Cognitive Dysfunction Is Associated with Greater Imbalance and Falls in Essential Tremor

Louis, Elan D.; Kellner, Sarah; Morgan, Sarah; Collins, Kathleen; Rohl, Brittany; Huey, Edward D.; Cosentino, Stephanie

doi:10.3389/fneur.2017.00154

Cited by 14 publications

(14 citation statements)

References 36 publications

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“…This is an interesting issue but a difficult one to address for ET. For example, studies that have used the MoCA have either enrolled subjects that are far younger than our FD-ET (e.g., 30 ET patients with mean age = 48.7 ± 7.4 years had a mean MoCA score of 25.2 ± 2.2) [29] or far older than our FD-ET (e.g., 199 ET cases with mean age = 78.6 ± 9.6 years had a mean MoCA score of 24.6 ± 3.9) [30]. There is some comparable literature in PD.…”

Section: Discussionmentioning

confidence: 99%

More unaffected first-degree relatives of essential tremor cases have mild cognitive deficits than age-matched controls

Meyers

Hickman

Cristal

et al. 2019

Parkinsonism & Related Disorders

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Background: In numerous case-control studies, essential tremor (ET) has been associated with cognitive impairment. ET is often familial. However, cognitive impairment has not been studied in family members of ET cases. Endophenotypes are measurable clinical characteristics that may be present in individuals with increased risk for disease; as such, they may be present before disease onset. We administered a global cognitive screen to first-degree relatives of ET cases (FD-ET) and age-matched controls (Co). Methods: We administered the Montreal Cognitive Assessment (MoCA) to 156 FD-ET and 73 Co, none of whom were diagnosed with ET or reported tremor. MoCA <26 was considered suggestive of cognitive impairment.

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Section: Discussionmentioning

confidence: 99%

More unaffected first-degree relatives of essential tremor cases have mild cognitive deficits than age-matched controls

Meyers

Hickman

Cristal

et al. 2019

Parkinsonism & Related Disorders

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“…Profiles of normal cognition in essential tremor is more likely to decline among subjects in Cluster 1, as it is characterized by lower global cognitive scores (MoCA), less balance confidence (ABC-6) and use of more medications, measures which are related to cognitive decline in ET (Louis et al, 2017).…”

Section: Demographic and Clinical Correlates Of Clustersmentioning

confidence: 99%

Profiles of Normal Cognition in Essential Tremor

Cersonsky

Kellner

Chapman

et al. 2019

J Int Neuropsychol Soc

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Objectives:Patients with essential tremor exhibit heterogeneous cognitive functioning. Although the majority of patients fall under the broad classification of cognitively “normal,” essential tremor is associated with increased risk for mild cognitive impairment and dementia. It is possible that patterns of cognitive performance within the wide range of normal functioning have predictive utility for mild cognitive impairment or dementia. These cross-sectional analyses sought to determine whether cognitive patterns, or “clusters,” could be identified among individuals with essential tremor diagnosed as cognitively normal. We also determined whether such clusters, if identified, were associated with demographic or clinical characteristics of patients.Methods:Elderly subjects with essential tremor (age >55 years) underwent comprehensive neuropsychological testing. Domain means (memory, executive function, attention, visuospatial abilities, and language) from 148 individuals diagnosed as cognitively normal were partitioned using k-means cluster analysis. Individuals in each cluster were compared according to cognitive functioning (domain means and test scores), demographic factors, and clinical variables.Results:There were three clusters. Cluster 1 (n = 64) was characterized by comparatively low memory scores (p < .001), Cluster 2 (n = 39) had relatively low attention and visuospatial scores (p < .001), and Cluster 3 (n = 45) exhibited consistently high performance across all domains. Cluster 1 had lower Montreal Cognitive Assessment scores and reported more prescription medication use and lower balance confidence.Conclusions:Three patterns of cognitive functioning within the normal range were evident and tracked with certain clinical features. Future work will examine the extent to which such patterns predict conversion to mild cognitive impairment and/or dementia.

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“…Impaired gait and balance have been studied to a limited extent in patients with ET, and these impairments associated with cranial tremor and poorer cognition in ET (17)(18)(19)), yet all previous research on gait and balance in ET has been limited to cross-sectional designs. There have been no longitudinal studies and no prospective studies assessing (1) natural history, (2) rate of change in gait and balance over time, or (3) the predictive utility of baseline clinical features for future gait and balance outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…Broadly, the baseline predictors of interest were tremor severity, cognition, daytime sleepiness, capacity to perform activities of daily living, mood, and alcohol use. More specifically, based on existing data in ET, in the elderly, and in individuals with other neurological diseases of late life, a priori we hypothesized that baseline features such as higher total tremor score ( 20 ) and cranial tremor score ( 17 ); lower global cognition, ( 18 ) higher Clinical Dementia Rating (CDR) ( 18 , 21 ); worse aggregate scores in the cognitive domains of executive function ( 22 , 23 ), attention ( 22 , 24 ) and visuospatial skills ( 25 ); greater daytime sleepiness ( 26 ); lower ability for daily activities ( 27 ); and finally, higher levels of depression, ( 28 ) and anxiety ( 29 ) and alcohol use ( 30 ) could function as predictors of long-term gait and balance impairment or greater decline in gait and balance in ET participants.…”

Section: Introductionmentioning

confidence: 99%

Prospective Longitudinal Study of Gait and Balance in a Cohort of Elderly Essential Tremor Patients

et al. 2020

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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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Cognitive Dysfunction Is Associated with Greater Imbalance and Falls in Essential Tremor

Cited by 14 publications

References 36 publications

More unaffected first-degree relatives of essential tremor cases have mild cognitive deficits than age-matched controls

More unaffected first-degree relatives of essential tremor cases have mild cognitive deficits than age-matched controls

Profiles of Normal Cognition in Essential Tremor

Prospective Longitudinal Study of Gait and Balance in a Cohort of Elderly Essential Tremor Patients

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