Background: Studies reported to date on cognitionaffect in idiopathic or essential tremor ET have fo

1
Cognition and Affect in Idiopathic-Essential
Tremor Vermilion K, Stone A, Duane D Arizona
Dystonia Institute / Arizona State
UniversityScottsdale / Tempe, Arizona, U.S.A.
Background Studies reported to date on
cognition/affect in idiopathic or essential
tremor (ET) have focused on visuomotor skills or
pre- versus post-operative effects of thalamotomy
or on versus off effects of deep brain
stimulation. Objective To asses cognition and
mood in a referral population of patients with
varying severity of ET. Methods 55 ET patients
(62 female), mean age onset 46 years, were
similarly evaluated at mean age 57 years /- 19.
Excluded from analysis were 79 other patients
with ET associated with focal dystonia. Analysis
included family history of psychiatric and
movement disorders scores on MMPI, Hamilton
Depression and/or Spielberger Anxiety Rating
Scales neuropsychological performance on Rey
Auditory Verbal Learning Test (AVLT), Three
Letter Cancellation Task (LCT), Digit Span (DS),
Rey-Osterrieth Complex Figure Test (ROCFT),
Conners Continuous Performance Test (CPT), Test
of Variables of Attention (TOVA), Wisconsin Card
Sorting Test (WCST). Results Family history
Anxiety/depression/OCD 23 (42) non-PD tremor
27 (49) dystonia 1 (2) scoliosis 3
(6) PD 1 (2).Personal evidence anxiety,
depression or both 34 (62) 8 also
OCD.Neuropsychological studies (age adjusted)
impaired auditory verbal learning - 11/46 (24)
Impaired auditory verbal memory - 9/46 (20)
Impaired auditory digital memory - 6/31 (19)
Impaired visual vigilance (LCT) - 25/45 (56)
Impaired visuomotor skill - 2/49 (5) Impaired
visual memory - 11/40 (27) Impaired visual
attention (TOVA, CPT) - 12/17 (71) Impaired
executive function (WCST) - 5/18
(28). Conclusions Family history of both
tremor and mood disorder are common in ET.
Anxiety, depression and OCD are especially
prevalent in ET patients but are not apparently
correlated with tremor severity. Attention more
than memory or perceptual motor deficits are
prevalent in ET, and are apparently not related
to tremor severity, but may represent selective
basal ganglion to frontal cortex dysfunction.
Contrasting these observations to those in other
movement disorders, especially focal dystonia,
may help to clarify the relationship between
these conditions as well as isolating
sub-categories within each. Platform
presentation, October 12 2001, International
Symposium on Mental and Behavioral Dysfunction in
Movement Disorders, Montreal, Quebec,
Canada. Vermillion K, Stone A, Duane DD.
Cognition and affect in idiopathic-essential
tremor. Movement Disorders 2001,16(supplement)
S30.
2
Cognition and Affect in Patients WithCervical
Dystonia and Tremor Vermilion K, Johnson J, Duane
D Arizona Dystonia Institute / Arizona State
UniversityScottsdale / Tempe, Arizona, U.S.A.
Background Isolating differential
characteristics may clarify the relationship
between tremor and cervical dystonia. Family
history of movement disorder and psychiatric
states, as well as personal characteristics of
cognition, mood and tremor location may differ in
patients with (idiopathic) essential tremor (ET)
vs. cervical dystonia with tremor (CD/T) vs.
cervical dystonia without tremor
(CDnoT). Objectives To assess family history of
movement and mood disorder, and personal
qualities of cognition and mood in a referral
population of patients with CD/T. Methods 79
CD/T (87 female), mean age onset CD 47 years and
mean age onset T 47 years, were similarly
evaluated at mean age 59 years. Analysis
included recalled age onset CD and T as well as T
location family history of psychiatric and
movement disorders scores on MMPI, Hamilton
Depression and/or Spielberger Anxiety Rating
Scales neuropsychological performance on Rey
Auditory Verbal Learning Test (AVLT), Three
Letter Cancellation Task (LCT), Digit Span (DS),
Rey-Osterrieth Complex Figure Test (ROCFT),
Conners Continuous Performance Test (CPT), Test
of Variables of Attention (TOVA), Wisconsin Card
Sorting Test (WCST) Results Family history
anxiety 10 (13), depression 17 (22) OCD 5,
psychosis 4, alcoholism 29, non-PD tremor 38
(48) head only 13, hands only 17, both head and
hands 8, dystonia 13 (17), scoliosis 11 (14),
PD 6 (8). Personal evidence anxiety 41 (52),
depression 57 (72) 7 also OCD.Neuropsychologic
al studies (age adjusted) Impaired AVLT 9/72
(13), Impaired verbal memory 6/72 (8), Impaired
auditory digital memory 4/41 (10), Impaired
visual vigilance (LCT) 46/72 (64), Impaired
visuomotor skills 1/68 (1), Impaired visual
memory 11/68 (16), Impaired visual attention
(TOVA/CPT) 13/14 (93), Impaired executive
function (WCST) 12/21 (57). Conclusions As we
have shown elsewhere, like patients with ET
(Vermillion, Stone, Duane, 2001), CD/T patients
have a high frequency of family history of
psychiatric disorder more apt to be depression
than anxiety but both are prevalent as they are
in the patients themselves. Similarly, family
history of tremor is prevalent in both ET and
CD/T, but a greater likelihood that tremor in
relatives is of the head in CD/T and of the hands
more than head in ET, as it is in the affected
patients themselves (Duane, et al, Mov Disord,
1993). In patients, psychiatric comorbidity is
high in CD/T, especially with respect to
depression, whether due to pain and distorted
self-image or biological is unclear. Cognitive
impairment is greatest in tasks requiring
attention, whether secondary to distraction from
the movement disorder or secondary to basal
ganglion to frontal cortex dysfunction is also
unclear but is similar to that observed in ET
(Vermillion, Stone, Duane, 2001). Platform
presentation, Dystonia Medical Research
Foundation Annual Conference, June 2002, Atlanta,
GA