The Non-motor Features of Essential Tremor: A Primary Disease Feature or Just a Secondary Phenomenon? (original) (raw)
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Non-motor features of essential tremor, Updated review of evolving aspects
Sohag Medical Journal, 2021
Essential tremor (ET) is defined as an action tremor syndrome with a duration of more than three years in both upper limbs with or without tremor in other areas and with no other neurological signs. ET's non-motor characteristics add to the evidence of clinical variability in ET, a disease with a wide range of pathological and etiological characteristics. Problems in frontal-executive function, comparable to Parkinson's disease (PD), were one of the most common patterns of cognitive affection in ET. ET individuals who started tremor after the age of 65 were 64 to 70% more likely than control subjects to develop dementia, but ET cases who started tremor before the age of 65 have an equal chance to develop dementia as controls. Depression rates were considerably higher in ET than controls and more severe depression is found. A strong evidence linking anxiety and ET. Many studies have documented sleep disturbances in ET.
Arquivos de Neuro-Psiquiatria, 2016
Essential tremor (ET) was long believed to be a monosymptomatic disorder. However, studies have evidenced structural changes and attention is now being focused on non-motor symptoms. The objective of the study is to describe and compare ET patients with control groups according to their cognitive functions, and secondarily, to compare their sociodemographic characteristics and other clinical features. All participants were assessed using the Fahn-Tolosa-Marin Tremor Rating Scale for the severity of tremor; a neuropsychological assessment battery and a screening questionnaire for mood and anxiety symptoms. There were no significant age and gender differences between all groups. As for neuropsychological assessment results, a significant difference was found only in the Pegboard test. We also found a significant negative correlation between a poorer cognitive test results and disease severity and a significant differences regarding depression or anxiety symptoms in patients with ET. T...
Nonmotor symptoms in essential tremor: Comparison with Parkinson's disease and normal control
Journal of the Neurological Sciences, 2015
Background: Recently, the definition of essential tremor (ET) has evolved to have two different meanings. One refers to classic ET, a benign mono-symptomatic disorder, and the other refers to a heterogeneous neurodegenerative disorder. The aim of this study was to categorize nonmotor symptoms according to ET phenotype, and compare them, along with autonomic function, in people with Parkinson's disease (PD) and normal controls. Methods: We divided patients with ET into 3 subtypes according to their motor features: 23 Pure-ET, 25 Cerebellar-ET, and 12 Parkinsonism-ET. Comparisons were made between 30 PD subjects and 22 normal controls, and 60 subjects with ET. The following assessments were conducted: the Nonmotor Symptoms Scale, the Mini-Mental State Exam, Montreal Cognitive Assessment,
Journal of the neurological sciences, 2016
Differential diagnosis of tremor disorders, including essential tremor (ET) and Parkinson's disease-tremor dominant type (PD-TDT), requires further investigation. Therefore, the current study aimed to compare non-motor and tremor features in order to differentiate between ET and PD-TDT. Twenty-eight patients with classic ET and 24 patients with typical PD-TDT were retrospectively enrolled in a multi-stage investigation process. Tremor features including surface electromyogram (EMG) were analyzed in detail. For non-motor symptom analyses, the global cognition test, frontal function test, and non-motor symptoms scale (NMSS) were administered, in addition to collecting patient history data. Patients with PD-TDT presented with more asymmetric tremor, whereas patients with ET presented with more symmetric tremor. Leg tremor was observed only in patients with PD-TDT. Surface EMG analyses of arm tremor demonstrated considerable overlaps in tremor type, tremor frequency, and contractive...
Tremor and other hyperkinetic movements (New York, N.Y.), 2014
It is now reported that non-motor features, cognitive and affective problems, are becoming a major factor in essential tremor (ET). The aim of this study was to investigate the prevalence of cognitive and affective dysfunction in ET and to prospectively follow-up changes in the subjects. Fifty-two persons over the age of 50 years were recruited from the Movement Disorder Clinic. The subjects underwent baseline neurological, cognitive, and mood assessments and repeat assessment 2 years later. The mean age was 68 years, with an average age of ET onset of 55.8 years and with a mean disease duration of 11.7 years. At initial cognitive assessment using various instruments and the Clinical Dementia Rating Scale, 69.2% had mild cognitive impairment (MCI). There were disturbances in phonemic fluency, verbal memory, concentration, and semantic fluency; 25% suffered from anxiety and 17.6% from depression. During the 2 years there was an annual 8.4% conversion rate to dementia, with all conver...
Journal of the American Medical Directors Association, 2009
Objective: Essential tremor (ET) is a neurological disorder that produces motor, cognitive, and functional disability. However, there has been no investigation linking cognitive impairment with functional disability in ET. Therefore, we examine the similarities and differences between ET, Alzheimer's disease (AD), and Parkinson's disease (PD) in terms of the linkage between cognitive and functional impairment. Design: Thirty-four ET, 26 PD, and 31 AD subjects were tested for cognition (Mini-Mental State Examination [MMSE]), motor disability (United Parkinson's Disease Rating Scale part III [UPDRS-III]), and functional disability (Minimum Data Set-Activities of Daily Living Section [MDS-ADL]).
Essential tremor: predictors of disease progression in a clinical cohort
Journal of Neurology, Neurosurgery & Psychiatry, 2006
To examine the utility of baseline factors to predict disease progression among a clinical cohort of patients diagnosed with essential tremor. Measures: Tremor Rating Scale (TRS). Methods: A clinical series of 128 consecutive patients diagnosed with essential tremor was included for study. 45 (35%) patients had at least one follow-up exam (mean = 3.6 years). Baseline predictive factors examined included age, age at onset of symptoms, disease duration, sex, handedness, total tremor rating score, asymmetric tremor ratings, location of initial tremor onset, use of drugs for movement disorders, ETOH responsiveness of tremor, association of head or neck tremor, history of depression, familial history of essential tremor, Parkinson's disease, Alzheimer's disease and other movement disorders. Results: On average, the TRS total score increased by ,1 point per year before the first visit to the clinic and by about 2 points per year during the observed study period. The increase of 2 points per year during the observed study period represented an approximate 12% annual change from the mean TRS total score at the first clinic visit. Significant (p,0.05) predictive factors associated with increased tremor severity at the initial clinic visit included older age, longer disease duration, use of movement disorder drugs and the presence of voice tremor (r = 0.24, 0.27, 0.25, 0.19). The major factors associated with an increase in tremor severity from the initial clinic visit to the last follow up included asymmetrical tremor ratings, unilateral initial tremor onset and longer follow-up duration (r = 0.32, 0.31, 0.30). Multivariate regression analysis accounted for about 17-30% of the variance in tremor ratings (p,0.05). Conclusion: Essential tremor is a slow, progressive disease. The rate of disease progression and the factors associated with disease progression may vary throughout the disease course.
PubMed, 2019
Background: Identifying the clinical phenotypes of non-motor symptoms (NMSs) of essential tremor (ET) among different populations is necessary due to their impact on the quality of life (QoL). This study aimed to investigate the clinical phenotype and impact of NMSs on QoL in Egyptian patients with ET. Methods: Thirty ET patients were compared to 30 matched controls. Subjects were evaluated by the Fahn-Tolosa-Marin Tremor Rating Scale, Non-Motor Symptoms Scale (NMSS), Montreal Cognitive Assessment, Hamilton Anxiety Rating Scale, Beck Depression Inventory, Pittsburgh Sleep quality Index, and the Short Form 36 Health Survey Questionnaire. Both groups were divided into two subgroups of younger (<45 years, 14 patients) and older age (>45 years, 16 patients) groups, to investigate age-related differences. Results: ET patients showed significantly worse cognition, depression, anxiety, sleep and NMSS domains (p < 0.001), compared to controls, that negatively affected and predicted QoL. Older patients had more cognitive impairment (p = 0.003) and worse sleep/fatigue (p = 0.032) and sexual functions (p = 0.006), compared to younger group. Discussion: The study supports that NMSs are integral part of ET, negatively affect QoL, and similarly affect younger and older patients. Therefore, NMSs should be explored for proper care of ET patients.
Knowledge gaps and research recommendations for essential tremor
Parkinsonism & related disorders, 2016
Essential tremor (ET) is a common cause of significant disability, but its etiologies and pathogenesis are poorly understood. Research has been hampered by the variable definition of ET and by non-standardized research approaches. The National Institute of Neurological Disorders and Stroke (USA) invited experts in ET and related fields to discuss current knowledge, controversies, and gaps in our understanding of ET and to develop recommendations for future research. Discussion focused on phenomenology and phenotypes, therapies and clinical trials, pathophysiology, pathology, and genetics. Across all areas, the need for collaborative and coordinated research on a multinational level was expressed. Standardized data collection using common data elements for genetic, clinical, neurophysiological, and pathological studies was recommended. Large cohorts of patients should be studied prospectively to collect bio-samples, characterize the natural history of the clinical syndrome including ...