Validation of a self-completed Dystonia Non-Motor Symptoms Questionnaire.

OBJECTIVE: To develop and validate a novel 14-item self-completed questionnaire (in English and German) enquiring about the presence of non-motor symptoms (NMS) during the past month in patients with craniocervical dystonia in an international multicenter study. METHODS: The Dystonia Non-Motor Symptoms Questionnaire (DNMSQuest) covers seven domains including sleep, autonomic symptoms, fatigue, emotional well-being, stigma, activities of daily living, sensory symptoms. The feasibility and clinimetric attributes were analyzed. RESULTS: Data from 194 patients with CD (65.6% female, mean age 58.96 ± 12.17 years, duration of disease 11.95 ± 9.40 years) and 102 age- and sex-matched healthy controls (66.7% female, mean age 55.67 ± 17.62 years) were collected from centres in Germany and the UK. The median total NMS score in CD patients was 5 (interquartile range 3-7), significantly higher than in healthy controls with 1 (interquartile range 0.75-2.25) (P < 0.001, Mann-Whitney U-test). Evidence for intercorrelation and convergent validity is shown by moderate to high correlations of total DNMSQuest score with motor symptom severity (TWSTRS: rs  = 0.61), clinical global impression (rs  = 0.40), and health-related quality of life measures: CDQ-24 (rs  = 0.74), EQ-5D index (rs  = -0.59), and scale (rs  = -0.49) (all P < 0.001). Data quality and acceptability was very satisfactory. INTERPRETATION: The DNMSQuest, a patient self-completed questionnaire for NMS assessment in CD patients, appears robust, reproducible, and valid in clinical practice showing a tangible impact of NMS on quality of life in CD. As there is no specific, comprehensive, validated tool to assess the burden of NMS in dystonia, the DNMSQuest can bridge this gap and could easily be integrated into clinical practice.

The physical and psychological health benefits of positive emotional writing: Investigating the moderating role of Type D (distressed) personality.

OBJECTIVES: Type D personality is associated with psychological and physical ill-health. However, there has been limited investigation of the role of Type D personality in interventions designed to enhance well-being. This study investigated associations between Type D personality and the efficacy of positive emotional writing for reducing stress, anxiety, and physical symptoms. DESIGN: A between-subjects longitudinal design was employed. METHOD: Participants (N = 71, Mage  = 28.2, SDage  = 12.4) completed self-report measures of Type D personality, physical symptoms, perceived stress, and trait anxiety, before completing either (1) positive emotional writing or (2) a non-emotive control writing task, for 20 min per day over three consecutive days. State anxiety was measured immediately before and after each writing session, and self-report questionnaires were again administered 4 weeks post-writing. RESULTS: Participants in the positive emotional writing condition showed significantly greater reductions in (1) state anxiety and (2) both trait anxiety and perceived stress over the 4-week follow-up period, compared to the control group. While these effects were not moderated by Type D personality, a decrease in trait anxiety was particularly evident in participants who reported both high levels of social inhibition and low negative affectivity. Linguistic analysis of the writing diaries showed that Type D personality was positively associated with swear word use, but not any other linguistic categories. CONCLUSION: These findings support the efficacy of positive emotional writing for alleviating stress and anxiety, but not perceived physical symptoms. Swearing may be a coping strategy employed by high Type D individuals. Statement of contribution What is already known on this subject? Type D (distressed) personality is characterized by high levels of both negative affectivity and social inhibition, and has been associated with adverse physical and psychological health. Positive emotional writing is known to reduce subjectively reported physical symptoms and increase positive affect. What does this study add? Positive emotional writing was shown to attenuate (1) state anxiety immediately post-writing, and (2) trait anxiety and perceived stress 4 weeks post-writing. The findings demonstrate that positive writing might be a useful intervention for attenuating the adverse psychological effects of Type D personality in the general population. Type D personality was associated with more frequent use of swear words, which may be a coping mechanism used by high Type D individuals.

Dietary Variations in a Multiethnic Parkinson's Disease Cohort and Possible Influences on Nonmotor Aspects: A Cross-Sectional Multicentre Study.

Dietary habits may differ between Parkinson's disease (PD) patients of different ethnicities. The primary aim of this cross-sectional analysis was to compare dietary habits in a multiethnic PD population and investigate potential nonmotor differences. All patients completed a dietary habits questionnaire. Besides basic demographics, patients' motor involvement (Hoehn and Yahr (HY)) and nonmotor symptoms (Nonmotor Symptoms Scale; Hospital Anxiety and Depression Scale) were assessed. 139 PD patients were included (mean age 66.8 ± 11.6 years; 61.2% male; mean disease duration 6.2 ± 5.2 years; median HY 3): 47.5% were White, 24.5% Asian, and 28.0% Black African and Caribbean (BAC). We found dietary differences between the groups, including a greater frequency of vegetarians and greater consumption of cumin, turmeric, and cinnamon as well as lower consumption of beef in Asian patients than in White and BAC and greater consumption of chili than in White patients and higher consumption of pork in White than Asian and BAC patients. There were no significant differences in dietary supplement consumption after correction for multiple comparisons. None of the dietary factors examined were associated with differences in nonmotor symptoms. Diet and supplement use vary in PD patients across ethnicities, this is both a problem and opportunity for nutritional medicine research. These data support the importance of considering ethnic diversity as part of recruitment strategy in nutrition and clinical studies.