Reliability of DNMSQuest as a Screening Tool for Mood Disorders in Cervical Dystonia

The high prevalence of mood disorders in cervical dystonia, often unaddressed in botulinum toxin clinics, is a major factor in impaired quality of life. There is a clear need for a brief screening method for identifying these disorders; the Dystonia non-motor symptoms questionnaire (DNMSQuest) has been proposed as such.

We aimed to assess the practical utility of the DNMSQuest and compare it with validated rating scales for anxiety, depression and quality of life.

In 88 patients with cervical dystonia, we compared results from the DNMSQuest with mood rating scales [Beck Anxiety Inventory (BAI), Beck Depression Index (BDI-II) and Hospital Anxiety and Depression Scale (HADS)], quality of life measures [European Quality of Life (EQOL) and European Quality of Life Visual Analogue Scale (EQOLVAS)] and with assessments of dystonia severity [Cervical Dystonia Impact Profile-58 (CDIP58) and Toronto Western Rating Scale for Spasmodic Torticollis (TWSTRS)].

Using a cut off score on the DNMSQuest of 5, we noted that DNMSQuest had a sensitivity of 85% for detecting anxiety and depression using the BAI and BDI-II, and 76% and 78% for anxiety and depression respectively using the HADS. The DNMSQuest correlated strongly with BAI (ρ = 0.715), BDI-II (ρ = 0.658), HADS-Anxiety (ρ = 0.616), HADS-Depression (ρ = 0.706), EQOL (ρ = 0.653) and CDIP-58 (ρ = 0.665).

The DNMSQuest is a brief, sensitive and non-specific instrument for identifying patients that warrant further review for anxiety and depression and can easily be implemented in a neurologist-run botulinum toxin clinic.