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Essential tremor and cognitive impairment: who, how, and why

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Abstract

Background and aims

Recent years have witnessed the switch from considering essential tremor (ET) a monosymptomatic disorder to consider it as part of a spectrum, including other neurological signs, such as mild cognitive impairment and dementia, thus defining it as “ET plus.” There are few data on cognitive impairment in ET patients. The aim of this review is to analyze the clinical characteristics of ET patients develo** cognitive impairment, their neuropsychological profile, the underpinning mechanisms, and the possible biomarkers.

Methods

The authors performed a narrative review on cognitive decline in essential tremor, including articles written in English since the year 2000.

Discussion

The most recent pathogenetic theories of cognitive impairment in ET rely on the cerebellar dysfunction, being part of the Cerebellar Cognitive Affective Syndrome spectrum. Cognitive impairment in ET patients could be assessed through many tests that demonstrate the involvement of different domains, such as attention, executive functions, and language. There are some clinical characteristics of ET that may indicate a greater risk of develo** cognitive impairment, namely, cerebellar symptoms, falls, age at onset, and family history. However, there are no established clinical, neurophysiological, neuropathological, and fluid biomarkers of cognitive impairment in ET.

Conclusions

Increasing data are showing in ET the presence of cerebellar symptoms and cognitive impairment. Further studies are needed to better understand cognition in ET patients, and to define the boundary between ET and ET plus, since deeper phenoty** might have important clinical and therapeutic implications.

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Acknowledgements

The authors are grateful to Italian Society of Neurology – Young Section (SIgN), and in particular to its Educational Network (EduNet) to which this project belongs.

EduNet is a research network, created and promoted by SIgN (Italian Society of Neurology – Young Section).

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  1. All authors equally contributed to this study.

Authors and Affiliations

  1. Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy

    Sandy Maria Cartella & Carmen Terranova

  2. “Rita Levi Montalcini” Department of Neuroscience, University of Turin, Turin, Italy

    Alessandro Bombaci & Claudia Ledda

  3. Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy

    Gaetano Gallo

  4. Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy

    Marta Pengo

  5. Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy

    Antonia Pignolo

  6. Neurology Department, Ospedale San Gerardo, Monza, Italy

    Federico Emanuele Pozzi

  7. Department of Neurosciences, Reproductive and Odontostomatology, University of Naples “Federico II” , Naples, Italy

    Emanuele Spina & Assunta Trinchillo

  8. Department of Clinical and Experimental Medicine, Unit of Neurology, University of Pisa, Pisa, Italy

    Giovanni Palermo

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Contributions

The idea behind this review was first conceived by S. M. Cartella. All authors contributed to literature search and article analysis. The work was drafted by all authors in separate sections; the final text was finally critically revised by F. E. Pozzi, A. Bombaci, G. Palermo, and S. M. Cartella, and it was read and agreed upon by all authors.

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Cartella, S.M., Bombaci, A., Gallo, G. et al. Essential tremor and cognitive impairment: who, how, and why. Neurol Sci 43, 4133–4143 (2022). https://doi.org/10.1007/s10072-022-06037-4

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