Analysis Of Related Factors Of Non-motor Symptoms In Patients With Essential Tremor And Their Influence On Quality Of Life

Background and objectiveEssential tremor(ET)is one of the most common movement disorders,whose core clinical features is motor tremor.In the 2018 International Parkinson’s Disease and Movement Disorders Association,essential tremor was redefined as isolated motor tremor that is present in both upper limbs for at least three years,and tremor may also be present elsewhere,usually in the neck or vocal cords.ET tremor with other signs of uncertain clinical significance(such as impaired tandem gait and dystonia)was classified as essential tremor superposition syndrome(ET-plus).In the past,ET was considered as an isolated,single-symptom disease.With the progress of neuroscience,more and more studies have shown that the clinical symptoms of ET are more diversified than imagined,and it is a heterogeneous disease.In addition to motor symptoms,it can also have cognitive impairment,neuropsychiatric disorders(anxiety and depression),fatigue,sleep disorders,sensory disorders(smell and hearing)and other non-motor symptoms.At home and abroad,more attention is paid to the motor symptoms of essential tremor,In recent years,the non-motor symptoms of ET patients have been paid more and more attention by clinical workers,Non-motor symptoms are also an important clinical manifestation of the disease and even have a more serious impact on the quality of life of the patients.Therefore,we collected and statistically collected the clinical data of ET patients who visited the outpatient department and wards of the Department of Neurology of our hospital from February 2018 to June 2020 to analyze the related factors of non-motor symptoms of ET patients and their impact on quality of life,so as to provide comprehensive coping strategies for ET patients in clinical practice.MethodsThe general data of 86 patients diagnosed with ET in outpatient and ward of the Department of Neurology of our hospital from February 2018 to June 2020 were collected and recorded,including age,gender,age of onset,course of disease,education level,family history,etc.The Fahn Tolosa Marin Tremor Rating Scale(FTMRS),Mini-Mental State Examination(MMSE),Montreal Cognitive Scale(MoCA),Hamilton Depression Scale(HAMD,24-item version),Non-Motor Symptoms Scale(NMSS),Pittsburgh Sleep Quality Index Scale(PSQI),Health Survey Constrate Form(SF-36)and Hamilton Anxiety Scale(HAMA,14-item version)were used for assessment.All the data were statistically analyzed using SPSS21.0.The variables conforming to normal distribution were represented by mean1standard deviation(x±s),the mean comparison was represented by t test,the non-normal distribution variables were represented by median(Upper quartile,lower quartile),and the differences between groups were tested by Mann-Whitney U test.Counting data were tested by Chi-squared test.Pearson test was used for correlation analysis,and multivariate regression analysis was used for analysis of predictors.P<0.05 was considered statistically significant.Results1.Among the 86 ET patients,35 cases(40.70%)had more than one domain NMS symptoms.In cardiovascular field disorders,80 cases(93.02%,80/86),sleep/fatigue domain disorders,86 cases(100.00%,86/86),emotional/86 cases of impaired cognitive domain(100.00%,86/86),problem awareness in 68 cases(79.07%,68/86),attention/memory domain disorders,82 cases(95.35%,82/86),67 cases of gastrointestinal symptoms(77.91%,67/86),urinary tract symptoms in 60 cases(69.77%,60/86),sexual dysfunction,81 cases(94.19%,81/86)and mixed symptoms in 85 cases(98.84%,85/86).All the 86 ET patients had sleep/fatigue domain and mood/cognitive domain disorders.The severity of cognitive impairment,anxiety,depression and sleep disorder were further analyzed by HAMA,HAMD,PQi,MOCA and MMSE.68 patients showed anxiety symptoms,including 27 cases(39.71%,27/68)with mild symptoms,32 cases(47.06%,32/68)with moderate symptoms,and 9 cases(13.23%,9/68)with severe symptoms.Among 63 patients,32(50.80%,32/63)had mild symptoms,28(44.44%,28/63)had moderate symptoms,and 3(4.76%,3/63)had severe symptoms.65 patients developed cognitive impairment,including 57(87.69%,57/65)patients with mild and 8(12.31%,8/65)patients with moderate cognitive impairment.Sleep disturbance occurred in 63 patients.2.The 86 ET patients were divided into groups according to gender,age of onset and course of disease,and the correlation between ET and anxiety,depression,cognitive impairment and sleep disorder was analyzed.According to statistical analysis,the presence or absence of anxiety symptoms is not related to gender,age of onset,and course of disease(P>0.05);presence or absence of depression symptoms is related to gender(P<0.05),but not related to age of onset and course of disease(P>0.05);Cognitive impairment is related to the course of the disease(P<0.05),but has nothing to do with gender and age of onset(P>0.05);the presence or absence of sleep disorders is not related to gender,age of onset,and course of disease(P>0.05).3.SF-36PH and SF-36MH were significantly negatively correlated with the total score of HAMA,HAMD,PQSI and NMSS,and SF-36MH was significantly positively correlated with the total score of MOCA.Furthermore,the factors affecting SF-36PH and SF-36MH were analyzed by regression analysis.The total NMSS score was the main predictor of SF-36PH,while the total NMSS score and the total MOCA score were the predictors of SF-36MH.Conclusion1.Patients with ET had the highest incidence of sleep/fatigue domain and emotional/cognitive domain disorders.2.Male ET patients are prone to depressive symptoms,and the longer the course of ET,the more likely it is to have cognitive impairment.3.Anxiety,depression,sleep disorders,cognitive impairment and other NMS have negative effects on the physical and mental health of ET patients.The total NMSS score was the main predictor of physical health,while the total NMSS score and the total MOCA score were the predictors of mental health.