Abstract
Objective: Essential tremor (ET) is among the most common neurologic diseases. Although in the past it was considered a benign condition, recent research has demonstrated increased risk of mortality. To date, however, no studies have examined predictors of mortality in ET.Methods: In a longitudinal, prospective study of 141 elders with ET, we used Cox proportional-hazards models to estimate hazard ratios (HRs) for death.Results: The mean baseline age was 81.1 ± 8.8 years. During the follow-up interval, 27 (19.1%) died. Average time from baseline to death was 12.3 ± 8.7 months (range = 0.3–31.2). In univariate Cox regression models, older age (HR = 1.16, p < 0.001), lower Montreal Cognitive Assessment score (HR = 0.88, p = 0.004), higher Clinical Dementia Rating (CDR) score (HR = 4.53, p < 0.001), higher score on the Geriatric Depression scale (GDS) (HR = 1.07, p = 0.048), less balance confidence (HR = 0.98, p = 0.006), more falls (HR = 1.11, p = 0.003), and more tandem mis-steps (HR = 1.53, p = 0.004) were associated with increased risk of mortality. In the final multivariate Cox model, older age (HR = 1.14, p = 0.005), higher CDR score (HR = 3.80, p = 0.002) and higher GDS (HR = 1.11, p = 0.01) were independently associated with increased risk of mortality.Conclusions: This study highlights several independent predictors of mortality in elderly ET; clinicians should consider screening for depressive symptoms, assessing cognition and tracking CDR scores, and assessing balance while evaluating patients with ET.
Highlights
Essential tremor (ET) is one of the most common neurological disorders among adults
ET cases were enrolled in an ongoing longitudinal, prospective study of cognitive function in ET (Clinical Pathological Study of Cognitive Impairment in Essential Tremor, NINDS R01NS086736), which started enrolling on a rolling basis in July 2014
In a series of univariate Cox regression models, we entered variables one at a time. These analyses revealed that older age (HR = 1.16, p < 0.001), lower Montreal Cognitive Assessment (MoCA) score (HR = 0.88, p = 0.004), worse cognitive diagnosis, higher Clinical Dementia Rating (CDR) score (HR = 4.53, p < 0.001), more difficulty with memory (HR = 0.52, p = 0.001), more difficulty with executive function
Summary
Essential tremor (ET) is one of the most common neurological disorders among adults. ET has been thought of as a monosymptomatic disorder, characterized by kinetic arm tremor. It has an ∼4% prevalence in adults older than age 40 and the prevalence is even higher among the elderly [1]. Mortality in Essential Tremor additional motor problems (i.e., mild gait ataxia with increased risk for falls in some) and non-motor problems [i.e., mild sleep impairment, depressive symptoms, mild cognitive impairment [MCI], and dementia] [2,3,4,5]. ET is a progressive disease; the tremor gradually worsens with time. This, along with the accumulation of the co-morbidities noted above, result in both a functional decline and increased frailty [6]
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