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Predictors of quality of life in dystonia – a longitudinal study

Predictors of quality of life in dystonia – a longitudinal study
Predictors of quality of life in dystonia – a longitudinal study
Objective: To determine the impact of physical and psychiatric morbidity on health-related quality of life (HR-QoL) in a large, international, multi-centre cohort of isolated dystonia patients over two years.

Background: Depression, generalized anxiety disorder (GAD) and social anxiety disorder (SAD) occur frequently in patients with dystonia [1-6]. HR-QoL not only relates to physical but also psychological aspects of the disorder [1,2]. The aim of this study was to evaluate long-term predictors of HR-QoL in dystonia.

Method: 603 isolated dystonia patients (mean age: 55.6 ± 12.5 years, female n=404) were prospectively enrolled in the Dystonia Coalition study, assessed at baseline and after one and two years. HR-QoL (RAND 36-Item Health Survey), severity of depression and GAD (Hospital Anxiety and Depression Scale), and SAD (Liebowitz Social Anxiety Scale) were evaluated. Dystonia severity and dystonic tremor were examined using a standardized video protocol and the Burke-Fahn-Marsden Dystonia Rating Scale. Predictors of HR-QoL were obtained from eight cross-lagged path models (Bonferroni corrected alpha ≤ 0.006) and a latent class growth analysis (LCGA).

Results: Higher depression scores at baseline predicted lower HR-QoL on all eight subscales after two years (all p ≤ .001). Higher anxiety scores at baseline predicted lower QoL related to general health, pain and emotional well-being, whereas higher social anxiety scores predicted higher pain-related QoL after two years (all p≤ 0.006). Dystonia severity at baseline predicted HR-QoL in the context of social functioning (p = 0.002). The presence of dystonic tremor, age and gender did not predict HR-QoL. LCGA revealed two latent classes, distinguished by the HR-QoL that was reported across the three time points. Class 1 (66%) reported a consistently higher level of HR-QoL that was susceptible to depression and SAD, whereas class 2 (34%) reported a consistently lower level of HR-QoL that was susceptible to GAD. There was no relationship between patients’ reports of quality of life in both classes and dystonia severity, age and gender.

Conclusion: The most potent predictors of HR-QoL in isolated dystonia are depression followed by GAD, whereas dystonia motor severity only predicts social functioning. Dystonia patients with higher levels of anxiety have lower HR-QoL than patients with depression and SAD. To improve long-term HR-QoL in dystonia, depression and anxiety should be specifically targeted.

References: 1. Slawek J, Friedman A, Potulska A, et al. Factors affecting the health-related quality of life of patients with cervical dystonia and the impact of botulinum toxin type A injections. Funct Neurol. 2007;22(2):95-100. 2. Lewis L, Butler A, Jahanshahi M. Depression in focal, segmental and generalized dystonia. J Neurol. 2008;255(11):1750-1755. 3. Gundel H, Wolf A, Xidara V, Busch R, Ceballos-Baumann AO. Social phobia in spasmodic torticollis. J Neurol Neurosurg Psychiatry. 2001;71(4):499-504. 4. Kuyper DJ, Parra V, Aerts S, Okun MS, Kluger BM. Nonmotor manifestations of dystonia: a systematic review. Mov Disord. 2011;26(7):1206-1217. 5. Moraru E, Schnider P, Wimmer A, et al. Relation between depression and anxiety in dystonic patients: implications for clinical management. Depress Anxiety. 2002;16(3):100-103. 6. Fabbrini G, Berardelli I, Moretti G, et al. Psychiatric disorders in adult-onset focal dystonia: a case-control study. Mov Disord. 2010;25(4):459-465.
anxiety, depression, dystonia, clinical features
Junker, J.
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Hall, J.
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Berman, B.
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Vidailhet, M.
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Roze, E.
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Malaty, I.
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Jankovic, J.
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Reich, S.
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Espay, A.
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Patel, N.
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Perlmutter, J.
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Jinnah, H.
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Brandt, V.
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Brueggemann, N.
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Junker, J.
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Hall, J.
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Berman, B.
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Vidailhet, M.
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Roze, E.
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Malaty, I.
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Jankovic, J.
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Reich, S.
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Espay, A.
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Patel, N.
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Perlmutter, J.
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Jinnah, H.
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Brandt, V.
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Brueggemann, N.
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Junker, J., Hall, J., Berman, B., Vidailhet, M., Roze, E., Malaty, I., Jankovic, J., Reich, S., Espay, A., Patel, N., Perlmutter, J., Jinnah, H., Brandt, V. and Brueggemann, N. (2019) Predictors of quality of life in dystonia – a longitudinal study. International Congress of Parkinson's Disease and Movement Disorders 2019, , Nice, France. 22 - 26 Sep 2019.

Record type: Conference or Workshop Item (Paper)

Abstract

Objective: To determine the impact of physical and psychiatric morbidity on health-related quality of life (HR-QoL) in a large, international, multi-centre cohort of isolated dystonia patients over two years.

Background: Depression, generalized anxiety disorder (GAD) and social anxiety disorder (SAD) occur frequently in patients with dystonia [1-6]. HR-QoL not only relates to physical but also psychological aspects of the disorder [1,2]. The aim of this study was to evaluate long-term predictors of HR-QoL in dystonia.

Method: 603 isolated dystonia patients (mean age: 55.6 ± 12.5 years, female n=404) were prospectively enrolled in the Dystonia Coalition study, assessed at baseline and after one and two years. HR-QoL (RAND 36-Item Health Survey), severity of depression and GAD (Hospital Anxiety and Depression Scale), and SAD (Liebowitz Social Anxiety Scale) were evaluated. Dystonia severity and dystonic tremor were examined using a standardized video protocol and the Burke-Fahn-Marsden Dystonia Rating Scale. Predictors of HR-QoL were obtained from eight cross-lagged path models (Bonferroni corrected alpha ≤ 0.006) and a latent class growth analysis (LCGA).

Results: Higher depression scores at baseline predicted lower HR-QoL on all eight subscales after two years (all p ≤ .001). Higher anxiety scores at baseline predicted lower QoL related to general health, pain and emotional well-being, whereas higher social anxiety scores predicted higher pain-related QoL after two years (all p≤ 0.006). Dystonia severity at baseline predicted HR-QoL in the context of social functioning (p = 0.002). The presence of dystonic tremor, age and gender did not predict HR-QoL. LCGA revealed two latent classes, distinguished by the HR-QoL that was reported across the three time points. Class 1 (66%) reported a consistently higher level of HR-QoL that was susceptible to depression and SAD, whereas class 2 (34%) reported a consistently lower level of HR-QoL that was susceptible to GAD. There was no relationship between patients’ reports of quality of life in both classes and dystonia severity, age and gender.

Conclusion: The most potent predictors of HR-QoL in isolated dystonia are depression followed by GAD, whereas dystonia motor severity only predicts social functioning. Dystonia patients with higher levels of anxiety have lower HR-QoL than patients with depression and SAD. To improve long-term HR-QoL in dystonia, depression and anxiety should be specifically targeted.

References: 1. Slawek J, Friedman A, Potulska A, et al. Factors affecting the health-related quality of life of patients with cervical dystonia and the impact of botulinum toxin type A injections. Funct Neurol. 2007;22(2):95-100. 2. Lewis L, Butler A, Jahanshahi M. Depression in focal, segmental and generalized dystonia. J Neurol. 2008;255(11):1750-1755. 3. Gundel H, Wolf A, Xidara V, Busch R, Ceballos-Baumann AO. Social phobia in spasmodic torticollis. J Neurol Neurosurg Psychiatry. 2001;71(4):499-504. 4. Kuyper DJ, Parra V, Aerts S, Okun MS, Kluger BM. Nonmotor manifestations of dystonia: a systematic review. Mov Disord. 2011;26(7):1206-1217. 5. Moraru E, Schnider P, Wimmer A, et al. Relation between depression and anxiety in dystonic patients: implications for clinical management. Depress Anxiety. 2002;16(3):100-103. 6. Fabbrini G, Berardelli I, Moretti G, et al. Psychiatric disorders in adult-onset focal dystonia: a case-control study. Mov Disord. 2010;25(4):459-465.

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More information

e-pub ahead of print date: 22 September 2019
Venue - Dates: International Congress of Parkinson's Disease and Movement Disorders 2019, , Nice, France, 2019-09-22 - 2019-09-26
Keywords: anxiety, depression, dystonia, clinical features

Identifiers

Local EPrints ID: 434728
URI: http://eprints.soton.ac.uk/id/eprint/434728
PURE UUID: b66d1de3-35f8-48da-a485-ee8c81f00c1a
ORCID for J. Hall: ORCID iD orcid.org/0000-0001-8002-0922

Catalogue record

Date deposited: 07 Oct 2019 16:30
Last modified: 13 Dec 2021 03:24

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Contributors

Author: J. Junker
Author: J. Hall ORCID iD
Author: B. Berman
Author: M. Vidailhet
Author: E. Roze
Author: I. Malaty
Author: J. Jankovic
Author: S. Reich
Author: A. Espay
Author: N. Patel
Author: J. Perlmutter
Author: H. Jinnah
Author: V. Brandt
Author: N. Brueggemann

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