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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Essential tremor (ET), more common than Parkinson's disease (PD), has commonly been considered "benign." This investigation compared diagnostic characteristics, patient satisfaction with treatment, and psychosocial complications between a group of male patients treated for essential tremor and a group of male parkinsonian patients. Those who had ET tended to be more commonly misdiagnosed than those with PD. Fewer ET patients were satisfied with response to treatment than PD patients. Both groups equally expressed embarrassment about their condition, and both perceived similar difficulties with common activities of daily living and social situations. There were no significant differences between ET and PD patients for history of ethanol use or pharmacotherapy for anxiety or depression.
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PMID:Severe essential tremor compared with Parkinson's disease in male veterans: diagnostic characteristics, treatment, and psychosocial complications. 150 24

Essential tremor (ET) is the most common type of movement disorder, although its etiology and neurophysiological substrates remain unclear. While thought to be a benign condition, it has yet to be studied from a neuropsychological perspective. We examined the neurocognitive functioning of 13 nondemented subjects with severe ET, including aspects of memory, cognitive flexibility, and attention. Results revealed that 12/13 subjects demonstrated impairment on 1 or more cognitive measures in comparison with published normative data. The pattern of findings was suggestive of relative dysfunction of frontal-mediated processes not unlike that seen in Parkinson's disease. These deficits were found in subjects irrespective of the presence of cognitive complaints, depression, or the existence of other potential neurocognitive risk factors. These findings suggest that mild cognitive deficits are not uncommon in association with severe ET and may be related to subcortical systems.
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PMID:Cognitive functioning in individuals with "benign" essential tremor. 1184 70

Essential tremor (ET) is associated with both functional disability and depression. Each could contribute to a poor sense of well-being and low morale. We hypothesized that morale would be lower in ET cases than controls. Using a population-based, cross-sectional design, morale was assessed in 187 ET cases and 561 matched controls living in three communities in central Spain using the Philadelphia Geriatric Center Morale Scale (PGCMS) (range = 0 [low morale]-17), which included three-dimensions of psychological well-being: agitation, lonely dissatisfaction, and attitude toward own aging. The PGCMS score was lower in ET cases than controls (9.41 +/- 3.21 vs. 10.39 +/- 2.92, P < 0.001), as were the Agitation subscore (3.17 +/- 1.71 vs. 3.78 +/- 1.67, P< 0.001) and Lonely Dissatisfaction subscore (3.75 +/- 1.34 vs. 4.02 +/- 1.24, P < 0.05). Nearly one-half of the ET cases were classified as having low morale compared with only one-third of controls (P = 0.006). In a linear regression analysis adjusting for demographic factors and multiple comorbid conditions, ET cases had a lower log PGCMS score than controls (P < 0.001). Exclusion of participants on antidepressant medication did not change the results. Our results indicate that morale is significantly lower in community-dwelling ET cases than in matched controls. This lower morale could in part be a proxy for mild, untreated depression. It therefore seems important to detect and then possibly treat this problem to improve the psychological well-being of patients with this disease.
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PMID:Philadelphia Geriatric Morale Scale in essential tremor: a population-based study in three Spanish communities. 1851 46

Essential tremor (ET) is a syndrome of tremor in posture and movement, but recent studies have revealed additional cerebellar motor disturbances, cognitive disturbances, personality changes, hearing loss, and olfactory deficits. Even dementia and shortened life expectancy were found in one cohort. Recent postmortem studies have found limited Lewy body pathology in some patients and Purkinje cell loss with torpedoes and Bergmann gliosis in others. These findings have led to the hypothesis that ET is a syndrome produced by at least two neurodegenerative diseases with more widespread clinical consequences than previously appreciated. We review the evidence for and against this hypothesis and conclude that studies purporting to support this hypothesis have failed to control for age-associated comorbidities, depression, medications, and other confounding factors. We propose the alternative hypothesis that abnormal neuronal oscillation is the fundamental abnormality in ET, and the well-documented cerebellar signs and symptoms, the controversial non-motor signs, and even the cerebellar pathology of ET could be caused by this oscillation. A major problem for many studies is the lack of a diagnostic gold standard. Lacking such a standard, we propose a subclassification of ET into three categories: hereditary ET, sporadic ET, and senile ET, which we believe will help researchers resolve many of the controversies in this field.
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PMID:Essential tremor--neurodegenerative or nondegenerative disease towards a working definition of ET. 1975 Apr 93

Classically, essential tremor (ET) was defined by the Movement Disorder Society Consensus Statement on Tremor (1998) as "a bilateral, largely symmetric postural or kinetic tremor involving hands and forearms that is visible and persistent". Additional or isolated tremor of the head may occur but in the absence of abnormal posture. Duration is more than 5 years and the neurological examination is normal, with exception of the cogwheel phenomenon. In the last years ET has evolved into two different meanings. First of all, the classical ET, as a monosymptomatic disorder, and second, a heterogeneous disorder, the Essential Tremors, or a family of diseases. Nowadays, ET can be classified with both motor and non-motor elements. Tremor may occur also in the legs, feet, trunk, jaw, chin, tongue, and voice. Although postural and kinetic tremors are the main features of ET, intentional tremor and tremor at rest may also occur in some patients. Other motor features described in patients with ET are gait ataxia, postural instability and eye-motion abnormalities. Non-motor features include cognitive (memory and executive problems and dementia), psychiatric (anxiety, depression and social phobia), and sensory abnormalities (olfactory deficits, hearing loss).
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PMID:Essential tremor: phenotypes. 2216 15

There is a growing evidence to suggest that apart from motor features, patients with Essential Tremor (ET) may have significant non-motor features. This review critically analyzes the available evidence of the various non-motor symptoms in patients with ET. Apart from tremor, patients with ET have been reported to have: (i) cognitive abnormalities characterized by mild frontal dysfunction that may have a functional impact, (ii) an association with dementia (both prevalent and incident) among those with late onset of tremor (>65 years), (iii) a higher prevalence of anxiety and an anxious and worrisome personality type, (iv) depressive symptomatology and may even have depression as a premotor symptom, (v) poor sleep quality and (vi) subjective hearing impairment. It is controversial whether olfactory dysfunction occurs in ET and its utility as a diagnostic aid. The biological basis for each of these observations requires further clarification and some findings need confirmation in population-based studies. However the available evidence is sufficient to support the notion that ET can no longer be considered as a pure motor disorder and further studies of these non-motor aspects will go a long way in understanding and comprehensively treating ET.
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PMID:Essential tremor: beyond the motor features. 2221 58

Deep brain stimulation (DBS) within the basal ganglia complex is an effective neurosurgical approach for treating symptoms of Parkinson's disease (PD), Essential Tremor, Dystonia, Depression, Obssessive Compulsive Disorder, and Tourette's Syndrome, among others. Elucidating DBS mechanism has become a critical clinical and research goal in stereotactic and functional neurosurgery and in neural engineering. Along with electro-physiological and microdialysis techniques, two additional powerful technologies, notably functional Magnetic Resonance Imaging (fMRI) and in vivo neurochemical monitoring have recently been used to investigate DBS-mediated activation of basal ganglia network circuitry. For this purpose, we have previously developed WINCS (Wireless Instantaneous Neurotransmitter Concentration Sensor System), which is an MRI-compatible wireless monitoring device to obtain chemically resolved neurotransmitter measurements at implanted microsensors in a large mammalian model (pig) as well as in human patients. This device supports an array of electrochemical measurements that includes fast-scan cyclic voltammetry (FSCV) for real-time simultaneous in vivo monitoring of dopamine and adenosine release at carbon-fiber microelectrodes as well as fixed potential amperometry for monitoring of glutamate at enzyme-linked biosensors. In addition, we have utilized fMRI to investigate subthalamic nucleus (STN) DBS activation in the pig with 3Tesla MR scanner. We demonstrate the activation of specific basal ganglia circuitry during STN DBS using both fMRI and FSCV in the pig model. Our results suggest that fMRI and electrochemistry are important emerging techniques for use in elucidating mechanism of action of DBS.
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PMID:Emerging techniques for elucidating mechanism of action of deep brain stimulation. 2225

Essential tremor (ET) is a pathologically heterogeneous neurodegenerative disorder with both motor and increasingly recognized non-motor features. It is debated whether the non-motor manifestations in ET result from widespread neurodegeneration or are merely secondary to impaired motor functions and decreased quality of life due to tremor. It is important to review these features to determine how to best treat the non-motor symptoms of patients and to understand the basic pathophysiology of the disease and develop appropriate pharmacotherapies. In this review, retrospective and prospective clinical studies were critically analyzed to identify possible correlations between the severities of non-motor features and tremor. We speculated that if such a correlation existed, the non-motor features were likely to be secondary to tremor. According to the current literature, the deficits in executive function, attention, concentration, and memory often observed in ET are likely to be a primary manifestation of the disease. It has also been documented that patients with ET often exhibit characteristic personality traits. However, it remains to be determined whether the other non-motor features often seen in ET, such as anxiety, depression, and sleep disturbances are primary or secondary to motor manifestations of ET and subsequent poor quality of life. Finally, there is evidence that patients with ET can also have impaired color vision, disturbances of olfaction, and hearing impairments, though there are few studies in these areas. Further investigations of large cohorts of patients with ET are required to understand the prevalence, nature, and true significance of the non-motor features in ET.
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PMID:The Non-motor Features of Essential Tremor: A Primary Disease Feature or Just a Secondary Phenomenon? 2512 Sep 45

Essential tremor (ET) is considered a benign disease without any pathological changes. Nevertheless, this point of view has recently been challenged. In recent years, studies have shown that ET occurs with other non-motor symptoms, such as cognitive deficits, depression, anxiety, balance disorder, hearing impairment, olfactory dysfunction and sleep problems. Advancements in neuroimaging have revealed widespread alterations in the brain, and cerebellar involvement was the most consistent finding. In addition, studies have also shown that ET patients might experience poor quality of life, reflecting motor or non-motor symptoms. Both pharmacotherapy and non-pharmacotherapy have recently been suggested for the treatment of ET. This review briefly describes the current information on ET, including the non-movement symptoms, neuroimaging findings, the impact on daily life and ET therapy.
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PMID:Review on clinical update of essential tremor. 2674 68

Essential tremor (ET) was long believed to be a monosymptomatic disorder. However, studies have evidenced structural changes and attention is now being focused on non-motor symptoms. The objective of the study is to describe and compare ET patients with control groups according to their cognitive functions, and secondarily, to compare their sociodemographic characteristics and other clinical features. All participants were assessed using the Fahn-Tolosa-Marin Tremor Rating Scale for the severity of tremor; a neuropsychological assessment battery and a screening questionnaire for mood and anxiety symptoms. There were no significant age and gender differences between all groups. As for neuropsychological assessment results, a significant difference was found only in the Pegboard test. We also found a significant negative correlation between a poorer cognitive test results and disease severity and a significant differences regarding depression or anxiety symptoms in patients with ET. The study results suggest that patients with ET have impaired manual dexterity and attention.
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PMID:Patients with essential tremor can have manual dexterity and attention deficits with no impairments in other cognitive functions. 2698 89


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