Objective: To assess the prevalence of depression and cognitive impairment and their potential risk factors in a group of Romanian patients with isolated focal-onset dystonia (IFD).

Background: The IFDs are a heterogeneous spectrum of movement disorders characterized by intermittent or sustained non-physiological postures. Clinical and epidemiological observations suggest that people with IFD may have higher rates of depression compared with the general population, while the association with cognitive impairment is inconsistently reported. A causal relation with the facial topography was proposed, but available evidence is scarce and conflicting.

Method: We performed a cross-sectional analysis and nested case-control study (IFD with and without depression, matched for age and sex) using the GENDYS database – i.e., an ongoing research project financed by the Romanian Ministry of Research and Innovation (UEFISCDI, PN-III-P4-ID-PCE-2016-0696). For the descriptive statistics we included all patients for whom depression and cognition tests were performed (i.e., PHQ-9 and MoCA). For the depression group we used a PHQ-9 cut-off of at least 10 points. The cut-off was less than 5 for the controls.

Results: The cross-sectional study included 48 patients (11 males and 37 females, median age 58). Of these 20 were eligible for the case-control study (i.e., 2 men and 8 women per group, mean age 51). According to the PHQ-9 scores 46% of the patients had depression, higher prevalence being noted in women (49% versus 36%, p=0.06) and in those with facial IFD (32% versus 19% for blepharospasm, p=0.03). MoCA scores indicating impairment were found in almost half of the patients, with higher prevalence in those older than 65 (53% versus 42%, p=0.1) and those with depression (55% versus 38%, p=0.01). A higher risk for depression was associated with facial IFD (OR=3.5, p=0.18 for all IFDs, and OR=3.85, p=0.26 for blepharosphasm only), worse perceived severity of the disease (OR=9, p=0.05), and concomitant administration of clonazepam and trihexyphenidyl (OR=6, p=0.12).

Conclusion: Depression may have higher prevalence in patients with blepharospasm and other facial IFDs and is associated with the perceived severity of the disease. A negative impact of commonly used drugs for IFD is plausible and should be addressed in future studies.

References: 1. Albanese A, Bhatia K, Bressman SB, Delong MR, Fahn S, Fung VS, Hallett M, Jankovic J, Jinnah HA, Klein C et al: Phenomenology and classification of dystonia: a consensus update. Mov Disord 2013, 28(7):863-873. 2. Albanese A, Di Giovanni M, Lalli S: Dystonia: diagnosis and management. Eur J Neurol 2019, 26(1):5-17. 3. Berman BD, Junker J, Shelton E, Sillau SH, Jinnah HA, Perlmutter JS, Espay AJ, Jankovic J, Vidailhet M, Bonnet C et al: Psychiatric associations of adult-onset focal dystonia phenotypes. J Neurol Neurosurg Psychiatry 2017, 88(7):595-602. 4. Conte A, Defazio G, Hallett M, Fabbrini G, Berardelli A: The role of sensory information in the pathophysiology of focal dystonias. Nat Rev Neurol 2019. 5. Kuyper DJ, Parra V, Aerts S, Okun MS, Kluger BM: Nonmotor manifestations of dystonia: a systematic review. Mov Disord 2011, 26(7):1206-1217. 6. Romano R, Bertolino A, Gigante A, Martino D, Livrea P, Defazio G: Impaired cognitive functions in adult-onset primary cranial cervical dystonia. Parkinsonism Relat Disord 2014, 20(2):162-165. 7. Yang J, Shao N, Song W, Wei Q, Ou R, Wu Y, Shang HF: Nonmotor symptoms in primary adult-onset cervical dystonia and blepharospasm. Brain Behav 2017, 7(2):e00592.

« Back to 2019 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/depression-and-cognitive-impairment-in-isolated-focal-onset-dystonia-prevalence-and-risk-factors-in-a-group-of-romanian-patients/