Tremor at Onset

Hershey, Linda A.

doi:10.1001/archneur.1991.00530220069021

Cited by 27 publications

(5 citation statements)

References 26 publications

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“…We observed that 100% of TD had a tremor onset, but there was also a non-negligible proportion of patients that converted from a tremor-dominant onset to an intermediate phenotype (45% of I) or even to PIGD(25% of PIGD). This suggests that, in accordance with the literature[ 2 ],PD patients with a tremor onset may evolve as the disease progresses to TD, I or, with a lower likelihood, to PIGD. Although a longitudinal study is necessary to corroborate this hypothesis, we speculate that those patients with a tremor onset that will maintain a TD phenotype may be those with higher levels of UA.…”

Section: Discussionsupporting

confidence: 86%

“…The former is characterized by a predominance of tremor and the latter by a predominance of rigidity, akinesia, and/or postural instability and gait disorder (PIGD) symptoms. This distinction differs between symptom predominance at presentation of the disease and symptom predominance at later stages, since some patients presenting with tremor at onset become predominantly rigid-akinetic or PIGD in more advanced stages[ 2 ]. Previous studies have demonstrated that PD patients who continue to have tremor dominance after several years progress more slowly than those with predominance of non-tremor symptoms[ 3 , 4 ], including a lower likelihood to develop cognitive impairment and dementia[ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Lower levels of uric acid and striatal dopamine in non-tremor dominant Parkinson's disease subtype

et al. 2017

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Parkinson’s disease (PD) patients who present with tremor and maintain a predominance of tremor have a better prognosis. Similarly, PD patients with high levels of uric acid (UA), a natural neuroprotectant, have also a better disease course. Our aim was to investigate whether PD motor subtypes differ in their levels of UA, and if these differences correlate with the degree of dopamine transporter (DAT) availability. We included 75 PD patients from whom we collected information about their motor symptoms, DAT imaging and UA concentration levels. Based on the predominance of their motor symptoms, patients were classified into postural instability and gait disorder (PIGD, n = 36), intermediate (I, n = 22), and tremor-dominant (TD, n = 17) subtypes. The levels of UA and striatal DAT were compared across subtypes and the correlation between these two measures was also explored. We found that PIGD patients had lower levels of UA (3.7 vs 4.5 vs 5.3 mg/dL; P<0.001) and striatal DAT than patients with an intermediate or TD phenotype. Furthermore, UA levels significantly correlated with the levels of striatal DAT. We also observed that some PIGD (25%) and I (45%) patients had a predominance of tremor at disease onset. We speculate that UA might be involved in the maintenance of the less damaging TD phenotype and thus also in the conversion from TD to PIGD. Low levels of this natural antioxidant could lead to a major neuronal damage and therefore influence the conversion to a more severe motor phenotype.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Lower levels of uric acid and striatal dopamine in non-tremor dominant Parkinson's disease subtype

et al. 2017

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“…Patients’ disease type was classified as tremor-at-onset type or bradykinesia/rigidity-at-onset type by review of their medical record, depending on their initial presentation at their first visit to our clinics. 24 , 25 Individuals with resting tremor predominant as initial presentation were classified as tremor-at-onset type; others were classified as bradykinesia/rigidity-at-onset type.…”

Section: Methodsmentioning

confidence: 99%

The impact of nonmotor symptoms on quality of life in patients with Parkinson's disease in Taiwan

Liu

Lin

et al. 2015

NDT

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PurposeThe nonmotor symptoms (NMS) of Parkinson’s disease (PD) are important factors for quality of life (QoL). Few studies on NMS have been conducted in Asian PD patients. Additionally, effects of anti-PD drugs on risk of NMS are still controversial. We therefore conducted this hospital-based cross-sectional study to examine the clinical factors, including concomitant anti-PD medication use, on the occurrence of NMS and QoL in Taiwanese PD patients.Patients and methodsPD patients who received long-term follow-up in the movement disorders clinics were enrolled and received NMS questionnaire (NMSQuest) and the 39-item Parkinson’s Disease Questionnaire (PDQ-39). Spearman’s rank correlation coefficient was checked for the correlation between clinical factors and NMSQT/PDQSI. Multiple linear regressions were applied to assess the influence of clinical factors on NMSQT/PDQSI.ResultsA total of 210 PD patients (mean age 66.1±9.86 years, Hoehn and Yahr stage 2.2±0.9) were included in this study. Up to 98% of patients reported at least one symptom of NMS. The most prevalent symptom was urinary complaints (56%), followed by memory/apathy (30%) and depression/anxiety (28%). The correlation between NMSQT and PDQSI was strong (rs=0.667), especially the item of depression/anxiety (rs=0.607). The regression model for NMSQT indicated that disease duration and severity, but not pharmacological therapy, were major predictors of NMS.ConclusionOur data indicated a high prevalence rate of NMS in PD patients. Among symptoms of NMS, depression and anxiety had the greatest impact on QoL. Concomitant anti-PD medication use did not affect the occurrence of NMS and QoL.

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“…Recently, some researchers have held the notion that the PIGD and TD could simply be different stages of PD (Nutt, 2016), since some TD patients evaluated at onset were predominantly PIGD in more advanced stages (Hershey et al, 1991). However, our results support the notion that the PIGD and TD motor phenotypes could not be accounted for by differences in disease stage or duration.…”

Section: Discussionmentioning

confidence: 99%

The Ventral Intermediate Nucleus Differently Modulates Subtype-Related Networks in Parkinson’s Disease

et al. 2019

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Background: Posture instability gait difficulty-dominant (PIGD) and tremor-dominant (TD) are two subtypes of Parkinson’s disease (PD). The thalamus is involved in the neural circuits of both subtypes. However, which subregion of the thalamus has an influence on the PD subtypes remains unclear.Objective: To explore the core subregion of the thalamus showing a significant influence on the PD subtypes and its directional interaction between the PD subtypes.Methods: A total of 79 PD patients (43 TD and 36 PIGD) and 31 normal controls (NC) were enrolled, and the gray matter volume and perfusion characteristics in the thalamus were compared between the three groups. The subregion of the thalamus with significantly different perfusion and volume among three groups was used as the seed of a Granger causality analysis (GCA) to compare the causal connectivity between different subtypes.Results: Perfusion with an increased gradient among the three groups (TD > PIGD > NC) in the bilateral ventral intermediate nucleus (Vim) was observed, which was positively correlated with the clinical tremor scores. The GCA revealed that TD patients had enhanced causal connectivity from the bilateral Vim to the bilateral paracentral gyrus, M1 and the cerebellum compared with the NC group, while the PIGD subtype revealed an increased causal connectivity from the bilateral Vim to the bilateral premotor cortex (preM) and putamen. Additionally, there were positive correlations between the tremor scores and a causal connectivity from the Vim to the cerebellum. The connectivity from the right Vim to the right preM and the right putamen was positively correlated with the PIGD scores.Conclusion: This multilevel analysis showed that the Vim had a significant influence on the PD subtypes and that it differentially mediated the TD and PIGD-related causal connectivity pattern in PD.

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Tremor at Onset

Cited by 27 publications

References 26 publications

Lower levels of uric acid and striatal dopamine in non-tremor dominant Parkinson's disease subtype

Lower levels of uric acid and striatal dopamine in non-tremor dominant Parkinson's disease subtype

The impact of nonmotor symptoms on quality of life in patients with Parkinson's disease in Taiwan

The Ventral Intermediate Nucleus Differently Modulates Subtype-Related Networks in Parkinson’s Disease

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Tremor at Onset

Cited by 27 publications

References 26 publications

Lower levels of uric acid and striatal dopamine in non-tremor dominant Parkinson's disease subtype

Lower levels of uric acid and striatal dopamine in non-tremor dominant Parkinson's disease subtype

The impact of nonmotor symptoms on quality of life in patients with Parkinson&#39;s disease in Taiwan

The Ventral Intermediate Nucleus Differently Modulates Subtype-Related Networks in Parkinson’s Disease

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Product

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The impact of nonmotor symptoms on quality of life in patients with Parkinson's disease in Taiwan