Abstract
Background: Essential tremor (ET), one of the most common neurological diseases, is associated with cognitive impairment. Surprisingly, predictors of cognitive decline in ET remain largely unidentified, as longitudinal studies are rare. In the general population, however, lower physical activity has been linked to cognitive decline.Objectives: To determine whether baseline physical activity level is a predictor of cognitive decline in ET.Methods: One hundred and twenty-seven ET cases (78.1 ± 9.5 years, range = 55–95), enrolled in a prospective, longitudinal study of cognition. At baseline, each completed the Physical Activity Scale for the Elderly (PASE), a validated, self-rated assessment of physical activity. Cases underwent an extensive battery of motor-free neuropsychological testing at baseline, 1.5 years, and 3 years, which incorporated assessments of cognitive subdomains. Generalized estimating equations (GEEs) were used to assess the predictive utility of baseline physical activity for cognitive change.Results: Mean follow-up was 2.9 ± 0.4 years (range = 1.3–3.5). In cross-sectional analyses using baseline data, lower physical activity was associated with lower overall cognitive function as well as lower cognitive scores in numerous cognitive domains (memory, language, executive function, visuospatial function and attention, all p < 0.05). In adjusted GEE models, lower baseline physical activity level significantly predicted overall cognitive decline over time (p=0.047), and declines in the subdomains of memory (p = 0.001) and executive function (p = 0.03).Conclusions: We identified reduced physical activity as a predictor of greater cognitive decline in ET. The identification of risk factors often assists clinicians in determining which patients are at higher risk of cognitive decline over time. Interventional studies, to determine whether increasing physical activity could modify the risk of developing cognitive decline in ET, may be warranted.
Highlights
Essential tremor (ET) is one of the most common neurological diseases, affecting approximately seven million patients in the US [1]
While the primary motor feature of ET is a kinetic tremor that can interfere with upper limb function [2], ET cases may experience a mild form of gait ataxia that has been associated with loss of confidence in balance and a greater propensity for near-falls and actual falls [3,4,5,6]
In one cross-sectional study of participants with ET, an association was identified between lower levels of physical activity and poorer performance on the Montreal Cognitive Assessment (MOCA), a common measure of global cognition [13]
Summary
Essential tremor (ET) is one of the most common neurological diseases, affecting approximately seven million patients in the US [1]. Lower physical activity has been identified as a longitudinal predictor of conversion to MCI [14] and dementia [15,16,17,18] in the general population. Research in Parkinson’s disease (PD), a related movement disorder, shows that lower physical activity is associated with greater cognitive impairment [19]. Along these lines, a variety of data suggest the neuroprotective capacity of physical activity [20]. Randomized controlled trials have shown that increased physical activity in MCI cases in the general population led to improved cognition, suggesting that the neuroprotective benefits of physical activity extend to those who are most at risk of developing dementia [21]. Lower physical activity has been linked to cognitive decline
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