Senile Tremor Research Articles

Machine Learning Techniques for Automated Tremor Detection in the Presence of External Stressors

In this study tremor data of 25 subjects (Senile tremor = 5, Alcohol induced tremor = 9, Healthy individuals = 11) were collected using a wearable device consisting of five Inertial Measuring Units (IMUs) and an embedded optical sensor. The subjects were made to draw the Archimedes spiral under the influence of external stressors. Features were extracted from measured acceleration data and also from an optical sensor. Using the selected features few supervised machined learning algorithms were explored for automatic classification of tremor. Performance matrix used to evaluate the classifier was accuracy, recall, and precision. It is observed that the algorithms are able to accurately classify healthy, senile tremor and alcohol induced tremor.

Finding New Ways To Treat Tremors.

An estimated ten million people in the United States have a condition known as essential tremor (ET). Yet although it's been recognized for over a century-it was originally known as senile tremor-there is relatively little awareness of it as a distinct medical condition. Sometimes mistaken for Parkinson's disease, ET can lead to shaking of the arms and hands, and sometimes the head or torso. When severe, it can interfere with eating or drinking, writing, dressing, and even make some tasks impossible. Now, new approaches for treating the condition are emerging, potentially offering options to many patients whose life activities have been curtailed by ET.

Brain Vascular Damage in Essential Tremor: Observational Study and Statistical Analysis in An Affected Population Compared with A Group with Parkinsons Disease and A Control Group

Previous studies of the Author pointed out that the incidence of vascular brain disease (cerebrovascular disease, CVD) in several expression modalities was statistically significant and relevant in Parkinson′s Disease (PD); subsequently the Author investigated the incidence of CVD in an extrapyramidal disease frequently detected in clinical practice and involved in the differential diagnostics within movement disorders, that is Essential Tremor (ET). The statistical chi-square calculator test for association between two categorical variables was applied in a first step between a population of 60 patients (2 patients without information on CVD were not included in the statistics) with ET and a control population (patients suffering from various central nervous system diseases excluding PD and ET but including the so-called Vascular Parkinsonism –VP-) of 145 subjects (16 patients without information on CVD were not included in the statistics). The result was negative (p-value is 0.696914. This result is not significant at p<0.01). In a second step a statistical comparison was performed between the same group of 60 patients with ET and the group of 85 patients with PD (1 patients without information on CVD was not included in the statistics) obtaining a highly significant result (the p-value is 0.000003. This result is significant at p<0.01). The statistical analysis concerns the presence or not of morphologically imaging signs of CVD (TC and RM Scan) in the two groups. These results demonstrate that while there is a correlation in the incidence of CVD and PD according with previous observations (actual p-value is 0.000001. This result is significant at p<0.01), the same correlation does not occur with the ET. The incidence of CVD in the ET has a random feature comparable to the randomness of the general population. Therefore it is hypothesized that the CVD in the ET is a pure comorbidity without pathogenetic value - even if apparently in contrast with what assumed in the classifications defining the atherosclerotic senile tremor as a variant of the same ET - according with hypothesized different neurotransmitter networks (dopaminergic vs supposed GABAergic). We can also speculate that the different therapeutic approach may depend on the different pathogenesis of the two pathologies (ET and PD). Further investigations result of particular interest also considering the fact often observed in clinical practice that the ET can over time evolve into PD or that in same cases there is an overlapping between PD and ET mainly in the in the tremorigen symptom.

Differentiating tremor patients using spiral analyses.

Essential tremor follows an autosomal dominant type of inheritance in the majority of patients, yet its genetic basis has not been identified. The age of onset in this tremor is bimodal, one in young age and another when they are old. The old onset is referred to as senile tremor in this study. The precise pathology is still not completely understood for both these tremors. We wanted to develop an easy diagnostic tool to differentiate these two tremors clinically. In this study, the spirals were asked to be drawn by 30 patients, 15 from each group. The spirals were recorded digitally from each hand, with and without the spiral template, using a Wacom intuos version 4 tablets. The aim of the study was to look at the easy diagnostic measures from these spirals to distinguish the two cohorts of patients. The first measure was to use the well-known clinical scores like the number of complete circles without the template, width, height, axis, and degree of severity. The second measure was to estimate the peak frequency and the peak amplitude for the position, velocity, and acceleration data, in the frequency domain. The well-known clinical scores, most of them, did not show any significant difference between the two patient cohorts except the degree of severity which showed significant difference. The peak frequency and the peak amplitude in most of the data were not significantly different between the two cohorts of patients, only the peak amplitude from the acceleration data showed significant difference. Thus, we could use these two parameters to differentiate between the two tremors patient groups, which would be an easy clinical diagnostic tool without the need for any complicated analyses.

Parkinson's disease without nigral degeneration: a pathological correlate of scans without evidence of dopaminergic deficit (SWEDD)?

ObjectiveTo describe 5 cases of Parkinson's disease lacking any detectable histopathology.BackgroundThe diagnosis of Parkinson's disease is supported histologically by the findings of α-synuclein immunopositive Lewy bodies and neurites and severe...

Editorial comment: is essential tremor a neurodegenerative disease?

The question of whether essential tremor (ET) is a neurodegenerative disease or not has been a focus of recent interest, and the two opposing views are very well expressed by the two opponents, Ubaldo Bonuccelli and Monica Kurtis, who presented their cases during a recent CONy Congress and have now written their arguments here. Both authors base their conclusions on overlapping studies. If so, why is there still a disagreement? The first issue raised is the spectrum of ET, which includes more than kinetic tremor in many cases. However, this is not a major issue. Amyotrophic lateral sclerosis has been considered a neurodegenerative disease for decades, assuming that it affects only the motor neurons. The recent identification of additional features, such as genetic heterogeneity and autonomic dysfunction (Chandran and Pal 2012) has not changed this substantially. There is no question that, to some extent, the symptoms in ET are progressive. Nobody is born with ET, and although the first manifestations may appear in early adulthood or later in life, we do not have good long-term prospective follow-up studies that describe the natural history. However, there is little doubt that tremor increases in severity in many patients, rarely to the extent of causing significant incapacity, while in most patients, tremor remains relatively stable, being merely a nuisance of cosmetic rather than clinical significance. A major point is our incomplete understanding of the pathogenesis of the tremor, and it is still unclear whether it originates in dysfunction of the cerebellum, the superior olives, or in disrupted circuitry. Associated with the non-specific changes which have been described in the limited autopsy material available, it is still impossible to identify and define the underlying processes. The most important missing data needed to answer the question of whether ET is a neurodegenerative disease are the lack of reliable, long-term, prospective studies, which will include quantitative evaluation of tremor amplitude as well as additional cerebellar, extrapyramidal and nonmotor manifestations. The available epidemiological data are mostly cross sectional, with a significant selection bias. It is likely that such future studies will result in finding ET to be a heterogeneous disease. There is a lot of data supporting this view: the age of onset (the previous distinction of ‘‘senile tremor’’ from an early onset entity has been discarded, but without scientific evidence that indeed early and late-onset disease constitutes a single nosologic entity); response to drug and alcohol; electrophysiological data (Golan et al. 2004); and finally, genetics and pathology. Of course, once different entities are identified which are now included under the umbrella term of ET, each may have its own etiology and natural history.

Locus coeruleus dysfunction: A feature of essential or senile tremor?

Movement DisordersVolume 27, Issue 1 p. 1-2 Editorial Locus coeruleus dysfunction: A feature of essential or senile tremor?†‡ Günther Deuschl MD, Corresponding Author Günther Deuschl MD g.deuschl@neurologie.uni-kiel.de Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-Universität, Kiel, GermanyUniversity Hospital Schleswig-Holstein, Campus Kiel, Department of Neurology, Schittenhelmstr. 10, 24105 Kiel, GermanySearch for more papers by this author Günther Deuschl MD, Corresponding Author Günther Deuschl MD g.deuschl@neurologie.uni-kiel.de Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-Universität, Kiel, GermanyUniversity Hospital Schleswig-Holstein, Campus Kiel, Department of Neurology, Schittenhelmstr. 10, 24105 Kiel, GermanySearch for more papers by this author First published: 17 January 2012 https://doi.org/10.1002/mds.24885Citations: 12 † Relevant conflicts of interest/financial disclosures: : Nothing to report. ‡ Full financial disclosures and author roles may be found in the online version of this article. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume27, Issue1January 2012Pages 1-2 RelatedInformation

A film of patients with movement disorders made in Queen Square, London in the Mid‐1920s by Samuel Alexander Kinnier Wilson

Through Edward Reynolds' collaboration with Samuel Alexander Kinnier Wilson's (SAKW) son, James, on Babylonian neurology and psychiatry, and his contact with James' nephew, Jim, grandson of SAKW, a remarkable film of patients with movement disorders, made by SAKW in the mid-1920s, has come to light. The 20-min silent film with captions by SAKW includes patients with senile tremor, Parkinson's disease and postencephalitic parkinsonism, hemiballismus, Huntington's chorea, Sydenham's chorea, hysterical palsy and tremor, multiple sclerosis, and progressive lenticular degeneration. Most of the patients are filmed in the square outside the National Hospital. The British Film Institute dates the film to 1924 and the captions to 1925. The case records of 6 of the 14 patients, who were admitted to the National Hospital, Queen Square, under the care of Dr. SAKW have been identified and summarized. SAKW may have been stimulated and facilitated to make this film through his personal contact with Charlie Chaplin with whom he stayed at his Californian estate, probably in the summer of 1924. The first films of neurological patients were made in Europe and USA at the beginning of the 20th century, although most have perished. This may be one of the oldest examples from UK. It is also notable for the inclusion of Wilson's disease and a brief shot of SAKW himself.

La cohorte de ancianos NEDICES. Metodología y principales hallazgos neurológicos

To summarise the methodological aspects and main findings of the NEDICES (Neurological Disorders in Central Spain) cohort study of the elderly population, with over 5000 participants. The article outlines the findings concerning the following chronic neurological diseases (CND): dementia, Parkinson's disease and Parkinsonisms, stroke and essential, or senile, tremor. The NEDICES study examined the health, mortality and a series of sociological aspects of the cohort that are not discussed here. The paper does describe, however, the objectives, methods, population and development, with the baseline (1994) and incidence (1997) cut-off points, and the main findings regarding the CND under study are discussed. The prevalence and incidence of the CND are comparable to those of other Spanish and European population-based studies, but with certain peculiarities, such as the fact that incidence of senile tremor is the highest of those reported in the literature and that this CND is associated with dementia. Over half the cases of Parkinson's disease were reported de novo with the study and Alzheimer's disease was associated with vascular risk factors.

Imaging dopamine neurotransmission in Parkinson's disease: biomarker versus surrogate end point

Imaging dopamine neurotransmission in Parkinson's disease: biomarker versus surrogate end point

Lewy body-related alpha-synucleinopathy in the aged human brain.

To clarify the significance of Lewy body (LB)-related alpha-synucleinopathy in aging and various neurodegenerative disorders, its incidence and topographic pattern were examined in 260 brains of elderly patients, including 116 autopsy-proven cases of Alzheimer disease (AD), 71 cases of clinically and autopsy-proven Parkinson disease (PD), 38 of dementia with Lewy bodies (DLB), 8 patients with progressive supranuclear palsy (PSP), one with senile tremor, and 26 age-matched controls without neuropsychiatric disorders. Using immunohistochemistry, alpha-synuclein (AS) positive lesions were assessed semiquantitatively. For technical reasons, the olfactory system was not systematically studied. All PD-brains showed AS-positive lesions in medullary, pontine and mesencephalic nuclei, with involvement of the nucleus basalis (90.1%), limbic cortex (58.9%), cingulate cortex (46%), amygdala, CA 2/3 hippocampal region (36.2%), neocortex (28.8%), and striatum (11%). 88% of clinical PD cases corresponded to LB pathology stages 4-6, 12% to stage 3 according to Braak et al. (2003). 84% of DLB brains were PD stage 5 or 6 and 17% stage 4, without significant differences between DLB with and without neuritic AD pathology, suggesting morphologic similarities betwee these disorders. 6/8 PSP and senile tremor cases, 49.1% of AD and 69% of aged controls were negative. AS-positive lesions in AD showed decreasing incidence from midbrain (24-28%), limbic cortex and amygdala (17-18%), nucleus basalis and medullary nuclei (13-17%), cingulate cortex (12%), CA 2/3 region (8%) to neocortex (2%), without gender differences or relationship to the severity of AD pathology (mean Braak stage 5.1). AD cases with AS positive lesions, particularly those with AS pathology in the amygdala, were older at death than negative ones (86.6 vs 83.3 yrs), but this difference was not statistically significant. 15 AD cases (seven of them with mild PD symptoms) and 3 aged controls without parkinsonian signs but LB pathology stages 3 (n=5) and 4 (n=13) were considered "incidental LB disease". 16 AD brains without parkinsonian symptoms had AS positive lesions in various areas without medullary involvement, suggesting deviation from the proposed stereotypic expansion pattern. Located AS-pathology in the midbrain and limbic cortex was seen in 31% of asymptomatic aged controls. These data 1. largely confirm Braak's staging of LB-pathology in PD; 2. suggest morphologic and pathogenic relations between PD (brainstem type) and DLB with and without coexistent AD pathology; 3. the occurrence of LB-related alpha-synucleinopathy in about 50% of AD brains and about 30% of aged controls. However, the basic mechanisms of LB-related AS-pathology and their pathogenic and clinical relevance in aged brain and neurodegenerative disorders await further elucidation.

Senile tremor: what is the prevalence and severity of tremor in older adults?

Senile tremor: what is the prevalence and severity of tremor in older adults?

Clinical and electromyographic examinations of patients with essential tremor.

It is believed that no clinical differences exist among essential, familial and senile tremor, or between the tremor with synchronous or alternating electromyographic activity. The aim of this study was to evaluate the clinical and electromyographic findings in a large group of patients with different types of essential tremor. Two hundred and twenty patients with sporadic, familial or senile variants of essential tremor were examined. According to the electromyographic activity recorded from the antagonistic muscles, the patients were subdivided into a group with synchronous (SYN) and a group with alternating (ALT) activity. The historical aspects of the disease were noted, and a detailed neurological examination was performed. A widespread tremor involving upper and lower limbs and 3-4 different anatomical regions was typical for familial tremor. It also had higher amplitude than the sporadic and senile tremor. ALT tremor had a higher amplitude and longer burst duration than SYN and more often involved lower limbs. Rest tremor was common in the ALT group. Overall, ALT tremor was more common than previously supposed. The familial and ALT tremors are more disabling than other types of essential tremor. Since electromyographic ALT activity is common in essential tremor, its presence does not reliably distinguish essential and Parkinsonian tremor.

Normale bzw. häufige neurologische Befunde bei älteren Menschen

Numerous normal age-related changes that occur in the nervous system differ more quantitatively than qualitatively from certain common neurological diseases of elder individuals. Changes in the cranial nerve examination primarily relate to an age-related decline in sensory functions, especially of vision and hearing, and to a restriction in the range of eye movements, especially vertically. A progressive decline in the bulk and strength of muscles and in the speed and coordination of movements has long been recognised as an accompaniment of aging. Posture and gait show conspicuous changes with advancing age, partially correlating with diminished sensation in the legs and/or with a nonspecific bradykinetic senile gait. The distal depression of deep tendon reflexes and sensory function is primarily due to distal degeneration of sensory axons. Among the release signs, only the reappearance of the grasp reflex is a reliable sign for indicating pathology of the nervous system. Senile tremor, a decline in the maintenance of thermal homoeostasis, an increasing frequency of orthostatic hypotension, and disorders of sleep are also commonly associated with aging.

Mild hypertension: critical analysis of different therapeutic approaches.

In 1988 the fourth Joint National Committee (JNC IV) issued new guidelines for the detection, evaluation, and treatment of hypertension. Pharmacologic along with nonpharmacologic therapy is indicated for hypertensive patients whose diastolic blood pressures average greater than or equal to 95 mmHg over a period of time and for patients who have a diastolic blood pressure of 90 mmHg to 94 mmHg with evidence of target organ disease and/or other major risk factors. In the absence of target organ disease and/or other major risk factors, a trial of nonpharmacologic treatment is recommended for patients with a diastolic blood pressure of 90 mmHg to 94 mmHg. The JNC IV report recommends initiating pharmacologic treatment with any one of the following classes of drugs: diuretics, beta blockers, calcium channel blockers, or ACE inhibitors. In general, diuretics and calcium channel blockers are especially indicated for elderly and black patients and beta blockers and ACE inhibitors for young and white patients, but there are many exceptions. In selecting the appropriate step-one agent for a given patient, the therapeutic "two-for-one" concept is emphasized whereby one antihypertensive drug may also be beneficial for a coexisting condition. Examples are: diuretics or ACE inhibitors in congestive heart failure; calcium channel blocking drugs or beta blockers in angina pectoris or paroxysmal supraventricular tachycardia; and beta blockers for migraine headache or senile tremor.

Association of Psychosis and Movement Disorders in the Elderly

There are a number of different relationships among aging, psychosis and movement disorders, most of which have been proposed to involve the neurotransmitter dopamine. Dopamine content and dopamine receptors have been shown to decrease with age, which may relate to the time of onset of different motor and psychotic disorders, as well as to the appearance of these disorders. For example, some so-called senile movement disorders, such as senile tremor and senile chorea, may relate to alterations in dopaminergic transmission with age, as might the general findings of increased slowing of movements and mildly increased rigidity with age, although it is not clear how common some of these changes are in the medically healthy elderly. Decrease in dopamine with age may also be associated with the findings that choreiform and psychotic disorders (which have been proposed to be related to excess dopaminergic activity) tend to predominate at younger ages, whereas parkinsonism is more common at later ages. Certain findings support this notion, such as the appearance of both dyskinesia and psychosis in patients treated with L-dopa, the finding that psychosis may be less common in patients with later-onset Huntington's disease, and the fact that neuroleptic-induced parkinsonism is often more severe in the elderly. However, the situation is more complicated than this, because there are a number of phenomena that do not fit the pattern, including the observation of an increased incidence of tardive dyskinesia in the elderly. Age-related changes in other transmitters are undoubtedly important in both movements disorders and psychosis, and even dopamine has been proposed to have both trophic and toxic properties over the aging process. In general, care is warranted in the use of any psychotropic medications in the elderly, because there can be widespread and often unpredictable effects of these drugs on both motor and mental function.

Tremor and Senile Parkinsonism

A study of 100 Day Hospital patients showed that 26 elderly patients with mild Senile Parkinsonism and varying degrees of dementia had subclinical tremor with the same frequency as Parkinson's Disease and distinguishable by amplified recordings from those of Parkinson's Disease and Senile Tremor. A significant history of cerebro-vascular disease was obtained in one-half of these patients. The recording of tremor is shown to be of value in diagnosing Parkinsonism and in assessing response to treatment.

Essential (hereditary or senile) tremor.

Sixteen cases (eight in males and eight in females) of essential (hereditary or senile) tremor were collected over a two-year period. Ten patients had near relatives with a similar disorder. All but one patient had a tremor of the upper limbs which was absent when the arms were at rest, but which appeared on movement, and was made worse by emotion. The severity of the tremor varied considerably from patient to patient, and often was temporarily lessened by alcohol. The tremor involved the head and neck in six subjects and the legs in two. One subject has associated neurological abnormalities probably due to cerebral arteriosclerosis. Otherwise no neurological abnormality except tremor was present in any patient. No patient showed evidences of Parkinsonism. To the time of collection of the series the tremor had been present for periods of between one and 62 years. Many patients with essential tremor are not severely enough affected to warrant therapy. Propranolol, a beta-adrenergic blocking agent, appears to reduce the tremor in at least some patients who need treatment.

Tremonil

Thiaxanthen (Tremonil - Wander) is recommended for Parkinsonism of any cause, for residual symptoms following neurosurgical procedures and for senile tremor. It is claimed not only to be particularly effective against tremor, but also to reduce rigidity and to have a “beneficial action on the psychic and autonomic disturbances often present in” Parkinsonism. Unfortunately thiaxanthen seems to be more effective in controlling fine tremor in Parkinsonism than in controlling the coarse tremor which is so much commoner. When tremor is reduced it may recur after 1 – 2 months, when it will fail to respond to increased dosage (K. Hartmann-v. Monakow, Schweiz. med. Wschr. 1960, 90, 1070). Tremor may also on occasion be worsened by thiaxanthen (H. P. Schulz, Med. Klin. 1961, 56, 2174). The drug has antihistamine and atropine-like effects. It is chemically related to chlorprothixene (Taractan - Roche), reviewed in The Medical Letter, Brit. ed. 1962, 1, 57.

Senile tremor versus Parkinson's disease.

The incidence of senile tremor has risen sharply with the lengthening of the life span. Extensive research is needed in this area of growing clinical concern.Senile tremor is often misdiagnosed as ...