Cognitive and Neuropsychiatric Impairment in Dystonia

Abstract

Purpose of review: To review recent literature evaluating psychiatric and cognitive symptoms in dystonia, the two non-motor symptom groups most frequently evaluated in dystonia research and recognised in clinical practice.

Recent findings: Recent work has embedded clinical recognition of psychiatric symptoms in dystonia, with depressive and anxiety-related symptoms routinely observed to be the most common. Less explored symptoms, such as self-harm, suicidal ideation, and substance abuse, represent newer areas of investigation, with initial work suggesting higher rates than the background population. Investigation of cognitive function has provided less consistent results, both within individual dystonia subtypes and across the spectrum of dystonias, partly reflecting the heterogeneity in approaches to assessment. However, recent work indicates impairments of higher cognitive function, e.g. social cognition, and disrupted visual and auditory sensory processing. Dystonia demonstrates psychiatric and cognitive symptom heterogeneity, with further work needed to recognise endophenotypes and improve diagnostic accuracy, symptom recognition, and management.

Keywords: Cognition; Dystonia; Non-motor symptoms; Psychiatric disorders.

Fig. 1

A Number of publications relating to the investigation of non-motor symptoms in dystonia per annum over the past 10 years (2011–2021). B Total number of publications examining each non-motor symptom type (psychiatric symptoms, cognition, sleep, pain, and quality of life (QoL)) over the past 10 year. C Schematic representation of key brain regions involved in the network-based model of dystonia and how the non-motor symptoms observed may map onto these anatomical regions