Cognitive deficits in patients with essential tremor

Lombardi, Wendy J.; Woolston, Dixie J.; Roberts, John W.; Gross, Robert E.

doi:10.1212/wnl.57.5.785

Cited by 245 publications

(284 citation statements)

References 30 publications

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“…The projection areas in patients with mild TBI showed greater activation in the present study, particularly in the dorsolateral prefrontal cortex, corresponding to the areas of working memory and executive functions (24). This finding may indicate preserved gray matter that was activated to compensate for the frontocerebellar circuit (25). Such compensatory activation was previously reported in alcoholics using functional MRI (26).…”

Section: Discussionsupporting

confidence: 75%

Differential SPECT Activation Patterns Associated with PASAT Performance May Indicate Frontocerebellar Functional Dissociation in Chronic Mild Traumatic Brain Injury

et al. 2009

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Patients with mild traumatic brain injury (TBI) often complain of cognitive fatigue during the chronic recovery phase. The Paced Auditory Serial Addition Test (PASAT) is a complex psychologic measure that may demonstrate subtle deficiencies in higher cognitive functions. The purpose of this study was to investigate the brain activation of regional cerebral blood flow (rCBF) with PASAT in patients with mild TBI to explore mechanisms for the cognitive fatigue. Methods: Two groups consisting of 15 patients with mild TBI and 15 healthy control subjects underwent 99m Tc-ethylene cysteine dimer SPECT at rest and during PASAT on a separate day. Cortical rCBF was extracted using a 3-dimensional stereotactic surface projection and statistically analyzed to identify areas of activation, which were compared with PASAT performance scores. Results: Image analysis demonstrated a difference in the pattern of activation between patients with mild TBI and healthy control subjects. Healthy control subjects activated the superior temporal cortex (Brodmann area [BA] 22) bilaterally, the precentral gyrus (BA 9) on the left, and the precentral gyrus (BA 6) and cerebellum bilaterally. Patients with mild TBI demonstrated a larger area of supratentorial activation (BAs 9, 10, 13, and 46) but a smaller area of activation in the cerebellum, indicating frontocerebellar dissociation. Conclusion: Patients with mild TBI and cognitive fatigue demonstrated a different pattern of activation during PASAT. Frontocerebellar dissociation may explain cognitive impairment and cognitive fatigue in the chronic recovery phase of mild traumatic brain injury.

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Section: Discussionsupporting

confidence: 75%

Differential SPECT Activation Patterns Associated with PASAT Performance May Indicate Frontocerebellar Functional Dissociation in Chronic Mild Traumatic Brain Injury

et al. 2009

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“…4,5,15,28,33 Sánchez-Ferro et al stated that patients with ET had impaired cognitive performance, predominantly in cognitive processing speed, even in nondementia cases. 33 Authors of some prospective studies have stated that patients with ET have an increased risk of dementia during the disease period.…”

Section: Discussionmentioning

confidence: 99%

Effects on cognition and quality of life with unilateral magnetic resonance–guided focused ultrasound thalamotomy for essential tremor

Jung

Park

Chang

et al. 2018

Neurosurgical Focus

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OBJECTIVEAlthough neurosurgical procedures are effective treatments for controlling involuntary tremor in patients with essential tremor (ET), they can cause cognitive decline, which can affect quality of life (QOL). The purpose of this study is to assess the changes in the neuropsychological profile and QOL of patients following MR-guided focused ultrasound (MRgFUS) thalamotomy for ET.METHODSThe authors prospectively analyzed 20 patients with ET who underwent unilateral MRgFUS thalamotomy at their institute in the period from March 2012 to September 2014. Patients were regularly evaluated with the Clinical Rating Scale for Tremor (CRST), neuroimaging, and cognition and QOL measures. The Seoul Neuropsychological Screening Battery was used to assess cognitive function, and the Quality of Life in Essential Tremor Questionnaire (QUEST) was used to evaluate the postoperative change in QOL.RESULTSThe total CRST score improved by 67.3% (from 44.75 ± 9.57 to 14.65 ± 9.19, p < 0.001) at 1 year following MRgFUS thalamotomy. Mean tremor scores improved by 68% in the hand contralateral to the thalamotomy, but there was no significant improvement in the ipsilateral hand. Although minimal cognitive decline was observed without statistical significance, memory function was much improved (p = 0.031). The total QUEST score also showed the same trend of improving (64.16 ± 17.75 vs 27.38 ± 13.96, p < 0.001).CONCLUSIONSThe authors report that MRgFUS thalamotomy had beneficial effects in terms of not only tremor control but also safety for cognitive function and QOL. Acceptable postoperative changes in cognition and much-improved QOL positively support the clinical significance of MRgFUS thalamotomy as a new, favorable surgical treatment in patients with ET.

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“…Patients also may have signs of more widespread cerebellar involvement (e.g., intention tremor, ataxia; Deuschl et al 2000;Singer et al 1994;Stolze et al 2000), abnormalities referable to the basal ganglia (e.g., rest tremor, subclinical signs of bradykinesia; Cohen et al 2003;Rajput et al 1993), and cognitive deficits (Gasparini et al 2001;Lombardi et al 2001). ET is considered to be distinct from age-related enhanced physiologic tremor, which has different clinical and electrophysiologic features (Louis et al 1997;Louis and Pullman 2001).…”

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confidence: 99%

Association between essential tremor and blood lead concentration.

Louis

Jurewicz

Applegate

et al. 2003

Environ Health Perspect

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Lead is a ubiquitous toxicant that causes tremor and cerebellar damage. Essential tremor (ET) is a highly prevalent neurologic disease associated with cerebellar involvement. Although environmental toxicants may play a role in ET etiology and their identification is a critical step in disease prevention, these toxicants have received little attention. Our objective was to test the hypothesis that ET is associated with lead exposure. Therefore, blood lead (BPb) concentrations were measured and a lifetime occupational history was assessed in ET patients and in controls. We frequency matched 100 ET patients and 143 controls on age, sex, and ethnicity. BPb concentrations were analyzed using graphite furnace atomic absorption spectrophotometry. A lifetime occupational history was reviewed by an industrial hygienist. BPb concentrations were higher in ET patients than in controls (mean +/- SD, 3.3 +/- 2.4 and 2.6 +/- 1.6 microg/dL, respectively; median, 2.7 and 2.3 microg/dL; p = 0.038). In a logistic regression model, BPb concentration was associated with diagnosis [control vs. ET patient, odds ratio (OR) per unit increase = 1.21; 95% confidence interval (CI), 1.05-1.39; p = 0.007]. BPb concentration was associated with diagnosis (OR per unit increase = 1.19; 95% CI, 1.03-1.37; p = 0.02) after adjusting for potential confounders. Prevalence of lifetime occupational lead exposure was similar in ET patients and controls. We report an association between BPb concentration and ET. Determining whether this association is due to increased exposure to lead or a difference in lead kinetics in ET patients requires further investigation.

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Cognitive deficits in patients with essential tremor

Abstract: Patients with ET have deficits in specific aspects of neuropsychological functioning, particularly those thought to rely on the integrity of the prefrontal cortex, which suggests involvement of frontocerebellar circuits in this disease.

Cited by 245 publications

References 30 publications

Differential SPECT Activation Patterns Associated with PASAT Performance May Indicate Frontocerebellar Functional Dissociation in Chronic Mild Traumatic Brain Injury

Differential SPECT Activation Patterns Associated with PASAT Performance May Indicate Frontocerebellar Functional Dissociation in Chronic Mild Traumatic Brain Injury

Effects on cognition and quality of life with unilateral magnetic resonance–guided focused ultrasound thalamotomy for essential tremor

Association between essential tremor and blood lead concentration.

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