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Cerebellar dysfunction may affect cognitive and affective processing in CD, mirroring cognitive and affective patterns observed in Cerebellar Cognitive and Affective Syndrome (CCAS). To investigate impairments in cerebellar-dependent cognitive and affective domains in CD patients using the Cerebellar Cognitive and Affective Syndrome scale (CCAS-S), and to analyze the potential relationship between cognitive deficits and clinical features of CD. The CCAS-S was administered to twenty CD patients and twenty controls (HC) matched for age, gender, level of education, and MMSE score. For CD patients, disease severity and disability were evaluated using the Toronto Western Spasmodic Torticollis Rating Scales (TWSTRS), while tremor was assessed through the Fahn-Tolosa\u2010Marin Clinical Rating Scale for Tremor (FTM). CD exhibited a significantly lower total CCAS-S score, and a higher number of failed items compared to HC, with marked deficits in specific sub-items such as fluency, delayed verbal recall, similarities, and affective domain. The total number of failed tests revealed high predictive ability (AUC\u2009=\u20090.90), with no significant correlations between disease duration, clinical outcomes, and CCAS-S performance. The CCAS-S is a sensitive screening tool in differentiating cognitive performance in CD and HC, showing a critical cerebellar involvement in the cognitive and affective symptoms of dystonia.<\/jats:p>","DOI":"10.1007\/s00702-025-03040-9","type":"journal-article","created":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T07:26:49Z","timestamp":1760340409000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Understanding cognitive features of cervical dystonia: application of the cerebellar cognitive affective syndrome scale (CCAS-S)"],"prefix":"10.1007","author":[{"given":"Sara","family":"Terranova","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro","family":"Botta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martina","family":"Putzolu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gaia","family":"Bonassi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Veronica","family":"Romano","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susanna","family":"Mezzarobba","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachele","family":"Simeon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanna","family":"Lagravinese","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Di Biasio","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberta","family":"Marchese","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisa","family":"Pelosin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6286-1509","authenticated-orcid":false,"given":"Laura","family":"Avanzino","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,10,13]]},"reference":[{"key":"3040_CR1","doi-asserted-by":"publisher","DOI":"10.3389\/FNEUR.2022.906293","author":"A Abderrakib","year":"2022","unstructured":"Abderrakib A, Ligot N, Naeije G (2022) Cerebellar cognitive affective syndrome after acute cerebellar stroke. 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Terranova, R.Simeon, S. Mezzarobba, and G. Lagravinese have nothing to declare. A. Botta reports a relationship with EU Joint Programme for Neurodegenerative Disease Research that includes: employment. M. Putzolu reports financial support was provided by Ministry of University and Research (MUR). G. Bonassi reports a relationship with Ministry of University and Research (MUR) that includes: employment. R. Marchese and F. Di Biasio have received speaker honoraria from Zambon and Bial. E. Pelosin is part of an Advisory Board for M.J. Fox Foundation. She has received grants from Italian Ministry of University and Research (PRIN 2022) and Michael J. Fox Foundation (Fall 2022 biomarkers to support therapeutic trials program), and research supports from Italian Ministry of Health (Ricerca Finalizzata 2022 and 5\u2009\u00d7\u20091000). L. Avanzino has received speaker honoraria from Zambon and Bial and received research supports (Grants) from the EU Joint Programme for Neurodegenerative Disease Research (JPND) (2022 call) and Michael J. Fox Foundation (Fall 2022 biomarkers to support therapeutic trials program). She received research support from FRESCO foundation and the Italian Ministry of Health (Ricerca Finalizzata 2022 and 5\u2009\u00d7\u20091000).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"The authors declare no conflicts of interest relevant to this work.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the local ethics committee.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}}]}}