia

Abstract

Cervical dystonia (CD) has a wide range of non-motor (neuropsychiatric, sensory, dyssomnic) disorders. Relationships between dystonia, nonmotor manifestations of the disease and patients quality of life (QoL) require clarification.Objective: to clarify the impact of dystonia, sensory, affective, behavioral disorders, quality of sleep and wakefulness on the quality of life of patients with CD.Patients and methods. We examined 61 patients with CD (mean age – 48.03±11.49 years, mean duration of CD – 4.89±4.05 years). We used Toronto Western Hospital Spasmodic Torticollis Rating Scale (TWSTRS), Cervical Dystonia Quality of Life Questionnaire (CDQ-24, with five subscales: «stigma», «emotional wellbeing», «pain», «activities of daily living», «social/family life»), Spielberger–Khanin Inventory (STAI),Beck Depression Inventory (BDI), Barratt Behavioral Impulsivity (BIS-11), Yale–Brown Obsessive Compulsive Scale (Y-BOCS), Montreal Cognitive Assessment Scale (MoCA), Stroop Test (VST), 12 Word Memory Test, Pittsburgh Sleep Quality Assessment Scale (PSQI), Epworth Sleepiness Scale (ESS).Results and discussion. There was a deterioration in all characteristics of QoL in patients with CD, largely in emotional well-being, stigmatization, pain syndrome (50% change from the maximum CDQ-24 score). A statistically significant moderate correlation was established between the total assessment of QoL and the severity of dystonia (r=0.35; p<0.01), a statistically significant strong correlation between the total assessment of QoL and depression index (r=0.73; p<0.001 ), moderate strength correlation – with indicators of anxiety (r=0.65; p<0.01), obsessivecompulsive disorders (r=0.61; p<0.01), sleep quality (r=0.52; p<0.001), impulsiveness in behavior (r=0.31; p<0.01), weak relationship with the assessment of executive cognitive functions (according to the Stroop test interference index; r=0.24; p<0.01). A statistically significant moderate correlation was found between the assessments of activity in everyday, social/family life and impulsiveness in behavior (r=0.33; p<0.001); between stigma, emotional well-being and an indicator of executive cognitive functions (r=0.3; p<0.05). There were no statistically significant relationships between indicators of affective, cognitive functions, behavioral disorders and the severity of dystonia. There was a moderate correlation between pain score and dystonia severity (r=0.35; p<0.01).Conclusion. The decrease in QoL in patients with CD is largely due to affective, sensory, and behavioral disorders. Diagnosis and appropriate therapy of the non-motor aspects of the disease are required for adequately improvement of QoL of patients.