Social cognition deficits are associated with lower quality of life in cervical dystonia: A single centre study

Background and objectives: Patients with cervical dystonia (CD) demonstrate significant non-motor symptoms including sensory, psychiatric and cognitive features. It has been shown that the non-motor symptoms have a major influence on quality of life. Social cognition, particularly deficits in Theory of Mind (ToM), can affect the development of interpersonal relationships, understanding of social situations and can affect patient outcomes. We used the “Faux Pas” measure of social cognition to assess ToM in patients with CD and compared this with quality of life, disease severity and psychiatric symptoms. Methods: Patients with adult-onset idiopathic isolated cervical dystonia were assessed using the “Faux Pas” questionnaire. Validated questionnaires were used to assess mood symptoms (BAI/BDI and HADS) and quality of life (CDIP-58). Disease-specific disability, motor severity and psychosocial symptoms were measured using TWSTRS2. Faux pas results were compared with published healthy control values. Results: 32 participants (19 female) were included with a mean age of 57.7 years. 20 participants met criteria for excess mood symptoms (anxiety and/or depression). Mean CDIP-58 was 31.9. There was no relationship between faux pas outcomes and motor severity. However, correlation analyses showed that participants who performed worse on the faux pas questionnaire had lower quality of life. Conclusion: The non-motor symptoms, including social cognition, are often neglected. We have demonstrated that low quality of life in CD is associated with to abnormal social cognition. Clinicians should be mindful of these symptoms, particularly in patients reporting low treatment satisfaction.