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Cognitive Deficit With Essential Tremor Predicts Gait, Balance Impairment

December 28, 2020

Cognitive impairment is a predictor of greater gait and balance impairment over time in older adults with essential tremor, according to a prospective study published in Frontiers in Neurology.

“Our study is the first to use longitudinal data to quantitatively assess the natural evolution of gait and balance deficits over the course of essential tremor,” wrote researchers from Yale University, Columbia University, and the University of Texas Southwestern. 

The investigation included 149 older adults, average age 79, with essential tremor. Over a 4.5-year span, participants received extensive evaluations of cognition, tremor, and gait and balance every 18 months. Gait and balance measures spanned both performance-based tests as well as self-reported assessments, such as number of falls and use of a walking aid.   

Multiple balance and gait measures showed evidence of decline over the study period, according to the study. Global cognition and executive function at baseline stood out as consistent predictors of gait and balance outcomes. 

Researchers are unsure of the mechanistic basis for gait and balance impairment in patients with essential tremor. Although aging and related factors are involved, the fact that gait impairment in patients with essential tremor has been shown to be greater than of age-matched controls suggests involvement of additional factors, they wrote.  

Regardless, the findings offer a much-needed look at the course of essential tremor in older adults, they observed. 

“The implications of these results are that physicians may be able to identify which essential tremor patients are at higher risk for dangerous falls,” researchers wrote. “If this risk could be identified early, preventative interventions could be suggested, such as balance-focused physical therapy, in hopes of mitigating the consequence of essential tremor-related gait and balance disorder later in life.” 

Jolynn Tumolo 


Dowd H, Zdrodowska MA, Radler KH, et al. Prospective Longitudinal Study of Gait and Balance in a Cohort of Elderly Essential Tremor Patients. Front Neurol. 2020;11:581703. Published 2020 Nov 13. doi:10.3389/fneur.2020.581703

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