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New horizons in late-onset essential tremor: a pre-cognitive biomarker of dementia?

Wang, X, St George, RJ ORCID: 0000-0001-6206-1069, Bai, Q ORCID: 0000-0003-1214-6317, Tran, S ORCID: 0000-0002-5912-293X and Alty, J ORCID: 0000-0002-5456-8676 2022 , 'New horizons in late-onset essential tremor: a pre-cognitive biomarker of dementia?' , Age and Ageing, vol. 51, no. 7 , doi:

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Essential tremor (ET) is the most common cause of tremor in older adults. However, it is increasingly recognised that 30-50% of ET cases are misdiagnosed. Late-onset ET, when tremor begins after the age of 60, is particularly likely to be misdiagnosed and there is mounting evidence that it may be a distinct clinical entity, perhaps better termed 'ageing-related tremor'. Compared with older adults with early-onset ET, late-onset ET is associated with weak grip strength, cognitive decline, dementia and mortality. This raises questions around whether late-onset ET is a pre-cognitive biomarker of dementia and whether modification of dementia risk factors may be particularly important in this group. On the other hand, it is possible that the clinical manifestations of late-onset ET simply reflect markers of healthy ageing, or frailty, superimposed on typical ET. These issues are important to clarify, especially in the era of specialist neurosurgical treatments for ET being increasingly offered to older adults, and these may not be suitable in people at high risk of cognitive decline. There is a pressing need for clinicians to understand late-onset ET, but this is challenging when there are so few publications specifically focussed on this subject and no specific features to guide prognosis. More rigorous clinical follow-up and precise phenotyping of the clinical manifestations of late-onset ET using accessible computer technologies may help us delineate whether late-onset ET is a separate clinical entity and aid prognostication.

Item Type: Article
Authors/Creators:Wang, X and St George, RJ and Bai, Q and Tran, S and Alty, J
Keywords: ageing-related tremor, biomarker, computer vision, dementia, late-onset essential tremor, late onset tremor, ageing, pre-clinical
Journal or Publication Title: Age and Ageing
Publisher: Oxford University Press
ISSN: 0002-0729
DOI / ID Number:
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© The Author(s) 2022. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) License (, which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited

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