Motor and Non-motor Features: Differences between Patients with Isolated Essential Tremor and Patients with Both Essential Tremor and Parkinson’s Disease

Apostolia Ghika; Andreas Kyrozis; Constantinos Potagas; Elan D. Louis

doi:10.5334/tohm.248

Figures & Tables

Table 1

Assessment of Non-motor Features

Assessment of hypophonia with three questions (+ clinical impression on the exam + reported by the caregiver)

Has your voice become weaker than it used to be?
Does your interlocutor often ask you to repeat what you said?
Do the above symptoms last more than three months?

(Yes to #3 AND to [#1 or 2] necessary for diagnosis)

Assessment of hearing impairment with four questions (+clinical impression at the exam)

Do you have a problem hearing voices over the telephone?
Are you frequently asking others to repeat the things they say?
Do you often think “my hearing is not as good as it used to be”?
Do the above symptoms last more than three months?

(Yes to #4 AND to [#1 or 2 or 3] necessary for diagnosis)

Assessment of olfactory dysfunction with four questions

Do you experience loss or change in your ability to taste or smell?
Can you enjoy the smell of your food?
Can you smell your perfume?
Do the above symptoms last more than three months?

(Yes to #4 AND to [#1 or 2 or 3] necessary for diagnosis)

Assessment of constipation with four questions

Do you have fewer than three defecations per week?
Are your stools lumpy or hard?
Do you need manual maneuvers or laxative drugs to facilitate defecations?
Do the above symptoms last more than three months?

(Yes to #1, #2 & #4 necessary for diagnosis)

Assessment of RLS with four questions

Do you sometimes experience unpleasant sensations (such as creeping, crawling, pulling, itching, tingling, burning, aching) in your legs and/or a strong urge to move your legs?
Do you feel relief from the symptoms after moving the legs?
Does this happen at night or while resting at other times as well?
Has any of your family experienced the same problem?

(Yes to #1, #2 & #3 necessary for diagnosis)

Assessment of RBD with four questions

Do you have frightening, intense, vivid dreams?
Have you ever hurt your bed partner or yourself during sleep?
Has your bed partner complained of sudden movements, talking, laughing or any other motor behavior such as acting out a dream while you are asleep?
Has any of your family experienced the same problem?

(Yes to #1 & #3 necessary for diagnosis)

[i] Abbreviations: RBD, Rapid Eye Movement Behavior Disorder; RLS, Restless Legs Syndrome.

Table 2

Comparison of Demographic Data, Data from History, Motor Features and Non-motor Features of ET→PD Patients (N = 54) vs. ET Patients (N = 121) at Last Visit

	ET→PD (n = 54)	ET (n = 121)	Significance (p)
Demographic data
Gender (males: n; %)	24/54; 44.4%	52/121; 42.9%	0.86 ¹
Age at last visit (mean ± SD years)	72.63 (±9.25)	66.90 (±12.35)	0.003 ³
Data from history
Age at onset of ET (mean ± SD years)	54.24 (±15.24)	53.21 (±15.84)	0.69 ³
Age at onset of PD (mean ± SD years)	69.61(±8.95)
Duration of ET (mean ± SD years)	18.39 (±14.39)	13.69 (±12.69)	0.03 ³
Duration of PD (mean ± SD years)	3.02 (±3.50)
Family history of ET (n; %)	14/54; 25.9 %	56/121; 46.3%	0.01 ¹
Family history of PD (n; %)	7/54; 13.0%	1/121; 0.8%	0.001 ²
Asymmetric tremor at ET onset (n; %)	37/54; 68.5%	18/121; 14.9%	<0.001 ¹
Ethanol response (n; %)	17/22 ⁴ ; 77.2%	95/99 ⁴ ; 96.0%	0.003 ¹
Extrapyramidal signs
Bradykinesia (n; %)	40/52 ⁴ ; 77.0%	28/121; 23.1%	<0.001 ¹
Rigidity (n; %)	50/50 ⁴ ; 100%	16/120 ⁴ ; 13.3%	<0.001 ¹
Cogwheel sign (n; %)	52/54; 96.3%	12/121; 10.0%	<0.001 ¹
Abnormal fine movements (n; %)	28/54; 51.9%	29/121; 24.0%	<0.001 ¹
Postural instability (n; %)	13/54; 24.1%	10/102 ⁴ ; 9.8%	0.03 ²
Gait swing (n; %)	42/52 ⁴ ; 80.1%	11/118 ⁴ ; 9.3%	<0.001 ²
Camptocormia (n; %)	26/52 ⁴ ; 50.0%	9/119 ⁴ ; 7.6%	<0.001 ²
Hypophonia (n; %)	21/52 ⁴ ; 40.4%	33/120 ⁴ ; 27.5%	0.09 ¹
Hypomimia (n; %)	31/52 ⁴ ; 59.6%	24/120 ⁴ ; 20.0%	<0.001 ¹
Abnormal blink reflex (n; %)	51/54; 94.4%	24/107 ⁴ ; 22.4%	<0.001 ¹
Tremor characteristics
Head (neck) tremor (n; %)	7/53 ⁴ ; 13.2%	50/115 ⁴ ; 43.5%	<0.001 ¹
Voice tremor (n; %)	14/51 ⁴ ; 27.5%	19/114 ⁴ ; 16.7%	0.11 ¹
Jaw tremor (n; %)	3/54; 5.6%	10/121; 8.3%	0.76 ²
Hand tremor (n; %)	54/54; 100%	121/121; 100%
Thumb (at rest) (n; %)	6/54; 11.1%	2/121; 1.7%	0.01 ²
Lower limb tremor (n; %)	5/54; 9.3%	15/121; 12.4%	0.62 ²
Widespread tremor (n; %)	24/54; 44.4%	77/121; 63.6%	0.03 ¹
Gait tremor (n; %)	37/52 ⁴ ; 71.1%.	11/119 ⁴ ; 9.2%	<0.001 ¹
Rest tremor (n; %)	51/51 ⁴ ; 100%	16/121; 13.2%	<0.001 ²
Postural tremor (n; %)	43/51 ⁴ ; 8.3%	97/121; 80.2%	0.52 ¹
Action tremor (n; %)	51/54; 94.4%	119/121; 98.4%	0.17 ²
Intention tremor (n; %)	5/54; 9.3%	108/121; 89.3%	<0.001 ²
Cerebellar signs (n; %)	5/54; 9.3%	50/121; 41.3%	<0.001 ²
Non-motor features
Hearing impairment (n; %)	15/53 ⁴ ; 28.3%	79/121; 65.3%	<0.001 ¹
Olfactory dysfunction (n; %)	45/54; 83.3%	66/121; 54.6%	<0.001 ¹
Constipation (n; %)	36/53 ⁴ ; 67.9%.	43/118 ⁴ ; 36.4%	<0.001 ¹
RLS (n; %)	2/54; 3.7%	41/118 ⁴ ; 34.8%	<0.001 ²
RBD (n; %)	28/54; 51.9%	12/120 ⁴ ; 10.0%	<0.001 ²

Abbreviations: ET, Essential Tremor; PD, Parkinson’s Disease; RBD, Rapid Eye Movement Behavior Disorder; RLS, Restless Legs Syndrome; SD, Standard Deviation.

1 Pearson’s chi-square test.

2 Fisher’s exact test.

3 Student’s t-test two-group mean comparison.

4 Data not available for all subjects.