Rate of progression from mild cognitive impairment to dementia in an essential tremor cohort: A prospective, longitudinal study

Radler, Keith; Zdrodowska, Maria Anna; Dowd, Hollie; Cersonsky, Tess E.K.; Huey, Edward D.; Cosentino, Stephanie; Louis, Elan D.

doi:10.1016/j.parkreldis.2020.04.008

Cited by 30 publications

(22 citation statements)

References 25 publications

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“…As expected and as noted in prior studies [ 45 46 47 ], patients with age at onset of tremor over 65 years had a significantly higher prevalence of cognitive impairment (37.0% vs 13.1%, p = 0.003). Several studies have shown cognitive deficits in ET patients exceeding those of age-matched [ 3 48 49 ] and historical controls [ 50 ]. A Spanish study found a higher incidence of dementia in ET patients versus controls (7.8% vs 3.9%, unadjusted relative risk = 2.08, p = 0.006) over a mean follow-up of 3.2 years, and ET patients over 65 were twice as likely to develop dementia compared to controls [ 46 ].…”

Section: Discussionmentioning

confidence: 99%

Phenotypic Features of Isolated Essential Tremor, Essential Tremor Plus, and Essential Tremor-Parkinson’s Disease in a Movement Disorders Clinic

Bellows

Jankovic

2021

Tremor and Other Hyperkinetic Movements

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Background: Patients with essential tremor were initially considered to have isolated tremor, but additional motor and non-motor features have been increasingly recognized. The term "essential tremor plus" was adopted by the Task Force on Tremor of the International Parkinson and Movement Disorder Society to describe essential tremor patients with additional neurologic signs.Objectives: To characterize essential tremor patients and their phenotypes in a movement disorders clinic population in the context of the new tremor classification.Methods: Demographic, clinical, historical, treatment, and diagnostic data were retrospectively collected on 300 patients diagnosed by movement disorder experts with essential tremor. Patients were classified as having essential tremor, essential tremor plus, or essential tremor-Parkinson's disease combination, and features between these groups were compared. Results:Of the 300 patients, 20.7% were classified as isolated essential tremor, 53.3% as essential tremor plus, and 26.0% as essential tremor-Parkinson's disease. There was no significant difference in the duration of tremor symptoms. Essential tremor plus patients were more likely to have dystonia, tandem gait abnormalities, head tremor and greater tremor severity. Essential tremor-Parkinson's disease patients were more likely to have RBD symptoms. There was no significant difference in cognitive impairment between essential tremor plus and essential tremor-Parkinson's disease patients.Conclusions: Additional motor and non-motor features, including parkinsonism, are common in patients with essential tremor. Further studies are needed to clarify essential tremor phenotypes and to provide insights into possible subtypes.Highlights: 300 patients with essential tremor from a movement disorders clinic were re-classified based on the Movement Disorder Society Consensus Statement on the Classification of Tremors. Additional motor and non-motor features, including parkinsonism, were common, and only 20.7% of patients remained classified as isolated essential tremor.

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Section: Discussionmentioning

confidence: 99%

Phenotypic Features of Isolated Essential Tremor, Essential Tremor Plus, and Essential Tremor-Parkinson’s Disease in a Movement Disorders Clinic

Bellows

Jankovic

2021

Tremor and Other Hyperkinetic Movements

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“…The study of cognitive impairment in ET is a nascent field and longitudinal data describing the course of cognitive change are scarce ( 12 ). We know that ET cases exhibit a higher burden of cognitive impairment when compared to control populations ( 7 – 11 ) and that the rate of cognitive decline appears to be accelerated in ET cases ( 39 ). However, until this point, the only baseline feature identified as predictive of cognitive decline in ET was older age ( 10 ).…”

Section: Discussionmentioning

confidence: 99%

Physical Activity as a Predictor of Cognitive Decline in an Elderly Essential Tremor Cohort: A Prospective, Longitudinal Study

et al. 2021

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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.

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“…Epidemiological studies in Spain and New York have demonstrated that, beyond the presence of mild cognitive deficits, ET is associated with both an increased odds of prevalent dementia ( 52 , 53 ) and an increased risk of incident dementia ( 53 , 54 ). Conversion rate in ET from mild cognitive impairment to dementia seems to be in excess of that seen in control groups ( 55 ). The basis for the cognitive changes and dementia in ET is likely to be multi-factorial, and further studies are needed ( 42 , 56 , 57 ).…”

Section: Expansion Of the Clinical Phenotype Of Etmentioning

confidence: 99%

“…Yet there is evidence that non-motor features, and particularly cognitive deficits, occur in ET. Some patients go on to develop mild cognitive impairment or dementia; however, the development of these more severe forms of cognitive impairment are not uniform; some patients dement and others do not ( 55 ).…”

Section: Greater Understanding Of the Natural History Of Et And Recogmentioning

confidence: 99%

The Essential Tremors: Evolving Concepts of a Family of Diseases

Louis

2021

Front. Neurol.

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The past 10 years has seen a remarkable advance in our understanding of the disease traditionally referred to as “essential tremor” (ET). First, the clinical phenotype of ET has been expanded from that of a bland, unidimensional, and monosymptomatic entity to one with a host of heterogeneous features. These features include a broader and more nuanced collection of tremors, non-tremor motor features (e.g., gait abnormalities) and a range of non-motor features, including cognitive, psychiatric, sleep, and other abnormalities. The natural history of these features, as well as their relationships with one another and with disease duration and severity, are better appreciated than they were previously. Studies of disease etiology have identified a number of candidate genes as well as explored several environmental determinants of disease. In addition, the decade has seen the beginnings and expansion of rigorous postmortem studies that have identified and described the postmortem changes in the brains of patients with ET. This emerging science has given rise to a new notion that the disease, in many cases, is one of cerebellar system degeneration. Across all of these studies (clinical, etiological, and pathophysiological) is the observation that there is heterogeneity across patients and that “essential tremor” is likely not a single disease but, rather, a family of diseases. The time has come to use the more appropriate terminology, “the essential tremors,” to fully describe and encapsulate what is now apparent. In this paper, the author will review the clinical, etiological, and pathophysiological findings, referred to above, and make the argument that the terminology should evolve to reflect advances in science and that “the essential tremors” is a more scientifically appropriate term.

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Rate of progression from mild cognitive impairment to dementia in an essential tremor cohort: A prospective, longitudinal study

Cited by 30 publications

References 25 publications

Phenotypic Features of Isolated Essential Tremor, Essential Tremor Plus, and Essential Tremor-Parkinson’s Disease in a Movement Disorders Clinic

Phenotypic Features of Isolated Essential Tremor, Essential Tremor Plus, and Essential Tremor-Parkinson’s Disease in a Movement Disorders Clinic

Physical Activity as a Predictor of Cognitive Decline in an Elderly Essential Tremor Cohort: A Prospective, Longitudinal Study

The Essential Tremors: Evolving Concepts of a Family of Diseases

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