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Background: Essential tremor (ET) encompasses a variety of features, including tremor, cognitive dysfunction, and gait and balance impairments. Gait and balance impairments in ET are often mild, but they can be severe and are, in some cases, associated with functional sequelae in terms of increased fall risk and reduced balance confidence. Previous research on gait and balance in ET has been limited to cross-sectional comparisons. There have been no longitudinal studies or prospective studies. As such, our understanding of natural history and possible predictors of declines in ET-related gait and balance impairments is incomplete. Objectives: We (1) present natural history data on the change in gait and balance measures over time, (2) provide estimates of annual rate of change in each gait and balance metric, and (3) examine the relationship between baseline clinical predictors and changes in gait and balance over time. Methods: 149 ET participants (mean age 78.7 years), enrolled in a prospective, longitudinal, clinical-pathological study, underwent an extensive evaluation of cognition, tremor, and gait and balance at three distinct intervals performed every 18 months. Gait and balance measures included a combination of performance-based tests (e.g., tandem gait, tandem stance) and self-reported assessments (e.g., number of falls, use of a walking aid). Results: Between the baseline and final assessments, numerous balance and gait measures showed evidence of decline and annual rates of change were quantified for each. We examined the predictive utility of clinical variables at baseline for five gait and balance outcomes, with global cognition and executive function standing out as the most consistent predictors. Conclusions: We present a much-needed look into the course of disease for elderly patients with ET, focusing on changes observed in gait and balance and the predictors of these changes. These results also add another dimension to the relevance of cognitive impairment observed in ET; such impairment can now be viewed as predictive of poorer gait and balance over time in ET. These findings are a useful tool for clinicians, patients, and their families to better understand and plan for changing disease-features over time.

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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.

17.84 ± 0.42s), (DS ¼ 17.69 ± 0.45s) while there was no significant effect (p ¼ 0.059) in sprint performance (NS ¼ 2.79 ± 0.14s), (DS ¼ 2.74 ± 0.17s). Significant improvement (0.045) was also detected in reaction time on the last of the testing days (Day1 ¼ 0.055 ± 0.025s), (Day2 ¼ 0.049 ± 0.024s). CONCLUSIONS: Results show that dynamic stretching warm-up has only a significant effect on sprint performance and agility if performed on longer distances or longer durations. Moreover the reaction time could be decreased by the adequate amount repetition of the specific movements.

Background Improving clinical diagnostic accuracy and refining criteria is challenging in dementia research. To explore our ADRC’s diagnostic accuracy, a QI project was initiated to identify potential systemic areas affecting our center’s performance. Method Clinical consensus diagnoses were compared to the neuropathological findings of 68 ADRC brain bank participants between 2008‐2017. Concordance level (full, partial, discordant) was assigned by three authors (MS, JN, and HG) with input from our neuropathologist (DP). Fisher's exact test was used to examine concordance and Clinical Dementia Rating (CDR), race, age at death, education, number of visits, time between last visit and death, onset age, and depression. Results Participants were 56% female, 88% non‐Hispanic white, education 14.6+/3.9 (range 2‐22), age of onset 71+/‐11 (range 47‐93), age at death 82.5+/‐10.4 (range 52‐102), CDR sum of boxes 12.8+/‐6.5, CDR Global 2.2+/‐1.03, number of follow‐up visits 2.5+/‐2.8, one visit only 40%, 56% had a visit within 18 months before death ( range 0‐132 months). Depression was present in 28%. Primary clinical diagnosis at death was 82.4% AD, 7.4% normal, 4.4% MCI, 2.9% DLB and 3% other. 88% were fully or partially concordant (clinical diagnosis matched at least one neuropathological diagnosis). Of the 8 discordant cases, 2 had no identifiable neuropathology despite dementia; 2 had tauopathies; 1 was an AD/FTD mismatch. Three who were >92yo had no clinical diagnosis but exhibited AD pathology. For partially concordant cases where the second diagnosis was mismatched, it was most frequently DLB (80%). Concordance rate was not associated with any of the above clinical/demographic variables except for CDR and race (p < 0.05). Regarding CDR, 5/8 (63%) discordant cases had a CDR of 0.5 (mild symptoms); the other three had a CDR of 3 (severe dementia). 3/8 minority cases were discordant but two had diagnoses currently only available at autopsy. Conclusion Consistent with the literature, the most common error was either missing DLB when present or diagnosing it when absent. No systemic issues were identified that contributed to inaccuracies.

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