Dementia in Essential Tremor: A Visual Record Cover

Dementia in Essential Tremor: A Visual Record

Tremor and Other Hyperkinetic Movements

Volume 9 (2019): Issue 0

By: Maria Anna Zdrodowska, Tess E. K. Cersonsky, Arash Salardini, Stephanie Cosentino and Elan D. Louis

Open Access

|Mar 2019

Figures & Tables

Abnormal Spiral Drawn by an ET Patient with Dementia. Patient 1 was unable to correctly complete the spiral drawing task because she did not understand the task. Rather than drawing spirals of increasing diameter, she attempted to draw one or two concentric circles and then got confused and stopped.

Video 1.

Three ET Patients with Co-morbid Dementia. Patient 1. This 85-year-old female has had essential tremor for 10 years. Her most recent total tremor score was 20 out of 36, indicative of moderate tremor. She has also experienced cognitive decline during the past 3 years, progressing during that period from Clinical Dementia Rating (CDR) = 1 (mild dementia) to CDR = 3 (severe dementia). Her most recent Mini-Mental State Examination score was 1 out of 30. In this video, the patient has difficulty performing the specified motor commands. With her right hand, she initially touches the pen and her own nose to command, but then goes on to have difficulty touching the pen as the task proceeds. Additionally, the hand gesture she uses for touching the pen is abnormal, with an open hand tilted to one side. She is then briefly confused when asked to use her left hand and struggles to complete the task correctly. This patient’s difficulties may be the result of several different impairments such as those related to verbal comprehension, working memory, response inhibition, and/or ideomotor apraxia (i.e., impaired ability to perform a skilled gesture with a limb upon verbal command). Patient 2. This 84-year-old female has had ET for 12 years. Her most recent total tremor score was 16 out of 36. During the previous three years, cognitive decline was observed from CDR = 0 (no dementia) to CDR = 2 (moderate dementia). Her most recent Mini-Mental State Examination score was 13 out of 30. Here she demonstrates problems with alternating between touching her nose and a pen. When using her right hand, she seems to have difficulty locating the pen and reaches for the examiner's hand instead. This may reflect a spatial disturbance such as optic ataxia, which arises from an inability to locate objects in visual space. However, it may also reflect a language disturbance, particularly comprehension of the word ‘pen’. Patient 3. This 99-year-old female has had ET for 24 years. Her most recent total tremor score = 27 out of 36. During the past three years, cognitive problems have developed, with a CDR = 1 (mild dementia) progressing to a CDR = 2 (moderate dementia). Her most recent Mini-Mental State Examination score was 17 out of 30. She has some difficulty initially following directions. When asked to repeat the sequence with her left hand, she comments, “I can’t find where I oughta be”. Her difficulty with correctly placing the left hand may be due to visuospatial dysfunction, dysfunctional left hemibody schema, or loss of mental set for the task instructions.

DOI: https://doi.org/10.5334/tohm.524 | Journal eISSN: 2160-8288

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Language: English

Submitted on: Jan 7, 2019

Accepted on: Feb 1, 2019

Published on: Mar 6, 2019

Published by: Columbia University Libraries/Information Services

In partnership with: Paradigm Publishing Services

Publication frequency: 1 issue per year

Keywords:

Essential tremor,

Clinical Dementia Rating,

cognitive decline

© 2019 Maria Anna Zdrodowska, Tess E. K. Cersonsky, Arash Salardini, Stephanie Cosentino, Elan D. Louis, published by Columbia University Libraries/Information Services
This work is licensed under the Creative Commons License.

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