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Cognitive and motor functional activity in non-demented community-dwelling essential tremor cases
  1. Elan D Louis1,2,3,4,
  2. Julián Benito-León5,6,
  3. Saturio Vega-Quiroga7,
  4. Félix Bermejo-Pareja5,6,
  5. The Neurological Disorders in Central Spain (NEDICES) Study Group
  1. 1GH Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, USA
  2. 2Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, USA
  3. 3Taub Institute for Research on Alzheimer's Disease and the Ageing Brain, College of Physicians and Surgeons, Columbia University, New York, USA
  4. 4Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
  5. 5The Department of Neurology, University Hospital ‘12 de Octubre,’ Madrid, Spain
  6. 6Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
  7. 7Arévalo Health Center, Arévalo, Spain
  1. Correspondence to Dr Elan D Louis, Unit 198, Neurological Institute, 710 West 168th Street, New York, NY 10032, USA; EDL2{at}


Background Many investigators have observed mild cognitive deficits in essential tremor (ET), yet the functional significance of these deficits is unclear. Also, there are very few data in which functional activity in ET has been divided into cognitively based activities (remembering appointments) versus motor-based activities (writing cheques).

Objective The authors (1) compared functional level in ET cases versus controls, assessing functional activities that are cognitively based and those that are dependent upon both motor and cognitive factors, and (2) determined whether lower mini mental status test scores in ET cases have a functional correlate.

Methods In a population-based study of people ≥65 years in central Spain (NEDICES), a 37-item version of the Mini-Mental State Examination (37-MMSE) and an 11-item version of the Pfeffer Functional Activities Questionnaire (FAQ) were administered to non-demented ET cases and controls.

Results The FAQ was 55.5% higher (ie, lower function) in 208 cases than 3616 controls (2.8±4.8 vs 1.8±4.2, p<0.001). Cases reported more difficulty (ie, higher FAQ scores) with FAQ items that were cognitive measures as well as FAQ items that were cognitive–motor in nature. In cases, a lower 37-MMSE was associated with more difficulty on both cognitively based and cognitive–motor-based FAQ items (p<0.001).

Discussion In this large, population-based study, ET cases reported more functional difficulty than controls, and this functional difficulty was present in both cognitive and cognitive–motor domains. Lower cognitive test scores were associated with more reported functional difficulty, indicating that lower cognitive test scores in ET, rather than being inconsequential, have a clear clinical–functional correlate.

  • Essential tremor
  • cognitive
  • dementia
  • function
  • disability
  • epidemiology
  • cognition
  • tremor

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  • Funding The NEDICES was supported by the Spanish Health Research Agency (FIS 93/0773 and 96/1993) and the Spanish Office of Science and Technology. Dr Louis was supported by R01 NS042859 and R01 NS039422 from the National Institutes of Health, Bethesda, Maryland.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by University Hospital ‘12 de Octubre’ and University Hospital ‘La Princesa.’

  • Provenance and peer review Not commissioned; externally peer reviewed.