Clinical Correlates of Action Tremor in Parkinson Disease | Movement Disorders | JAMA Neurology | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 35.175.212.130. Please contact the publisher to request reinstatement.
1.
Koller  WCVetere-Overfield  BBarter  R Tremors in early Parkinson's disease.  Clin Neuropharmacol.1989;12:293-297.Google Scholar
2.
Lance  JWSchwab  RSPeterson  EA Action tremor and the cogwheel phenomenon in Parkinson's disease.  Brain.1963;86:95-110.Google Scholar
3.
Forssberg  HIngvarsson  PEIwasaki  NJohansson  RSGordon  AM Action tremor during object manipulation in Parkinson's disease.  Mov Disord.2000;15:244-254.Google Scholar
4.
Schrag  ASchelosky  LScholz  UPoewe  W Reduction of Parkinsonian signs in patients with Parkinson's disease by dopaminergic versus anticholinergic single-dose challenges.  Mov Disord.1999;14:252-255.Google Scholar
5.
Teravainen  HCalne  DB Action tremor in Parkinson's disease.  J Neurol Neurosurg Psychiatry.1980;43:257-263.Google Scholar
6.
Zimmermann  RDeuschl  GHornig  ASchulte-Monting  JFuchs  GLucking  CH Tremors in Parkinson's disease: symptom analysis and rating.  Clin Neuropharmacol.1994;17:303-314.Google Scholar
7.
Findley  LJGresty  MAHalmagyi  GM Tremor, cogwheel phenomenon and clonus in Parkinson's disease.  J Neurol Neurosurg Psychiatry.1981;44:534-546.Google Scholar
8.
Louis  EDBarnes  LWendt  KJ  et al A teaching videotape for the assessment of essential tremor.  Mov Disord.2001;16:89-93.Google Scholar
9.
Jankovic  JSchwartz  KSOndo  W Re-emergent tremor of Parkinson's disease.  J Neurol Neurosurg Psychiatry.1999;67:646-650.Google Scholar
10.
Stern  YSano  MPaulson  JMayeux  R Modified mini-mental state examination: validity and reliability.  Neurology.1987;37(suppl 1):179. Google Scholar
11.
Mayeux  RDenaro  JHemenegildo  N  et al A population-based investigation of Parkinson's disease with and without dementia: relationship to age and gender.  Arch Neurol.1992;49:492-500.Google Scholar
12.
Hughes  AJDaniel  SEKilford  LLees  AJ Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinicopathological study of 100 cases.  J Neurol Neurosurg Psychiatry.1992;55:181-184.Google Scholar
13.
Hughes  AJBen-Shlomo  YKilford  LLees  AJ What features improve the accuracy of clinical diagnosis in Parkinson's disease: a clinicopathological study.  Neurology.1992;42:1142-1146.Google Scholar
14.
Ward  CDGibb  WR Research diagnostic criteria for Parkinson's disease.  In: Streifler  MB, Korczyn  AD, Melamed  E, Youdin  MBH, eds.  Parkinson's Disease: Anatomy, Pathology and Therapy. New York, NY: Raven Press; 1990:245-248. Google Scholar
15.
Stern  MB The clinical characteristics of Parkinson's disease and parkinsonian syndromes: diagnosis and assessment.  In: Stern  MB, Hurtig  HI, eds.  The Comprehensive Management of Parkinson's Disease. New York, NY: PMA Publishing Corp; 1978:34-39. Google Scholar
16.
Hoehn  MMYahr  MD Parkinsonism: onset, progression and mortality.  Neurology.1967;17:427-442.Google Scholar
17.
Louis  EDFord  BBismuth  B Reliability between two observers using a protocol for diagnosing essential tremor.  Mov Disord.1998;13:287-293.Google Scholar
18.
Piccini  PMorrish  PKTurjanski  N  et al Dopaminergic function in familial Parkinson's disease: a clinical and 18F-dopa positron emission tomography study.  Ann Neurol.1997;41:222-229.Google Scholar
19.
Zetusky  WJJankovic  JPirozzolo  FJ The heterogeneity of Parkinson's disease: clinical and prognostic implications.  Neurology.1985;35:522-526.Google Scholar
20.
Louis  EDTang  MXCote  LAlfaro  BMejia  HMarder  K Progression of extrapyramidal signs in Parkinson's disease.  Arch Neurol.1999;56:334-337.Google Scholar
21.
Vingerhoets  FJGSchulzer  MCalne  DB  et al Which clinical sign of Parkinson's disease best reflects the nigrostriatal lesion?  Ann Neurol.1997;41:58-64.Google Scholar
Original Contribution
October 2001

Clinical Correlates of Action Tremor in Parkinson Disease

Author Affiliations

From the Gertrude H. Sergievsky Center (Drs Louis, Levy, Côte, and Marder, and Ms Mejia) and the Department of Neurology (Drs Louis, Côte, Marder, and Fahn), College of Physicians and Surgeons, Columbia University, New York, NY.

Arch Neurol. 2001;58(10):1630-1634. doi:10.1001/archneur.58.10.1630
Abstract

Background  Action tremor is often noted in patients with Parkinson disease (PD), yet the clinical correlates of this type of tremor have been the focus of few studies. It is not clear whether this action tremor is a manifestation of the underlying basal ganglia disease.

Objective  To determine whether the severity of action tremor in PD is associated with age, age at disease onset, disease duration, levodopa dose, severity of rest tremor, or other motor (ie, bradykinesia, rigidity) and nonmotor manifestations of PD.

Methods  Patients with PD (N = 197) were ascertained as part of a familial aggregation study. All patients underwent a neurological examination. Rest tremor was rated with the Unified Parkinson Disease Rating Scale; and action tremor, with the Washington Heights–Inwood Genetic Study of Essential Tremor Rating Scale.

Results  Action tremor was present in 184 (93.4%) of 197 patients. Four patients (2%) met criteria for definite essential tremor. The action tremor score was not associated with age, age at onset, or disease duration. The action tremor score was associated with the rest tremor score (r = 0.37; P<.001), and more strongly with the ipsilateral than contralateral rest tremor score. The association between the action tremor score and the rest tremor score was diminished but still significant (r = 0.21, P<.02) even when we excluded these 63 patients with re-emergent tremor. Neither the action nor the rest tremor score was associated with the bradykinesia or rigidity scores, Hoehn and Yahr scale score, or modified Mini-Mental State Examination score.

Conclusions  Action tremor was associated with rest tremor in PD, suggesting that, at least in part, action tremor is a manifestation of the underlying basal ganglia disease. Neither tremor was associated with other motor and nonmotor manifestations of PD. This in turn suggests that tremor in PD may represent an underlying pathophysiological process different from these other manifestations.

×