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Original Data Collection Questionnaires. (PDF 1507 kb)

Essential tremor (ET) has been associated with a spectrum of clinical features, with both motor and nonmotor elements, including cognitive deficits. We employed resting-state functional magnetic resonance imaging (fMRI) to assess whether brain networks that might be involved in the pathogenesis of nonmotor manifestations associated with ET are altered, and the relationship between abnormal connectivity and ET severity and neuropsychological function.Resting-state fMRI data in 23 ET patients (12 women and 11 men) and 22 healthy controls (HC) (12 women and 10 men) were analyzed using independent component analysis, in combination with a dual-regression technique, to identify the group differences of resting-state networks (RSNs) (default mode network [DMN] and executive, frontoparietal, sensorimotor, cerebellar, auditory/language, and visual networks). All participants underwent a neuropsychological and neuroimaging session, where resting-state data were collected.Relative to HC, ET patients showed increased connectivity in RSNs involved in cognitive processes (DMN and frontoparietal networks) and decreased connectivity in the cerebellum and visual networks. Changes in network integrity were associated not only with ET severity (DMN) and ET duration (DMN and left frontoparietal network), but also with cognitive ability. Moreover, in at least 3 networks (DMN and frontoparietal networks), increased connectivity was associated with worse performance on different cognitive domains (attention, executive function, visuospatial ability, verbal memory, visual memory, and language) and depressive symptoms. Further, in the visual network, decreased connectivity was associated with worse performance on visuospatial ability.ET was associated with abnormal brain connectivity in major RSNs that might be involved in both motor and nonmotor symptoms. Our findings underscore the importance of examining RSNs in this population as a biomarker of disease.

Background: Our aim was to assess the diagnostic agreement among the neurologists in the Neurological Disorders in Central Spain 2 (NEDICES‐2) study; these neurologists were assigning diagnoses of essential tremor (ET) vs. no ET. Methods: Clinical histories and standardized video‐taped neurological examinations of 26 individuals (11 ET, seven Parkinson’s disease, three diagnostically unclear, four normal, one with a tremor disorder other than ET) were provided to seven consultant neurologists, six neurology residents, and five neurology research fellows (18 neurologists total). For each of the 26 individuals, neurologists were asked to assign a diagnosis of “ET” or “no ET” using diagnostic criteria proposed by the Movement Disorders Society (MDS). Inter‐rater agreement was assessed both with percent concordance and non‐weighted Κ statistics. Results: Overall Κ was 0.61 (substantial agreement), with no differences between consultant neurologists (Κ = 0.60), neurology residents (Κ = 0.61), and neurology research fellows (Κ = 0.66) in subgroup analyses. Subanalyses of agreement only among those 15 subjects with a previous diagnosis of ET (11 patients) and those with a previous diagnosis of being normal (four individuals) showed an overall Κ of 0.51 (moderate agreement). Discussion In a population‐based epidemiological study, substantial agreement was demonstrated for the diagnosis of ET among neurologists of different levels of expertise. However, agreement was lower than that previously reported using the Washington Heights–Inwood Genetic Study of Essential Tremor criteria, and a head‐to‐head comparison is needed to assess which is the tool of choice in epidemiological research in ET., Tremor and Other Hyperkinetic Movements, Tremor and Other Hyperkinetic Movements

Background: The classical concept of essential tremor (ET) as a monosymptomatic tremorogenic disorder has been questioned in the last decade as new evidence has been described. Clinical, neuroimaging, and pathological studies have described a probable structural basis (mainly in cerebellum) and evidence that ET is associated with subtle clinical cerebellar deficits and several non-motor clinical manifestations, such as cognitive and mood disorders. Case Report: We performed literature searches in Medline, ISI Web of Knowledge, and PsycInfo databases. The aim of this review is to describe cognitive deficits associated with ET. First, we present a brief history of ET cognitive disorders presented. Second, we describe several clinical cross-sectional series demonstrating that ET is associated with mild cognitive deficits of attention, executive functions, several types of memory (working memory, immediate, short term, delayed, and possibly others) and, mood disorders (depression). Discussion: Recent neuroimaging studies favor a cerebellar basis for these cognitive deficits. Population-based surveys confirm that mild cognitive dysfunction is not limited to severe ET cases, the entire ET group, including mild and undiagnosed cases, can be affected. Cohort studies indicated that ET cognitive deficits could be progressive and that ET patients had an increased risk of dementia. The mood and cognitive deficits in ET are in agreement with cognitive affective cerebellar syndrome described in patients with cerebellar disorders. New evidence, mainly from functional (neuroimaging) and prospective clinical studies would further bolster recent descriptions of ET clinical manifestations., Tremor and Other Hyperkinetic Movements, Tremor and Other Hyperkinetic Movements

[EN] Objectives: The International Classification of Functioning, Disability and Health (ICF) advocates a multifactorial and multifaceted conceptualization of disability. The objective of this study was to ascertain major medical, environmental and personal determinants of severe/extreme disability among the elderly population in Spain. The assessment scheme was consistent with the ICF model of disability. Methods: Nine populations contributed probabilistic or geographically-defined samples following a two-phase screening design. The Mini-Mental State Examination and the 12-item version of the World Health Organization-Disability Assessment Schedule, 2(nd) ed. (WHO-DAS II), were used as cognitive and disability screening tools, respectively. Positively screened individuals underwent clinical work-up for dementia and were administered the 36-item version of the WHO-DAS II to estimate ICF disability levels. We used logistic regression for the purposes of data combination, adjusted for age and sex in all analyses. Results: The sample was composed of 503 participants aged ≥ 75 years. Alzheimeŕs disease and depression were highly predictive of severe/extreme disability (OR: 17.40, 3.71). Good access to social services was strongly associated with a low level or absence of disability (OR: 0.05 to 0.18). Very difficult access to services and having dementia or another psychiatric disorder were associated with an increase in disability (OR: 66.06). There was also a significant interaction effect between access to services and neurological disorders (OR: 12.74). Conclusions: Disability is highly prevalent among the Spanish elderly and is influenced by medical, social and personal factors. Disability could potentially be reduced by ensuring access to social services, preventing dementia and stroke, and treating depression. [ES] Objetivos: La Clasificación Internacional del Funcionamiento, la Discapacidad y la Salud (CIF) propone un enfoque multifactorial de la discapacidad. El presente estudio analiza los principales determinantes médicos, ambientales y personales de la discapacidad grave y extrema en población anciana española siguiendo una evaluación congruente con el modelo CIF. Métodos: Nueve poblaciones aportaron muestras probabilísticas o definidas geográficamente siguiendo un diseño de cribado. Se usaron el Minimental State Examination y el World Health Organization-Disability Assessment Schedule, 2nd ed. (WHO-DAS II, 12 ítems), como cribados cognitivo y de discapacidad, respectivamente. Se evaluaron la presencia de demencia y los grados de discapacidad de la CIF usando la escala WHO-DAS II (36 ítems) entre los positivos al cribado. Los datos se combinaron usando regresión logística, ajustando por edad y sexo en todos los análisis. Resultados: Participaron 503 sujetos de 75 y más años de edad. Los individuos con enfermedad de Alzheimer y/o depresión tenían una mayor probabilidad de presentar discapacidad grave o extrema (OR: 17,40, 3,71). El acceso a los servicios sociales tuvo un efecto protector (OR: 0,05 a 0,18), mientras que el acceso «muy difícil» y la presencia de demencia u otro trastorno psiquiátrico se asociaron a un incremento de la discapacidad (OR: 66,06). Hubo una interacción significativa entre acceso a servicios y diagnóstico neurológico (OR: 12,74). Conclusiones: La discapacidad es altamente prevalente entre los ancianos españoles y está muy asociada a factores médicos, sociales y personales. La accesibilidad a los servicios sociales, la prevención de la demencia y del infarto cerebral, y el tratamiento de la depresión, pueden reducir la discapacidad entre los ancianos españoles. This project, led by J. de Pedro-Cuesta, was supported by the Pfizer Foundation and by the RECSP C03-09, CIEN C03-06 and CIBERNED and CIBERSAM research networks. Sí