Prevalence of non‐motor symptoms and their association with quality of life in cervical dystonia

• Published in: Acta neurologica Scandinavica Vol. 142; no. 6; pp. 613 - 622
• Main Authors: Han, Vladimir, Skorvanek, Matej, Smit, Marenka, Turcanova Koprusakova, Monika, Hoekstra, Tialda, Dijk, Jitse P., Tijssen, Marina A.J., Gdovinova, Zuzana, Reijneveld, Sijmen A.
• Format: Journal Article
• Language: English
• Published: Denmark Hindawi Limited 01-12-2020; Hindawi Publishing Corporation
• Subjects: Adult; Aged; Anxiety; Anxiety - epidemiology; Apathy; Cross-Sectional Studies; depression; Depression - epidemiology; Dystonia; Dystonic Disorders - complications; Dystonic Disorders - psychology; Emotional behavior; Fatigue; Fatigue - epidemiology; Female; Humans; Male; Mental depression; Middle Aged; Motivation; non‐motor; pain; Pain - epidemiology; Patients; Prevalence; Quality of Life; Sleep; Sleep and wakefulness; Sleep disorders; Sleep Wake Disorders - epidemiology; Slovakia - epidemiology; Torticollis - complications; Torticollis - psychology; Slovakia; non-motor; sleep; anxiety; fatigue; pain; dystonia; depression; apathy
• ISSN: 0001-6314; 1600-0404
• DOI: 10.1111/ane.13304

Objectives
Non‐motor symptoms (NMS) are commonly present along with motor impairment in patients with cervical dystonia (CD) and have a significant impact on health‐related quality of life (HRQoL). However, the prevalence of NMS and their association with dystonia are still unclear. The aim of our study was to assess the prevalence of depression, anxiety, fatigue, apathy, pain, sleep problems, and excessive daytime sleepiness (EDS) in CD using different evaluation approaches and to explore their association with HRQoL relative to that of motor symptoms.
Materials and Methods
We enrolled 102 Slovak patients with CD. The severity of both motor and non‐motor symptoms was assessed using validated scales. HRQoL was determined by the 36‐item Short Form Health Survey (SF‐36). Association of NMS with poor HRQoL was assessed using multiple regressions.
Results
The most frequent NMS in our sample were sleep impairment (67.3%), anxiety (65.5%), general and physical fatigue (57.5% and 52.9%, respectively), depression (47.1%), mental fatigue (31.4%), apathy (30.4%), reduced activity (29.4%), EDS (20.2%), and reduced motivation (18.6%). Univariate analysis showed that NMS, but not motor symptoms, were significantly linked to poor HRQoL, with EDS being most commonly associated with poor HRQoL, followed by disrupted sleep, depression, and fatigue.
Conclusions
The prevalence of NMS among patients with CD is high, and some NMS are strongly associated with poor HRQoL, while motor impairment was not associated with the severity of NMS or poor HRQoL. Actively diagnosing and treating NMS should therefore be a routine part of the clinical management of patients with CD.