Essential tremor linked to tripled risk of dementia, study finds | Hacker News Reader

Essential tremor linked to tripled risk of dementia, study finds

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74 pointsbookofjoe33 comments

I’m 38 and I’ve had essential tremor for as long as I can remember. For most of my life it wasn’t much of a nuisance but it’s slowly and progressively worsened over the last 5 or so years. I won’t dare try to pick up a full drinking glass anymore, and a forkful of food is unlikely to make it to my mouth without jiggling off. Glad to hear that early onset isn’t implicated here but it’s still surprising to me how little is known and how quickly it’s dismissed whenever I’ve brought it up with my PCP.

Have you tried using Liftware? https://www.liftware.com/steady/ It's surprisingly owned by Verily which is owned by Alphabet (The parent company of Google).

If you're going to go look for devices to help, you should consider something like the Cala kIQ: https://calahealth.com/

It is covered by some insurance and there are also clinical trials that you could get in which would provide it for free.

Have you seen this research? https://www.nature.com/articles/s41467-020-20581-7

Have you looked at implants or other treatments for essential tremor?

We were quite surprised to learn recently from an unrelated HN article that there is now an essential tremor cure through ultrasonic brain surgery. FDA approved 2016 and now available in various countries. https://www.fusfoundation.org/diseases-and-conditions/essent...

The word cure that you use seems pretty certain, and even your link doesn't use it to describe how the treatment affects the condition. Just curious, what made you say that it's curative? Do you know of people who've been cured by this therapy?

My dad suffered terrible ET from age 40 on. At 65 he became terribly depressed and isolated as he couldn't do basic things like write or hold a fork. Fearing for his wellbeing I researched anything I could get my hands on and called doctors around the world. Finally found a research hospital in S Korea and a clinic in Florida willing to meet him. In 2018 they did the non-invasive surgery in SK and the ET stopped completely in his dominant hand and has been good since.

It seems a cure rather than a treatment. If the correct neurons can be found via MRI and the condition deemed suitable for treatment, the neurons get destroyed and I think no ongoing medication or repeat treatments are required. I believe they treat one limb at a time if you have the condition in both hands. All this is my initial impressions because we only learned of this recently and my relative won't be able to chase this up until later this year. I have second hand feedback about people who have undergone the treatment successfully in Australia. I don't actually know anyone outside of my family with the condition at all, so no first hand.

https://news.ycombinator.com/item?id=39551457 was the HN article where I picked it up. Buried in the middle of the video is a minute or so talking about earlier successes with ultrasound, the essential tremor treatment. HN commenters indicate successful treatments.

yes, I can confirm the doctor told us only one limb can be targeted so we picked his dominant arm.

Thanks for your earlier reply. I was honestly curious about your reasoning for the way you described it, and especially these days in which many things are branded as cures despite not being shown as such by something reliable.

You mention that only one limb could be targeted. Did they explain that this applied to one limb at a time or that it applied to only one limb period? The other reply states both, but maybe that's because of differences in procedure or clinic.

We were told one limb, period. I can get you more info if you need, email me direct at: hnews.crunching363 at passmail.net

Sincerely Thank you, and I will through my Protonmail address.

Essential tremor is a potential marker of prodromal Parkinson's, which has been fairly conclusively linked to gut microbiota alterations with evidence of dysbiosis, transmission to animals via PD feces, and improvement following FMT: https://www.mdpi.com/2673-8007/3/3/67

Gut - and oral - dysbiosis have been linked to other neurodegenerative diseases as well, so I'd really encourage you to look into this avenue.

I'd like to understand more about essential tremors - is there anyone here experienced in such matters and/or able to point me toward some good resources?

First off, there's two different kinds: in young people and in old people (known as age-related or late-onset essential tremor). It's the same disorder but evidently different etiologies.

Personally I believe it will be cured with gene editing someday.

Also, it was already known that age-related essential tremor increases your risk of dementia.

This is.... a bit depressing considering I have had essential tremor probably since I was about 12 or so years old.

Same :( Also family history of dementia and Parkinson’s but I tested clear for Parkinson’s markers

We're really going to have to wait until the paper comes out to evaluate this. They compared to the general population, and there is a good chance that the participants in the study were severe enough to have approached a neurologist for care. That's not going to be representative if it's true. It will also matter whether the diagnostic process was rigorous. Basically...don't worry yet if you can help it.

>Essential tremor is associated with dementia: Prospective population-based study in New York (2009)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2731620/

ABSTRACT

Background: Mild cognitive deficits, mainly in frontal-executive function and memory, have been reported in patients with essential tremor (ET). Furthermore, an association between ET and dementia has been reported in a single population-based study in Spain. This has not been confirmed elsewhere.

Objective: To determine whether baseline ET is associated with prevalent and incident dementia in an ethnically diverse, community-based sample of elders.

Methods: Community-dwelling elders in northern Manhattan were enrolled in a prospective cohort study. Baseline ET diagnoses were assigned from handwriting samples. Dementia was diagnosed at baseline and follow-up using DSM-III-R criteria.

Results: In cross-sectional analyses, 31/124 (25.0%) ET cases had prevalent dementia vs 198/2,161 (9.2%) controls (odds ratio [OR]unadjusted = 3.31, 95% confidence interval [CI] = 2.15–5.09, p < 0.001; ORadjusted = 1.84, 95% CI = 1.13–2.98, p = 0.01). In prospective analyses, 17/93 (18.3%) ET cases vs 171/1,963 (8.7%) controls developed incident dementia (hazard ratio [HR]unadjusted = 2.78, 95% CI = 1.69–4.57, p < 0.001; HRadjusted = 1.64, 95% CI = 0.99–2.72, p = 0.055).

Conclusions: In a second population-based study of elders, essential tremor (ET) was associated with both increased odds of prevalent dementia and increased risk of incident dementia. Presence of dementia, therefore, appeared to be greater than that expected for age (i.e., a disease-associated feature). Rather than attributing cognitive complaints in patients with ET to old age, assessment and possible treatment of dementia should be routinely incorporated into the treatment plan.

Thanks. The best way to evaluate this is the prospective analysis, adjusted for control variables. The confidence interval on that hazard ratio includes 1.00, so the null hypothesis that there is no difference stands.

For the cross-sectional analysis, essential tremor was associated with dementia, but it gives no information as to whether ET increases risk for later dementia vs. dementia raises risk of ET.

Finally, the criteria used for dementia diagnosis are the psychiatric criteria from 4 DSM editions ago, though the criteria have been revised and updated numerous times by neurologists and other neuroscientists (i.e. those who work with essential tremor).

At least the sample was community-based instead of clinic-based.

FWIW my grandfather also had tremors and his final years had dementia. So at least for me this could be some genetic validation.

We just don't know when my grandfathers tremors began. We always figured it was more of a WWII/Holocaust survivorship PTSD symptom.

Understood. It's tough not to personalize findings like this. ET is heritable and dementia is heritable to some extent, but that doesn't mean one causes the other. I'm not saying you have nothing to worry about, but this paper shouldn't make you more worried than anyone with a grandparent with dementia. My best to you.

For sure, thanks for the reassurance.

In that case, you have early onset essential tremor, not age-related essential tremor. I believe only age-related essential tremor has increased risk of dementia. For example:

In an adjusted model, ET cases with tremor onset after age 65 years were twice as likely to develop incident dementia than were controls (RR = 1.98, 95% CI = 1.14–3.45, P = 0.01), whereas ET cases with tremor onset < age 65 years and controls were equally to develop incident dementia (RR = 0.74, 95% CI = 0.19–3.20, P = 0.79).

https://movementdisorders.onlinelibrary.wiley.com/doi/10.100...

However, I think essential tremor needs more research in general.

Look, astronomically few people are at baseline or zero risk for all ailments. Essentially everyone is genetically or environmentally predisposed to an increased relative risk of some many terrible things that could befall them in the future.

Some people get to know about some of those biases ahead of time, some people don't get to know about them at all.

This is now on your list. When you're in your seventies, and assuming continued research in this area doesn't refine in a way that excludes your case, you may be more likely to have dementia than some random person you know without ET. Relatively few people get diagnosed with dementia though, and that includes relatively few people with ET (although, apparently, more), so who really knows.

Meanwhile, the rando that you picked to compare yourself to has their own known or unknown 3x risk for pancreatic cancer or aortic aneurism or kidney failure or something, and -- like you -- will probably not develop that particular condition anyway.

This should not be read as "oh shit, I'm going to develop dementia because of this damned ET!" so much as "oh, well, I now know I should be extra attentive to early dementia symptoms in as I get older since ET might occasionally be associated with it"

The dementia rate is 25% at 80 and raises to 37% at 90.

You know those numbers reflect survivor bias, right? By 80 and 90, most peers have already been lost to other organ failures, cancers, etc -- if longevity is important to them, most people would be lucky to be in those populations instead of the in much larger populations no longer being counted at all.

> By 80 and 90, most peers have already been lost to other organ failures, cancers, etc

In many wealthy countries, life expectancy at birth is greater than 80, which means that the average 80 year old, >50% of their same-age peers will still be alive. By age 90, what you say would be true.

@dang Can you let us know why this got flagged if it was not an error? It is a less well known medical condition and some of us have a vested interest in knowing if the article is rubbish or not.

Users flagged it. We can only guess why users flag things. In this case the article is rather short, and is about a study that hasn't been published yet. Perhaps they felt it wasn't substantive enough? or perhaps they object to scientific studies being preceded by press releases? It does seem odd to see an article like this without a link to the paper because the paper hasn't been published yet.

As a rule, results such as these, "...set to be presented at the American Academy of Neurology's 76th Annual Meeting in April 2024," are published prior to meetings as part of an "abstracts to be presented" document sent to all meeting registrants.

These published abstracts are considered scientific publications and indexed as such online/on Google Scholar/in C.V.s.

Only about 5-10% — my personal estimate, having been there done that many times [https://scholar.google.com/citations?user=5DdrMc8AAAAJ&hl=en] — of abstracts are ever expanded into published papers, which sometimes appear many years after the abstract.

Re: this particular article on this subject, I would refer HN readers to the 2009 prospective study cited yesterday in the discussion section:

>Essential tremor is associated with dementia

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2731620/

From the paper's Abstract:

>Furthermore, an association between ET and dementia has been reported in a single population-based study in Spain. This has not been confirmed elsewhere.

It is a peer-reviewed scientific paper on precisely the same subject.

On mobile, I frequently bump the "flag" button by mistake. Often it happens quick and I don't notice it.

I once checked my list of flagged topics and they were all pretty anodyne, inoffensive, constructively posted links I don't even remember flagging.

So I think it may be a UX issue, potentially remedied by a mobile-purpose stylesheet with larger UI elements.

It's a factor, yes, and it's on my list to add a confirmation step on mobile.

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