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Differences in clinical manifestations of late onset, compared to earlier onset essential tremor: a scoping review

Wang, Xinyi, St George, RJ ORCID: 0000-0001-6206-1069, Bai, Q ORCID: 0000-0003-1214-6317, Tran, SN ORCID: 0000-0002-5912-293X and Alty, JE ORCID: 0000-0002-5456-8676 2022 , 'Differences in clinical manifestations of late onset, compared to earlier onset essential tremor: a scoping review' , Journal of the neurological sciences, vol. 440 , pp. 1-5 , doi: 10.1016/j.jns.2022.120336.

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Abstract

Across the world, Essential Tremor (ET) is the most common tremor diagnosis but up to half of these diagnoses are inaccurate. The misdiagnosis rate is particularly high in late-onset ET, when tremor begins after the age of 60 years. Currently, ET is reported to affect 5.5% of those over 65 years old and 21.7% aged over 95 but there is emerging evidence that late-onset ET has associations with dementia, mortality and more rapid progression. With ageing populations, and a range of new surgical treatments for ET, there is urgent need to clarify whether the clinical manifestations of late-onset ET are the same as for earlier-onset ET. This scoping review used MEDLINE, EMBASE and CINAHL as the information sources of published peer-reviewed research articles between 2011 and 2021. Analysis was done by narrative synthesis. 14 relevant papers were retrieved from studies conducted in Denmark, India, Italy, Germany, Spain and the US and, together, they comprised 7684 participants in total. Compared to older adults with earlier-onset ET, there is evidence that late-onset ET is associated with higher risk of cognitive impairment and dementia, higher mortality rate, faster rate of progression, lack of family history, altered cortical electrical activity, prolonged pupillary responses, and less propensity to demonstrate characteristic alcohol sensitivity. There is evidence that late-onset ET has different clinical manifestations to earlier-onset ET; in particular there is higher risk of dementia and mortality. The prognosis is important for clinicians to consider when selecting candidates for deep brain stimulation surgery and also for advanced care planning.

Item Type: Article
Authors/Creators:Wang, Xinyi and St George, RJ and Bai, Q and Tran, SN and Alty, JE
Keywords: Tremor, ageing, dementia, motor, biomarker, cognitive impairment, fraility
Journal or Publication Title: Journal of the neurological sciences
Publisher: Elsevier Science Bv
ISSN: 0022-510X
DOI / ID Number: 10.1016/j.jns.2022.120336
Copyright Information:

Copyright 2022 Elsevier B.V.

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