Objective: To compare mood symptom rating scales and influence of anxiety and depressive symptoms on motor severity and aspects of quality of life.

Background: Cervical dystonia presents as a motor disorder but shows a high prevalence of anxiety and depression. Psychiatric symptoms have a greater influence on quality of life than the motor  features. The ideal assessment tool for these symptoms is unclear. The influence that mood symptoms play on motor severity and aspects of daily living is unknown.

Method: Patients with adult onset idiopathic cervical dystonia (CD) who had previously been assessed for psychiatric symptoms and impairment in quality of life were included. The Beck Anxiety Inventory (BAI), Beck Depression Index (BDI; using a cut-off score of > 13 for both BDI and BAI), Hospital Anxiety and Depression Scales (HADS-A, HADS-D; using a cut-off score of > 8) were used to assess mood symptoms. Toronto Western Spasmodic Torticollis Rating Scale-2 severity (TWSTRS2-S) score was used for evaluating severity. The Cervical Dystonia Impact Profile 58 (CDIP58) subscales were correlated with mood assessment tools.
Independent samples t test and Pearson’s test were used for group analysis and correlations.

Results: 201 participants were included. Mean age was 61.5 years. 42% of participants had either significant depression/ anxiety symptoms or both when measured by BAI and BDI. 62 patients had a BAI > 13; 74 had BDI > 13.
51% of patients met criteria for significant mood symptoms as measured by the HADS. The HADS-D and HADS-D were poorly correlated with TWSTRS2-S, r= .14 (p= .021) and r= .163 (p= .048) respectively. There was a poor correlation between BAI and BDI and TWSTRS2-S, r= 0.152 (p= .016) and r= 0.124 (p=0.04) respectively. The HADS-A and HADS-D both showed strong correlation with the sleep subdomain of CDIP58 (r= .514 and r= .511 respectively, p<.001). The BAI correlated strongly with CDIP58 total subdomain (r= .532, p < .001).

Conclusion: The HADS-A and HADS-D showed greater sensitivity than BAI and BDI. Patients with significant mood symptoms did not show a difference in TWSTRS2-S scores compared to patients without excess mood symptoms. This would indicate that anxiety and depression are not overtly influencing motor severity. Patients with HADS-A and HADS-D scores > 8, showed strong correlation with the sleep subdomain of CDIP58 (r=.514 and r= .511 respectively, p<.001).

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MDS Abstracts - https://www.mdsabstracts.org/abstract/assessment-of-mood-symptoms-and-influence-on-disease-in-cervical-dystonia/