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Does Essential Tremors Cause Dementia

Essential Tremor Vs Parkinsons Tremors: A Guide To The Major Differences

Range of Symptoms in Essential Tremor

When people think of Parkinsonsdisease, they may picture the shaking hands commonly associated with thecondition. Persistent shaking of hands and limbsalso known as tremorcan makeit difficult to write a grocery list, hold a cup of tea, button a shirt andapply makeup, among other routine tasks. When tremors interfere with dailylife, it can be very disruptive. While tremors are a hallmark of Parkinsonspatients, there are other diseases similar to Parkinsons that can causetremors.

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Essential Tremor Is Not Parkinsons Disease

Essential tremor and Parkinsons disease are different conditions. Essential tremor is characterised by shaking when movement starts, which can continue or worsen during movement. The symptoms of Parkinsons disease include:

  • involuntary tremor when you are not moving
  • muscle stiffness
  • slowness of movement
  • freezing.

Parkinsons disease is caused by a lack of supply of the brain chemical dopamine, which is necessary for smooth and controlled muscular movement.

Clinical Correlates Of Aging In Et

Older ET patients are less able to tolerate the side effects of pharmacotherapy than are younger patients . Both the cognitive side effects of primidone and the cardiac effects of propranolol are more difficult for older patients to tolerate. Hence, the age of the patient limits tolerance to the front-line medications .

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The Other Side Of The Coin

On the other hand, a research group out of the Banner Sun Health Research Institute challenges some of these conclusions. For one publication, Shill et al. used a large database generated by a long-term study on aging called the Arizona Study of Aging and Neurodegenerative Disorders to explore patterns of ET and associated dementia.2 AZSAND includes over 3000 participants, which makes sense given the number of retirees living in and around Sun City. Beginning with baseline evaluations in 1997, each AZSAND subject has undergone annual follow-up assessments. For their analysis, the Shill team identified a total of 507 cases that met their criteria. Of the total cases, 83 had essential tremor and 424 did not. The average age for the tremor patients was 80 , and for normal individuals it was 76 . Among those with tremor, the average duration since it started was 5.2 years at the time they enrolled in the study. All participants had been followed for an average of 5.4 years. Thus, the team drew their conclusions from what they describe as subjects with ET versus controls without tremor in a large, well-categorized cohort of individuals involved in a longitudinal aging study

Are Essential Tremors Hereditary

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Movement disorders are a group of neurological conditions that cause irregular body movements. Parkinsons disease and Tourettes syndrome are two of the most well-known movement disorders, but this group also includes other conditions such as essential tremors.

Thankfully, essential tremors wont shorten your lifespan, but they can interfere with your ability to use utensils, brush your teeth, get dressed, type, or demonstrate other fine motor skills. Our neurology specialists here at Link Neuroscience Institute in Oxnard, California, encourage you to reach out if youre concerned about movement disorders or if you have questions about your treatment options.

Below, we answer one of the most common questions related to essential tremors: are they hereditary?

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Identifying And Managing Essential Tremor

Many people worry when they have a tremor that it may be a sign of Parkinsons disease. However, there is another more common cause of tremor known as essential tremor , and it doesnt have the serious implications of Parkinsons. In fact, ET is more than ten times as common as Parkinsons disease, and, unlike Parkinsons, does not cause worsening unsteadiness, rigidity, or dementia.

Although it might be a relief to hear that your tremor isnt caused by Parkinsons disease, it doesnt necessarily make the tremor less annoying. For some people, essential tremor comes and goes and hardly bothers them. For others, essential tremor is so bad that tying shoes or eating with utensils is nearly impossible.

Association Of Et With Psychiatric Disorders

Psychiatric issues such as depression and anxiety, personality changes, social phobias and low measures of subjective health status or health-related quality of life are all frequently observed in patients with ET . Some studies have estimated that as many as 30% of patients with ET have mild depressive symptoms . Depression in ET may have different clinical manifestations than in patients with primary affective disorders, in that patients with ET are more likely to report concentration difficulties and fatigue . Although the association between psychiatric issues and ET is documented in many studies, more information is needed regarding their initiation and evolution. Traditionally, psychiatric symptoms have been regarded as occurring in response to debilitating neurological symptoms in ET . However, other evidence suggests that depression might occur before the motor symptoms of ET manifest in such situations this psychiatric disorder cannot be a secondary response to disability .The pathophysiological basis of depression and anxiety in patients with ET is currently unknown and awaits prospective studies. Importantly, however, depression does not appear to account for cognitive deficits in ET .

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What Are The Complications Of Parkinson Disease

Parkinson disease causes physical symptoms at first. Problems with cognitive function, including forgetfulness and trouble with concentration, may arise later. As the disease gets worse with time, many people develop dementia. This can cause profound memory loss and makes it hard to maintain relationships.

Parkinson disease dementia can cause problems with:

  • Speaking and communicating with others
  • Problem solving
  • Forgetfulness
  • Paying attention

If you have Parkinson disease and dementia, in time, you likely won’t be able to live by yourself. Dementia affects your ability to care of yourself, even if you can still physically do daily tasks.

Experts don’t understand how or why dementia often occurs with Parkinson disease. Its clear, though, that dementia and problems with cognitive function are linked to changes in the brain that cause problems with movement. As with Parkinson disease, dementia occurs when nerve cells degenerate, leading to chemical changes in the brain. Parkinson disease dementia may be treated with medicines also used to treat Alzheimer’s disease, another type of dementia.

Et Review Of Its Links To The Cerebellum

Essential tremor

In this section, we review the clinical, neuroimaging, and postmortem studies that point towards a link between ET and the cerebellum.

Clinical

A complete discussion of the clinical features that link ET to the cerebellum may be found elsewhere . In approximately one-half of patients with ET, the kinetic tremor may have an intentional component . This is of interest to the present discussion because intention tremor has canonically been viewed as a sign of cerebellar dysfunction. Thus, in these patients, during the finger-nose-finger maneuver, the tremor amplitude increases when the patients finger approaches his/her own nose or the examiners finger . Furthermore, intention tremor is not restricted to the upper limbs in ET. Thus, an intention tremor of the head is seen in as many as 10% of ET patients . Intention tremor is also more prevalent in the legs of ET patients than in controls, observed in 1-in-4 ET patients .

In summary, as reviewed above, a range of clinical features link ET to a dysfunction of the cerebellar system. There are others. These include the observed resolution of ET in a patient after cerebellar stroke as well as the observation that cerebellar outflow pathways are the focus of several highly-effective surgical approaches to ET . As noted above, a detailed elaboration of the clinical features that link ET to the cerebellum may be found elsewhere .

Neuroimaging

Pathological

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Tremors Yes Parkinson’s Disease No

Essential tremor is often mistaken for Parkinson’s disease, but the two conditions differ in several ways. Essential tremor is an action tremor, meaning that the involuntary shaking increases when you move and try to use your hands. In Parkinson’s disease, tremors occur mainly at rest, and activity reduces the symptoms. Some people with essential tremor develop head nodding or shaking few people with Parkinson’s do. Balance problems and rigidity of the arms and legs are common features of Parkinson’s disease but not of essential tremor. One of the hallmarks of essential tremor, useful in diagnosing the disorder, is that alcohol can temporarily ease symptoms in Parkinson’s, alcohol has little effect on the tremor.

Parkinson’s disease is marked by a progressive loss of brain cells that produce dopamine, a chemical messenger that enables normal body movements. Essential tremor also appears to involve a disruption in the activity of motor pathways, but it’s uncertain whether there is any loss of brain cells. Postmortem examinations of brain tissue taken from people with essential tremor reveal various abnormalities in the cerebellum and brainstem, including the loss of Purkinje cells, which produce an important neurotransmitter, called GABA. But the samples don’t all show the same changes, so the import of these findings is uncertain.

Medications For Essential Tremor

Propanolol and primidone are two of the medicines often prescribed to treat essential tremor.

Propanolol blocks the stimulating action of neurotransmitters to calm your trembling. This beta blocker is effective in 40% to 50% of patients and is less useful in reducing head and voice tremor. It is usually avoided in patients with asthma, emphysema, congestive heart failure or heart block, and should be used with caution by people with diabetes who are on insulin. These drugs may reduce exercise tolerance, lower blood pressure or heart rate, exacerbate depression and cause impotence. Other adrenergic blockers with fewer side effects include atenolol, nadolol, metoprolol and timolol.

Primidone controls the actions of neurotransmitters. Some patients starting primidone may experience a first dose phenomenon during which they have transient feelings of unsteadiness, dizziness and nausea during the beginning stages of treatment. This is usually short-lived. Sedation is another common side effect and can be reduced by following a slowly escalating dose schedule. Most patients are able to tolerate the side effects, and studies have shown that 60% to 100% of patients respond positively.

If primidone or propranolol are not effective by themselves, a combination of both may provide relief for some patients.

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Why Does Essential Tremor Impact Cognitive Function

Essential tremor most often affects an individuals motor skills, which are controlled by the nervous system. With essential tremor, daily tasks like brushing your hair and teeth or holding your arms outstretched can be extremely difficult, but from where does the connection between essential tremor and cognitive impairment stem?

The nervous system regulates movement and motor skills, equilibrium, and the five senses, but its also responsible for thinking processes, awareness, and consciousness levels. In total, the nervous system comprises the brain, the spinal cord, and all of the nerves in the body.

While ET has traditionally been associated with its physical symptoms, like active and stress tremors, researchers have more recently found a connection between ET and mild cognitive impairment, memory loss, and dementia. In a study of essential tremor patients, NIH.gov reported that 25% had prevalent dementia, and 8.7% developed incident dementia. The cognitive issues with essential tremor are still being examined, but the connection likely has to do with the cerebellum.

What Are The Symptoms Of Parkinson Disease

Much more than a tremor

Parkinson disease symptoms usually start out mild, and then progressively get much worse. The first signs are often so subtle that many people don’t seek medical attention at first. These are common symptoms of Parkinson disease:

  • Tremors that affect the face and jaw, legs, arms, and hands
  • Slow, stiff walking

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High Prevalence Of Et Review Of The Data

ET is one of the most common movement disorders and the most common form of tremor. A review of 28 population-based prevalence studies from 19 countries broadly examined the prevalence of ET globally . In a meta-analysis, the prevalence among all ages was 0.9% . In additional descriptive analyses, the crude prevalence among all ages was 0.4% . Prevalence increased markedly with age, and especially with more advanced age . In the meta-analysis, prevalence among persons age 65 years or older was 4.6% , and in additional descriptive analyses, the median crude prevalence among those age 60 65 and older was 6.3% . In one study of those age 95 and older, the crude prevalence was 21.7% . In the United States alone, an estimated 7 million of individuals are affected, representing 2% of the entire population .

What Is Parkinson Disease

Parkinson disease is a movement disorder. It can cause the muscles to tighten and become rigid This makes it hard to walk and do other daily activities. People with Parkinsons disease also have tremors and may develop cognitive problems, including memory loss and dementia.

Parkinson disease is most common in people who are older than 50. The average age at which it occurs is 60. But some younger people may also get Parkinson disease. When it affects someone younger than age 50, it’s called early-onset Parkinson disease. You may be more likely to get early-onset Parkinson disease if someone in your family has it. The older you are, the greater your risk of developing Parkinson disease. It’s also much more common in men than in women.

Parkinson disease is a chronic and progressive disease. It doesn’t go away and continues to get worse over time.

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Cause Of Essential Tremor

Essential tremor is the most common type of tremor, and affects more people than Parkinsons disease. Some estimates suggest that around 1 in 5 people over the age of 65 years is affected.

There is no known cause, but a genetic link is strongly suspected. Each child of a person with essential tremor has a 50% chance of inheriting the disorder themselves. If a person with essential tremor has other affected family members, then the disorder is called familial tremor.

Cognitive And Psychological Differences In Patients With Essential Tremor

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Benign essential tremor is probably the most common of all movement disorders. Someone with essential tremor has increased shakiness, usually of the hands or arms, whenever the limb is being used. This distinguishes the tremor from that of classical Parkinson’s disease, which is usually worse when the arm and hand are at rest.

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Clinical Features And Clinical Heterogeneity

Some degree of action tremor is nearly universal among adults – physiological tremor and enhanced physiological tremor . In addition, a wide range of tremor disorders has been described . There is a tendency for clinicians to be lumpers’, overapplying the diagnosis ET’ to many of these conditions and treating ET as if it were formless . Yet, far from being featureless and nondescript, the disease, ET, is characterized by specific and consistently described pattern of tremor: kinetic tremor is greater than postural tremor there is an involvement of specific joints in specific directions intention tremor of the arms occurs in approximately 50% of cases rest tremor as a late feature occurs in up to 20% of cases arm tremor precedes cranial tremor, of which there is a female preponderance there is a prevalence of neck greater than jaw greater than tongue/cheek/forehead tremor there is a tendency for tremor severity to increase over time , and there is a co-occurrence of cerebellar features aside from intention tremor in many patients . Thus, in addition to these consistencies of pattern , there is a general course/prognosis across patients.

Where Can I Get More Information

For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institutes Brain Resources and Information Network at:

Office of Communications and Public LiaisonNational Institute of Neurological Disorders and StrokeNational Institutes of HealthBethesda, MD 20892

NINDS health-related material is provided for information purposes only and does not necessarily represent endorsement by or an official position of the National Institute of Neurological Disorders and Stroke or any other Federal agency. Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patients medical history.

All NINDS-prepared information is in the public domain and may be freely copied. Credit to the NINDS or the NIH is appreciated.

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Functional Magnetic Resonance Imaging Regional Effects

The ANOVA exploring the main effect of group did not identify significant activations in any brain region including our a priori regions of interests .

The ANOVA investigating the main effect of task revealed several areas that showed either an enhancement or a reduction of their activity as a function of increasing working memory load . In particular, dorsolateral prefrontal cortex, parietal lobules, anterior cingulate cortex, insula, basal ganglia and cerebellum displayed a significant increase of their responses as a function of working memory load . In contrast, precuneus/retrosplenial cortex and ventromedial prefrontal cortex showed the opposite pattern .

Main effect of the task . Brain regions showing a main effect of the task . The colour bar represents F statistics. Co-ordinates are in the MNI space. BOLD=blood oxygenation level-dependent DLPFC=dorsolateral-prefrontal cortex ET=essential tremor R=right hemisphere vmPFC=ventromedial prefrontal cortex.

More importantly, a significant GroupĂ—Task interaction in the left cerebellum and, at a lower statistical threshold, on the right side was found . As shown in , the GroupĂ—Task interaction was mainly driven by abnormally enhanced activity of crus I/lobule VI in patients with essential tremor relative to controls when performing high-load working memory trials. Two additional regions showed a similar effect: the left thalamus and the right caudate .

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