Cognitive Deficits Associated with Essential Tremor34
Classic Concept of Essential Tremor
Essential Tremor: New Findings
Cognition in Patients with Essential Tremor
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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]