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Table 1.  

Cognitive Deficits Associated with Essential Tremor34

Box 1.  

Classic Concept of Essential Tremor

Box 2.  

Essential Tremor: New Findings

Box 3.  

Cognition in Patients with Essential Tremor


Essential Tremor -- A Neurodegenerative Disorder Associated With Cognitive Defects?

  • Authors: Félix Bermejo-Pareja, MD, PhD
  • CME Released: 4/12/2011
  • Valid for credit through: 4/12/2012
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Target Audience and Goal Statement

This activity is intended for primary care clinicians, family practitioners, and other health professionals caring for patients with benign essential tremor.

The goal of this activity is to review the evidence that essential tremor may be a slowly progressive neurodegenerative disorder.

Upon completion of this activity, participants will be able to:

  1. Describe cognitive and mood abnormalities in patients with essential tremor on the basis of review findings
  2. Describe evidence for cerebellar and other pathology in patients with essential tremor on the basis of review findings
  3. Describe recommended diagnostic workup in patients with essential tremor on the basis of review findings


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  • Félix Bermejo-Pareja, MD, PhD

    Department of Neurology, University Hospital "Doce de Octubre," Madrid, Spain


    Disclosure: Félix Bermejo-Pareja, MD, PhD, has disclosed no relevant financial relationships.


  • Heather Wood

    Chief Editor, Nature Reviews Neurology


    Disclosure: Heather Wood has disclosed no relevant financial relationships.

CME Author(s)

  • Laurie Barclay, MD

    Freelance writer and reviewer, Medscape, LLC


    Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

CME Reviewer(s)

  • Nafeez Zawahir, MD

    CME Clinical Director, Medscape, LLC


    Disclosure: Nafeez Zawahir, MD, has disclosed no relevant financial relationships.

  • Sarah Fleischman

    CME Program Manager, Medscape, LLC


    Disclosure: Sarah Fleischman has disclosed no relevant financial relationships.

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Essential Tremor -- A Neurodegenerative Disorder Associated With Cognitive Defects?: Diagnosis



Clinical diagnostic criteria for essential tremor were established in 1995 by the Tremor Investigation Group (TRIG),[50] and in 1998 Deuschl et al. published a consensus statement that detailed criteria for classifying all tremorogenic syndromes.[13] The TRIG criteria were based predominantly on clinical symptomatology (for example, tremor severity and duration), but they also assessed the intensity and bodily distribution of the tremor. In the TRIG criteria, the authors suggested that patients with chronic tremor with typical essential tremor symptoms in the absence of secondary causes of tremor, such as tremorogenic drug use, cranial trauma or sudden onset or psychogenic features, should be given a diagnosis of definite essential tremor. By contrast, if a patient had the above symptoms for less than 3 years, the authors suggested that they be diagnosed with probable essential tremor. Finally, if a patient satisfied the clinical characteristics of definite or probable essential tremor but also exhibited neurological manifestations associated with dystonia or other neurological symptoms of unknown origin, then a diagnosis of possible essential tremor was proposed to account for such cases.

In the criteria proposed by Deuschl and colleagues,[13] cases of essential tremor associated with neurological disorders, such as PD, dystonia and myoclonus, and secondary cases of tremor—including lesion-induced tremor, drug-induced tremor and psychogenic tremor—were classified as distinct entities and were considered to be different from 'classic tremor'.[13] Furthermore, isolated tremors, such as those that affect only one body part; for example the hand, voice or leg, were grouped in a separate category from those mentioned above.[13] For scientific evaluation of tremor, Deuschl et al. recommended the performance of electrophysiological tests, and for studies of therapeutic strategies for tremor, the authors proposed the utilization of scales that graded tremor and disability.[13] No pathophysiological criteria were proposed in either the above diagnostic criteria or the consensus statement.[13,50]