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Tremors in elderly

Sameer Hassamal, Susan Waller, Kimberly Reese, Claudia Testa
Valproic acid (VPA) is approved by the Food and Drug Administration (FDA) for the treatment of manic or mixed episodes associated with bipolar disorder. VPA is also used off-label to treat other conditions in psychiatry such as impulse control disorders, major depression, and posttraumatic stress disorder (PTSD). Although VPA is mostly well-tolerated, common adverse effects include gastrointestinal symptoms (nausea, vomiting, diarrhea), neurological symptoms (sedation, ataxia, tremor), weight gain, and alopecia...
2016: Türk Psikiyatri Dergisi, Turkish Journal of Psychiatry
Jung Han Yoon, Min Seung Kim, Sun Min Lee, Hyun Jae Kim, Ji Man Hong
BACKGROUND: Essential tremor (ET) and Parkinson's disease (PD) are the most common movement disorders in the elderly, but it is difficult to differentiate ET from early-stage tremor-dominant Parkinson's disease (TDPD). METHODS: We investigated heart rate variability (HRV) in 23 patients with ET, 27 patients with TDPD, and 23 healthy controls. HRV was determined using the RR intervals of a 5-min electrocardiogram recording. Measurements of beat-to-beat RR variability, including time domains [(standard deviation of the normal-to-normal RR interval (SDNN), and the root mean square difference of successive RR intervals (RMSSD)] and frequency domains [low-frequency (LF) and high-frequency (HF) components and total spectral power (TP)], were assessed retrospectively...
September 15, 2016: Journal of the Neurological Sciences
Yuichi Hayashi, Shohei Nishida, Akira Takekoshi, Muneharu Murakami, Megumi Yamada, Akio Kimura, Akio Suzuki, Takashi Inuzuka
Lithium carbonate is considered to be a first-line treatment for bipolar disorder; however, this drug has a narrow therapeutic window, and lithium intoxication is commonly induced by various drugs interaction and situations. We herein report a case of lithium intoxication induced by the administration of an antihypertensive agent targeting the angiotensin 1 (AT1) subtype of the angiotensin II receptor in a 65-year-old woman with a 40-year history of bipolar disorder type 1, and 1-year history of essential hypertension...
2016: Nihon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics
Adriana P Hermida, A Umair Janjua, Oliver M Glass, Camille P Vaughan, Felicia Goldstein, Lynn Marie Trotti, Stewart A Factor
Lithium is a mood stabilizer rarely associated with drug-induced parkinsonism (DIP). We present a case of an elderly woman with bipolar disorder who developed parkinsonian symptoms after chronic lithium administration despite therapeutic serum levels. Upon evaluation, classic parkinsonian signs of muscle rigidity, tremor, bradykinesia, freezing of gait, and cognitive decline were observed. Initially, she was diagnosed with Parkinson's disease (PD); however, DaTscan SPECT imaging clarified the diagnosis as DIP...
December 2016: International Psychogeriatrics
Shang-Ming Chiou
OBJECTIVES: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an accepted treatment for advanced Parkinson disease (PD). However, there is general reluctance in considering this therapy for PD patients over age 70 years with limited supporting evidence. Present study investigates age impacts in STN-DBS outcomes, focusing particularly on the elderly patients. PATIENTS AND METHODS: Seventy-two consecutive patients were divided into younger and elderly (n=16, cutoff age=70years) groups...
October 2016: Clinical Neurology and Neurosurgery
Takuya Konno, Joanna Siuda, Zbigniew K Wszolek
Parkinson's disease (PD) is a common neurodegenerative disorder that usually affects the elderly. Resting tremor, rigidity, bradykinesia, and postural instability are the main symptoms of PD. The loss of dopaminergic neurons in the substantia nigra and Lewy bodies in remaining neurons are pathological characteristics of PD. To combat these symptoms, dopaminergic therapy can benefit PD patients; however, it is only symptomatic therapy. Although the pathogenesis of PD has yet to be elucidated, approximately 10% of PD patients have familial history of PD...
2016: Wiadomości Lekarskie: Organ Polskiego Towarzystwa Lekarskiego
Yuka Tsukahara, Keisuke Suzuki, Norito Kokubun, Toshiki Nakamura, Hidehiro Takekawa, Koichi Hirata
A 74-year-old man was referred to our department for dizziness and progressive unsteady gait over 6 years. His family history was unremarkable. Neurological examination showed dysarthria, saccadic eye movement, palatal tremor (1.7 Hz)-synchronous with rotational ocular movement, and truncal ataxia. T2-weighted magnetic resonance imaging (MRI) of the brain revealed hyperintense and hypertrophic bilateral inferior olivary nuclei at the medulla and mild cerebellar atrophy. On the basis of neurological findings of oculopalatal tremor and cerebellar ataxia with brain MRI findings, the diagnosis of progressive ataxia and palatal tremor (PAPT) was made...
August 31, 2016: Rinshō Shinkeigaku, Clinical Neurology
Anna De Rosa, Alessandro Tessitore, Leonilda Bilo, Silvio Peluso, Giuseppe De Michele
Parkinson's Disease (PD) represents one of the most common neurodegenerative disorders in the elderly. PD is caused by a loss of dopaminergic cells in the substantia nigra pars compacta. The motor cardinal signs include a resting tremor, bradykinesia, rigidity and postural reflex impairment. Although levodopa represents the gold standard also in the advanced stage of the disease, over the years most patients develop disabling motor fluctuations, dyskinesias, and non-motor complications, which are difficult to manage...
November 2016: Geriatric Nursing
Connie Marras, Nathan Herrmann, Hadas D Fischer, Kinwah Fung, Andrea Gruneir, Paula A Rochon, Soham Rej, Simone Vigod, Dallas Seitz, Kenneth I Shulman
OBJECTIVE: To test the hypothesis of an increased incidence of antiparkinson drug prescribing or Parkinson disease (PD) diagnostic codes after chronic lithium treatment compared with chronic valproic acid or antidepressant treatment among older adults. METHODS: A retrospective cohort study using healthcare administrative databases in Ontario, Canada included 1,749 lithium users, 1,787 valproic acid users, and 285,154 other antidepressant users ≥ 66 years old having used the drug continuously in monotherapy for at least 1 year...
April 2016: American Journal of Geriatric Psychiatry
Kenji Wada-Isoe, Kenichiro Tanaka, Yusuke Uemura, Satoko Nakashita, Yuki Tajiri, Shugo Tagashira, Mikie Yamamoto, Mika Yamawaki, Masafumi Kishi, Kenji Nakashima
We aimed to clarify the longitudinal course of mild parkinsonian signs (MPS) and their association with dementia and functional disability by conducting a comprehensive epidemiological study, including brain MRI, and assessments of cognition, depression, and sleep, in people aged ≥65years living in Ama-cho. We diagnosed MPS and parkinsonism (PS) using a modified Unified Parkinson's Disease Rating Scale. The phase I study was conducted between 2008 and 2010 (n=729) and the phase II between 2011 and 2013 (n=436)...
March 15, 2016: Journal of the Neurological Sciences
M C Trindade, T Bittencourt, G Lorenzi-Filho, R C Alves, D C de Andrade, E T Fonoff, E Bor-Seng-Shu, A A Machado, M J Teixeira, E R Barbosa, G G Tribl
OBJECTIVE: To determine characteristics, clinical significance, frequency, and mimics of restless legs syndrome (RLS) in a cohort of Wilson's disease (WD, n = 42/f = 18), compared to healthy, matched controls. MATERIALS AND METHODS: Structured clinical interviews (patients and caregiving family members), repeated neurological examinations (afternoon and presleep), comprehensive laboratory tests, WD-, RLS-, and sleep-specific rating scales, and video-polysomnography...
February 2017: Acta Neurologica Scandinavica
Volker Arnd Coenen, Michel Rijntjes, Thomas Prokop, Tobias Piroth, Florian Amtage, Horst Urbach, Peter Christoph Reinacher
BACKGROUND: Refractory tremor in tremor-dominant (TD) or equivalent-type (EQT) idiopathic Parkinson's syndrome (IPS) poses the challenge of choosing the best target region to for deep brain stimulation (DBS). While the subthalamic nucleus is typically chosen in younger patients as the target for dopamine-responsive motor symptoms, it is more complicated if tremor does not (fully) respond under trial conditions. In this report, we present the first results from simultaneous bilateral DBS of the DRT (dentato-rubro-thalamic tract) and the subthalamic nucleus (STN) in two elderly patients with EQT and TD IPS and dopamine-refractory tremor...
April 2016: Acta Neurochirurgica
Joong-Seok Kim, Yoon-Sang Oh, Hyung-Eun Park, Si-Hoon Lee, Jeong-Wook Park, In-Uk Song, Jae-Young An, Hun-Jun Park, Byung-Chul Son, Kwang-Soo Lee
Questionnaire-based analyses show that patients with essential tremor (ET) may have several autonomic dysfunctions, especially in the cardiovascular and genitourinary domains; yet the laboratory correlates of autonomic dysfunction in ET are unknown and have not been studied. Herein, we explored whether sympathetic and parasympathetic functions differed between control subjects and patients with ET. Seventy-five elderly patients with ET were enrolled in this study, along with 25 age-matched controls. Orthostatic vital signs, ambulatory 24-h blood pressure monitoring and 24-h Holter monitoring values were recorded and metaiodobenzylguanidine (MIBG) uptake was assessed using the heart-to-mediastinum ratio (H/M ratio)...
May 2016: Neurological Sciences
(no author information available yet)
Hypothyroidism is a common disorder due to inadequate thyroid hormone secretion. When a patient has signs and symptoms suggestive of hypothyroidism, how is it determined whether thyroid hormone replacement therapy will have a favourable harm-benefit balance? How should treatment be managed? To answer these questions, we conducted a review of the literature using the standard Prescrire methodology. The symptoms of hypothyroidism are due to slow metabolism (constipation, fatigue, sensitivity to cold, weight gain, etc...
October 2015: Prescrire International
J Belin, J L Houéto, T Constans, C Hommet, B de Toffol, K Mondon
Parkinson's disease (PD) is a frequent and complex progressive neurological disorder that increases in incidence with age. Although historically PD has been characterized by the presence of progressive dopaminergic neuronal loss of the substantia nigra, the disease process also involves neurotransmitters other that dopamine and regions of the nervous system outside the basal ganglia. Its clinical presentation in elderly subjects differs from that in younger subjects, with more rapid progression, less frequent tremor, more pronounced axial signs, more frequent non-motor signs linked to concomitant degeneration of non-dopaminergic systems, and more frequent associated lesions...
December 2015: Revue Neurologique
Sivagini Prakash, Thomas Harbo, Jakob Christensen
Valproate (VPA) is a widely used antiepileptic drug – also in the elderly. A female patient was diagnosed with epilepsy at the age 60 of years and treated with VPA for 16 years before developing tremor, rigidity, cognitive impairment and descending consciousness progressing to coma. After discontinuation of VPA she regained full consciousness, could talk and feed herself. The extrapyramidal and cognitive symptoms completely subsided during the following months. VPA-induced encephalopathy is an uncommon but serious adverse effect that should be considered in patients with cognitive decline during VPA treatment...
May 11, 2015: Ugeskrift for Laeger
Branislav Veselý, Angelo Antonini, Ivan Rektor
White matter lesions (WML) associated with cerebrovascular disease (CVD) may be observed on magnetic resonance imaging in Parkinson's disease (PD) patients. WML are an important factor contributing to postural, gait, and cognitive impairment in the elderly without PD and worsening the course of Alzheimer's disease (AD). Numerous articles are available on this topic. Whether WML modify and negatively influence the clinical symptoms, and course of PD is a subject of debate. The aim of this review is to examine the available literature on the contribution of WML to PD motor symptoms in relation to clinical characteristics and methods of assessing WML on MRI...
March 2016: Journal of Neural Transmission
Mon S Bryant, Jyhgong Gabriel Hou, Robert L Collins, Elizabeth J Protas
OBJECTIVE: The objective of this study was to investigate the relationships between motor symptoms of Parkinson disease (PD) and activity limitations in persons with PD. DESIGN/METHODS: This is a cross-sectional study of persons with mild to moderate PD (N = 90). Associations among axial motor features, limb motor signs, the Physical Activity Scale for the Elderly, the ability to perform Activities of Daily Living (ADLs), and level of ADL dependency were studied...
May 2016: American Journal of Physical Medicine & Rehabilitation
Holly A Shill, Joseph G Hentz, Sandra A Jacobson, Christine Belden, Marwan N Sabbagh, Thomas G Beach, Erika Driver-Dunckley, Charles H Adler
The objective is to examine the risk of dementia in subjects with essential tremor (ET) involved in the Arizona Study of Aging and Neurodegenerative Disorders. All subjects were free of a neurodegenerative diagnosis at baseline and had annual motor, general neurological, and neuropsychological assessments. Subjects with ET were compared with controls for the risk of dementia. There were 83 subjects with ET and 424 subjects without tremor. Mean age at study entry was 80 ± 5.9 for ET and 76 ± 8.5 for controls...
2014: Journal of Neurodegenerative Diseases
Helen Ling, Seamus Kearney, Helen Lai Kuen Yip, Laura Silveira-Moriyama, Tamas Revesz, Janice L Holton, Catherine Strand, Karen Davey, Kin Ying Mok, James M Polke, Andrew J Lees
OBJECTIVE: To describe 5 cases of Parkinson's disease lacking any detectable histopathology. BACKGROUND: The diagnosis of Parkinson's disease is supported histologically by the findings of α-synuclein immunopositive Lewy bodies and neurites and severe substantia nigra cell loss. Bradykinesia as defined by slowness of initiation of movement and a progressive reduction in speed and amplitude on finger tapping is a clinical correlate of pars compacta nigral degeneration...
June 2016: Journal of Neurology, Neurosurgery, and Psychiatry
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