Tremor at onset. Predictor of cognitive and motor outcome in Parkinson's disease?
L. A. Hershey, B. J. Feldman, K. Y. Kim, C. Commichau and D. G. Lichter
Department of Neurology, Department of Veterans Affairs Medical Center, Buffalo, NY.
We examined 46 male patients with idiopathic Parkinson's disease to see
whether tremor at onset was as useful a predictor of benign clinical
outcome as tremor predominance after several years. When we compared
patients with tremor at onset (n = 27) with those whose disease began with
brady-kinesia/rigidity (n = 9), or gait disorder (n = 10), we found no
significant differences after a mean of 7 years in motor, cognitive, or
affective status. Sixteen of the tremor-onset patients continued to have
tremor predominance with minimal gait disorder after about 7 years. These
tremor-predominant patients had significantly better motor outcome and
somewhat better cognitive outcome than either tremor-onset patients who
subsequently developed gait disorder (n = 11) or patients without tremor at
onset (n = 19). Tremor predominance after several years appears to be a
better predictor of a benign clinical course of Parkinson's disease than
tremor at onset.
