Non-motor Symptoms In Essential Tremor Research Articles

REM sleep behavior disorder and Prodromal Parkinson’s Disease in patients with Essential Tremor

Several studies suggested the presence of non-motor symptoms in Essential Tremor (ET), including REM sleep behavioral disorder (RBD). RBD is an essential criterion for Prodromal Parkinson's Disease (PPD), suggesting a link between ET and PD. Our objective was to assess the prevalence and features of ET patients with RBD and PDD.RBD was diagnosed by questionnaire screening, followed by polysomnography. PPD risk factors and prodromic markers were assessed with a structured protocol. Patients were characterized regarding tremor features. ET patients with RBD (ET-RBD) and PPD (ET-PPD) were compared to patients without RBD (ET-nonRBD) and without PPD (ET-nonPPD), respectively. ET-RBD patients were also compared with a group of isolated RBD (iRBD) regarding PPD features.We assessed a total of 64 ET patients. Five (8.3 %) and 4 (6.3 %) had criteria for RBD and PPD, respectively. ET-RBD patients did not differ from ET-nonRBD except for a higher prevalence of PPD. There were no significant differences between ET-RBD and iRBD (n = 12) groups. ET-PPD had a higher prevalence of positive DaT-Scans and RBD compared to ET-nonPPD. Three ET-RBD patients had PPD and 3 ET-PPD had RBD.Both RBD and PPD are more frequent in ET patients than in general aged population but not related with specific tremor features. ET-RBD patients did not differ significantly from iRBD patients, a group prone to develop PD. These data suggest a link between ET and PD and are in accordance with studies showing an increase incidence of lewy-body pathology and PD in ET populations.

Voice Analysis in Patients with Essential Tremor

The objective of this study was to reveal the phonetic characteristics of patients with or without voice tremor in patients with essential tremor (ET), determine whether these phonetic features are ET specific, and test the influence of ET on vocal tremor. The study included a total of 30 patients with ET and 29 healthy volunteers. The severity of ET was evaluated using the Washington Heights Inwood Genetic Study of Essential Tremor (WHIGET) tremor rating scale. Patients with major tremor complaints for at least 3years, WHIGET scoring scores below 15, and patients newly diagnosed in our clinic and for whom drug therapy has not yet been started were selected. A total of 59 participants (n=34 with ET and n=25 as control) were included in the study. The ages of the participants ranged from 20 to 82years, with a mean age of 54.50±15.04years. The gender distribution was 57.6% male and 42.4% female, and there was no statistically significant difference between the two groups in terms of age and gender. The study found that individuals with ET had significantly higher jitter, shimmer, S/Z, Pataka, frequency tremor intensity index, amplitude tremor intensity index, and frequency tremor power index values than the control group. However, there was no statistically significant difference between the two groups in terms of MPT, frequency tremor cyclicality, amplitude tremor cyclicality, frequency tremor frequency, and amplitude tremor frequency values. Our study shows that, even in the absence of essential voice tremor, there is an effect of ET on voice quality. These findings contribute to the understanding of the nonmotor symptoms of ET and may aid in the diagnosis and management of this condition. Further research is needed to explore the potential use of acoustic analysis parameters in the diagnosis and monitoring of ET.

Identifying Depressed Essential Tremor Using Resting-State Voxel-Wise Global Brain Connectivity: A Multivariate Pattern Analysis.

Background and Objective: Although depression is one of the most common non-motor symptoms in essential tremor (ET), its pathogenesis and diagnosis biomarker are still unknown. Recently, machine learning multivariate pattern analysis (MVPA) combined with connectivity mapping of resting-state fMRI has provided a promising way to identify patients with depressed ET at the individual level and help to reveal the brain network pathogenesis of depression in patients with ET.Methods: Based on global brain connectivity (GBC) mapping from 41 depressed ET, 49 non-depressed ET, 45 primary depression, and 43 healthy controls (HCs), multiclass Gaussian process classification (GPC) and binary support vector machine (SVM) algorithms were used to identify patients with depressed ET from non-depressed ET, primary depression, and HCs, and the accuracy and permutation tests were used to assess the classification performance.Results: While the total accuracy (40.45%) of four-class GPC was poor, the four-class GPC could discriminate depressed ET from non-depressed ET, primary depression, and HCs with a sensitivity of 70.73% (P < 0.001). At the same time, the sensitivity of using binary SVM to discriminate depressed ET from non-depressed ET, primary depression, and HCs was 73.17, 80.49, and 75.61%, respectively (P < 0.001). The significant discriminative features were mainly located in cerebellar-motor-prefrontal cortex circuits (P < 0.001), and a further correlation analysis showed that the GBC values of significant discriminative features in the right middle prefrontal gyrus, bilateral cerebellum VI, and Crus 1 were correlated with clinical depression severity in patients with depressed ET.Conclusion: Our findings demonstrated that GBC mapping combined with machine learning MVPA could be used to identify patients with depressed ET, and the GBC changes in cerebellar-prefrontal cortex circuits not only posed as the significant discriminative features but also helped to understand the network pathogenesis underlying depression in patients with ET.

Follow-up evaluation of motor and non-motor symptoms in essential tremor

Essential Tremor (ET) is a common and heterogeneous movement disorder characterized by action tremor of upper limbs and other body parts, as well as non-motor symptoms (e.g., cognitive and psychiatric abnormalities). However, only few studies have attempted to estimate symptoms progression in ET.

Non-motor symptoms in essential tremor, akinetic rigid and tremor-dominant subtypes of Parkinson's disease.

ObjectivesTo compare non-motor symptoms (NMSs) among patients with essential tremor (ET), Parkinson’s disease (PD) subtypes (akinetic-rigid type (ART) and tremor-dominant type (TDT)), and healthy controls.Patients and methodsThis retrospective study included 129 participants, 72 PD (33 PD-ART, 33 PD-TDT, and 6 Mixed), 29 ET patients, and 28 controls. PD patients were assessed by the unified Parkinson’s disease rating scale (UPDRS), Hoehn, and Yahr scale (H&Y), while ET patients were evaluated by the Fahn Tolosa Marin Tremor Rating Scale. All subjects were evaluated by non-motor symptoms scale (NMSS) for NMSs and Beck depression inventory (BDI) for depression.ResultsPD subtypes groups, ET, and controls were age and gender-matched. Compared to controls, all PD, PD subtypes, and ET showed significantly worse most of NMSs (p<0.001) and depression. Compared to ET, all PD and PD-ART had significantly worse gastrointestinal (p = 0.002), urinary symptoms (p = 0.001, p = 0.003) and depression (p = 0.002) and PD-TDT worse depression, while ET patients showed worse memory/attention than PD subtypes. Total NMSS of ET is highly correlated to depression and moderately to tremor severity and age of onset, while total of NMSS is highly correlated to depression, disease severity, and disability.ConclusionThe current study demonstrated several comparable domains of NMSs of PD subtypes and ET, except worse gastrointestinal and urinary symptoms among PD-ART. Identifying different NMSs profiles is important for predicting, better assessing, and tailoring management of ET and PD subtypes.

Auditory and Olfactory Deficits in Essential Tremor – Review of the Current Evidence

Background:Essential tremor (ET) is the most common adult movement disorder, characterized by several motor and increasingly well recognized non-motor symptoms. Sensory deficits, such as hearing impairment and olfactory dysfunction, are amongst them. This review analyzes the available evidence of these sensory deficits and their possible mechanistic basis in patients with ET.Method:A PubMed literature search on the topic was performed in the May 2019 database.Results:Nineteen articles on hearing impairment and olfactory dysfunction in ET patients were identified. The prevalence of hearing impairment is higher in ET patients than healthy controls or Parkinson disease. Cochlear pathologies are suggested as the underlying cause, but there is still a lack of information about retrocochlear pathologies and central auditory processing. Reports on olfactory dysfunction have conflicting results. The presence of mild olfactory dysfunction in ET was suggested. Conflicting results may be due to the lack of consideration of the disease’s heterogeneity, but according to recent data, most studies do not find prominent evidence of olfactory loss in ET.Conclusion:Although there is increasing interest in studies on non-motor symptoms in ET, there are few studies on sensory deficits, which are of particularly high prevalence. More studies are needed on to investigate the basis of non-motor symptoms, including sensory deficits.

Functional disconnection of the dentate nucleus in essential tremor.

Despite previous functional MRI studies on alterations within the cerebello-thalamo-cortical circuit in patients with essential tremor (ET), the specific role of disconnection of the dentate nucleus (DN), the main output cerebellar pathway, still needs clarification. In this study, we evaluated DN functional connectivity (FC) changes and their relationship with motor and non-motor symptoms in ET. We studied 25 ET patients and 26 healthy controls. Tremor severity was assessed using the Fahn-Tolosa-Marin tremor rating scale (FTM-TRS) and tremor amplitude and frequency were evaluated using kinematic techniques. Cognitive profile was assessed by montreal cognitive assessment (MoCA) and frontal assessment battery (FAB). All participants underwent a 3T MRI protocol including resting-state blood oxygenation level dependent and diffusion tensor sequences. We used a seed-based approach to investigate DN FC and to explore the diffusion properties of cerebellar peduncles. There was significantly decreased DN FC with cortical, subcortical, and cerebellar areas in ET patients compared with healthy controls. Correlation analysis showed that: (1) the DN FC with the supplementary motor area, pre and postcentral gyri, and prefrontal cortex negatively correlated with FTM-TRS score and disease duration; (2) DN FC changes in the thalamus and caudate negatively correlated with peak tremor frequency, changes in the cerebellum positively correlated with tremor amplitude, and changes in the bilateral thalamus negatively correlated with tremor amplitude, and (3) DN FC with the associative prefrontal and parietal cortices, basal ganglia, and thalamus positively correlated with the MoCA score. Diffusion abnormalities were found in the three cerebellar peduncles, which did not correlate with clinical scores.

Assessment of Non-Motor Symptoms in Essential Tremor

Assessment of Non-Motor Symptoms in Essential Tremor

Comparison of the Olfactory Bulb Volume and the Olfactory Tract Length Between Patients Diagnosed with Essential Tremor and Healthy Controls: Findings in Favor of Neurodegeneration.

PurposeEssential tremor (ET) is the most common movement disorder. In recent years, an increasing number of studies have shown that this disease also has a variety of non-motor findings and may be of a neurodegenerative nature. This study aimed to evaluate the olfactory bulb volume (OBV) and the olfactory tract length (OTL) and to demonstrate possible neurodegeneration in ET patients using magnetic resonance imaging (MRI).MethodsThe study included 30 ET patients (mean age=29.53±11.82 years) and 30 healthy controls (mean age=30.00±11.68 years). In the cranial MRI examination of both groups, the right, left and total OBV values ​​were measured in mm3 and the right and left OTL values ​​were calculated manually in mm.ResultsThere was no significant difference between the patient and control groups in the measured OBV values, but the OTL value of the patient group was statistically significantly lower than the control group.ConclusionOur study showed that the olfactory system might be involved in ET cases. We think that olfactory dysfunction, one of the non-motor symptoms in ET, can be clearly elucidated through both anatomical and functional studies, to be conducted with larger patient groups.

Analysis on the non-motor symptoms of essential tremor

Objective To explore the the characteristics of non-motor symptoms of essential tremor(ET). Methods Totally 50 ET patients and 45 age-gender-matched healthy volunteers, admitted in Department of Neurology, The Second Affiliated Hospital of Zhejiang University School of Medicine from May 2015 to April 2016, were included.Clinical data and tremor analyses under different postures were obtained.The non-motor symptoms were evaluated using the Pittsburgh Sleep Quality Index(PSQI), Hamilton anxiety scale(HAMA), Hamilton's Depression Scale(HAMD), and the MOS item short from health survey(SF-36). Cognitive functions were evaluated by the Mini-mental state examination(MMSE). Results ET group had lower MMSE total score of(25.81±2.75 vs.28.16±1.71), increased rate of dyssomnia(62.0% vs.15.6%)and higher PQSI score(6.42±2.71 vs.3.84±2.13)compared with the control group(all P<0.05). Moreover, more patients in the ET group had moderate and severe anxiety(60.0% vs.37.8%), moderate and severe depression(34.0% vs.15.6%)than the control group(both P<0.05). Anxiety and depression had effects on physical and mental health and were also related to the quality of life. Conclusions Non-motor symptoms, such as mild cognitive deficits, depression, anxiety and dyssomnia are common in ET patients.Furthermore, depression and anxiety have negative effects on physical and mental health. Key words: Essential tremor; Depression; Anxiety; Cognition disorders; Nonmotor symptoms

Nonmotor Symptoms in Essential Tremor and Other Tremor Disorders.

Tremor, like dystonia, is a term used at the phenomenological, syndromic, and aetiopathological level. Parkinsonian, essential, and dystonic tremor are the three most common tremor diagnoses encountered in clinical practice. Investigation of nonmotor symptoms in essential tremor and dystonic tremor syndromes is significantly hampered by the lack of clear clinical diagnostic criteria for these groups at a syndromic level, and the absence of biomarkers which allow definitive diagnosis at an aetiopathological level. Much work is needed in clarifying the motor features of these disorders in order to allow delineation of the nonmotor features of the most common tremor syndromes. With this limitation in mind, this chapter reviews what is known about nonmotor symptoms in these two tremor types. The final sections deal with nonmotor symptoms observed in patients with lesional tremor, thankfully a much more clearly defined albeit less common group of patients.

Non-Motor Symptoms of Essential Tremor Are Independent of Tremor Severity and Have an Impact on Quality of Life.

BackgroundSeveral publications have focused on accompanying non-motor symptoms (NMS) in essential tremor (ET) patients; however, it remains unclear if NMS are an intrinsic part of the disease or secondary phenomena. We present the results of several neuropsychiatric tests and their impact on quality of life (QoL) in community-dwelling patients with ET.MethodsParticipants were recruited via a newspaper article about ET published in the local media and on the internet. All participants completed several standard neuropsychiatric tests, including those that assess QoL. To compare differences between cases and controls, Student’s t-tests with Bonferroni-Holm post hoc tests were performed. Spearman’s correlation coefficients were also calculated.ResultsWe enrolled 110 patients with definite or probable ET. Highly significant changes were observed for apathy, anxiety, and cognition and negatively impacted QoL. Most aberrations were independent of tremor severity and duration.DiscussionThe significant neuropsychiatric deficits and reduced QoL demonstrate a degree of illness that appears to be a non-motor phenotype rather than a secondary effect of ET. In the future, NMS should carefully be explored in ET patients as they may have an impact on QoL and treatment.

Non-Motor Symptoms of Essential Tremor Are Independent of Tremor Severity and Have an Impact on Quality of Life

<strong>Background:</strong> Several publications have focused on accompanying non-motor symptoms (NMS) in essential tremor (ET) patients; however, it remains unclear if NMS are an intrinsic part of the disease or secondary phenomena. We present the results of several neuropsychiatric tests and their impact on quality of life (QoL) in community-dwelling patients with ET. <strong>Methods:</strong> Participants were recruited via a newspaper article about ET published in the local media and on the internet. All participants completed several standard neuropsychiatric tests, including those that assess QoL. To compare differences between cases and controls, Student’s t-tests with Bonferroni-Holm post hoc tests were performed. Spearman’s correlation coefficients were also calculated. <strong>Results:</strong> We enrolled 110 patients with definite or probable ET. Highly significant changes were observed for apathy, anxiety, and cognition and negatively impacted QoL. Most aberrations were independent of tremor severity and duration. <strong>Discussion:</strong> The significant neuropsychiatric deficits and reduced QoL demonstrate a degree of illness that appears to be a non-motor phenotype rather than a secondary effect of ET. In the future, NMS should carefully be explored in ET patients as they may have an impact on QoL and treatment.

Prevalence and clinical features of non-motor symptoms of essential tremor in Shanghai rural area

ObjectiveFew studies regarding the epidemiology of essential tremor (ET) and its non-motor symptoms (NMS) have been conducted to date. We thus conducted a door-to-door survey to investigate the ET and its NMS and their clinical manifestations in a rural area of Shanghai, China. MethodsWe recruited 19,614 residents (≥50 years old), living in Malu town, Shanghai. Investigations were divided into two steps. In first step, trained physicians conducted door-to-door surveys and reported probable ET subjects to movement disorder specialists. In the second step, participants with suspected ET had their diagnosis confirmed by movement disorder specialists. We randomly selected 123 subjects from those adults who screened negative for neurological conditions as healthy controls for the study of NMS. ResultsThe prevalence of ET in individuals (≥50 years old) was 0.306% (PR = 3.06 per 1000). The mini–mental state examination (MMSE) scores were lower in ET patients than in controls (25.81 ± 4.20 vs. 26.63 ± 3.14, P= 0.024). Complaints of restless legs reported by ET patients were significantly higher than those in controls (P < 0.05). In contrast, we did not observe a significant difference for other NMS between ET patients and controls, including olfactory function (P = 0.82), depression (P = 0.94), and rapid eye movement sleep behavior disorder (RBD) (P = 0.71). ConclusionsThe prevalence of ET in people≥50 years old in a rural area of Shanghai China is low. Prevalence of certain NMSs was higher among participants with ET relative to health controls.

Non-motor symptoms in essential tremor: A review of the current data and state of the field

BackgroundThe motor features of essential tremor (ET) include its hallmark element, kinetic tremor, yet non-motor features are increasingly being recognized as an accompanying part of what was previously viewed as a solely motor disorder. Given the evolving state of the ET field with respect to these non-motor features, the purpose of this manuscript is to critically review the current data. MethodsA PubMed search was conducted on July 1, 2015. The term “essential tremor” was crossed in sequential order with 13 additional search terms (e.g., “cognitive”, “dementia”, “depression”). The total number of unique hits was 322. ResultsNumerous studies seem to substantiate the presence of a range of non-motor features occurring in excess in ET cases compared to age-matched controls. These comprise cognitive features (including a full spectrum from mild cognitive difficulty through to frank dementia), psychiatric (including depression, apathy, anxiety, and personality characteristics), sensory (hearing and possibly olfactory abnormalities), and other non-motor features (e.g., sleep dysregulation). Emerging evidence suggests that some of these features could be primary disease features that pre-date motor features of ET. ConclusionsThe presence of numerous non-motor features in ET is increasingly evident. The biological basis of these features deserves additional study.

Non-motor symptoms of essential tremor are independent of tremor severity and have an impact on quality of life

Non-motor symptoms of essential tremor are independent of tremor severity and have an impact on quality of life

Nonmotor symptoms in essential tremor: Comparison with Parkinson's disease and normal control

BackgroundRecently, 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. MethodsWe 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, the Montgomery–Asberg Depression Rating Scale, Neuropsychiatric Inventory Questionnaire, Beck Anxiety Inventory, the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and the Scales for Outcomes in Parkinson's Disease—Autonomic. ResultsThere were significant differences in the Nonmotor Symptoms Scale total scores of the ET, PD, and control groups (ET: 25.500±2.346; PD: 27.960±3.267; Control: 3.328±3.796.). There were no significant differences in terms of each ET phenotype. ET patients had significant cognitive dysfunction, neuropsychiatric problems including depression and have complained about significant autonomic dysfunction and excessive daytime somnolence compared to normal controls. ConclusionsPatients with ET have several nonmotor symptoms similar to those of patients with PD, which have a similar impact on their quality of life. Therefore, nonmotor symptoms should be considered in the clinical evaluation and management of ET.

Increased Prevalence of Non-motor Symptoms in Essential Tremor

<strong>Background:</strong> Cases with essential tremor (ET) have been described with Lewy body inclusions, the hallmark of Parkinson disease (PD). Patients with PD may suffer from anosmia, depression, constipation, and rapid eye movement sleep behavior disorder (RBD), sometimes years before the appearance of their motor syndrome. The objective of this study was to evaluate the prevalence of these non-motor Parkinson’s associated symptoms in patients with ET. <strong>Methods:</strong> Fifty ET subjects were contacted by phone and given questionnaires evaluating the presence or absence of anosmia, depression, constipation, and RBD. Frequencies of these symptoms were compared with their published prevalence in the general population. <strong>Results:</strong> Of the patients with ET, 4.5% reported having anosmia or hyposmia and 21.7% reported being constipated, similar to what is observed in the general population. Using a screening questionnaire for RBD, 43.5% of ET patients are possibly suffering from RBD, whereas in the general population prevalence is estimated to be 0.5%. Finally, depression was detected in 21.7% of ET patients; in the general population, prevalence is 5%. <strong>Discussion:</strong> Patients with ET seem to have more RBD and more depression than found in the general population. Prospective studies with normal control groups are needed to confirm these findings.

Increased Prevalence of Non-motor Symptoms in Essential Tremor.

BackgroundCases with essential tremor (ET) have been described with Lewy body inclusions, the hallmark of Parkinson disease (PD). Patients with PD may suffer from anosmia, depression, constipation, and rapid eye movement sleep behavior disorder (RBD), sometimes years before the appearance of their motor syndrome. The objective of this study was to evaluate the prevalence of these non-motor Parkinson's associated symptoms in patients with ET.MethodsFifty ET subjects were contacted by phone and given questionnaires evaluating the presence or absence of anosmia, depression, constipation, and RBD. Frequencies of these symptoms were compared with their published prevalence in the general population.ResultsOf the patients with ET, 4.5% reported having anosmia or hyposmia and 21.7% reported being constipated, similar to what is observed in the general population. Using a screening questionnaire for RBD, 43.5% of ET patients are possibly suffering from RBD, whereas in the general population prevalence is estimated to be 0.5%. Finally, depression was detected in 21.7% of ET patients; in the general population, prevalence is 5%.DiscussionPatients with ET seem to have more RBD and more depression than found in the general population. Prospective studies with normal control groups are needed to confirm these findings.

Research progress in non-motor symptoms of essential tremor

Essential tremor (ET), a movement disorder characterized by postural or kinetic tremor as the main clinical manifestations, is one of the most common neurological diseases. Traditional view contends that essential tremor is a benign movement disorder with merely motor symptoms. Recent researches show that patients may have some non-motor symptoms besides motor symptoms. Researches and exploration on its non-motor symptoms provide us with a new perspective for clinical diagnosis, treatment and better understanding of the disease. doi: 10.3969/j.issn.1672-6731.2014.05.016