Age and Sex Affect Essential Tremor (ET) Plus: Clinical Heterogeneity in ET Based on the National Survey in China

Qiying Sun; Runcheng He; Hongyan Huang; Hongmei Cao; Xuejing Wang; Hong Liu; Chunyu Wang; Lifang Lei; Puqing Wang; Guiyun Cui; Jianjun Ma; Ping Gu; Di An; Min Jia; Zhanfang Sun; Heng Wu; Jinsheng Lin; Jiayu Tang; Xun Zhou; Mingqiang Li; Sheng Zeng; Yase Chen; Xinxiang Yan; Jifeng Guo; Qian Xu; Zhenhua Liu; Lu Shen; Hong Jiang; Xinyin Wu; Qin Xiao; Haibo Chen; Yanming Xu; Beisha Tang; China Essential Tremor Alliance

doi:10.14336/AD.2022.1205

Age and Sex Affect Essential Tremor (ET) Plus: Clinical Heterogeneity in ET Based on the National Survey in China

Aging Dis. 2023 Aug 1;14(4):1360-1373. doi: 10.14336/AD.2022.1205.

Authors

Qiying Sun^{1

2}, Runcheng He^{1

2}, Hongyan Huang³, Hongmei Cao⁴, Xuejing Wang⁵, Hong Liu⁶, Chunyu Wang⁷, Lifang Lei⁸, Puqing Wang⁹, Guiyun Cui¹⁰, Jianjun Ma¹¹, Ping Gu¹², Di An¹³, Min Jia¹⁴, Zhanfang Sun¹⁵, Heng Wu¹⁶, Jinsheng Lin¹⁷, Jiayu Tang¹⁸, Xun Zhou^{1

2}, Mingqiang Li¹⁶, Sheng Zeng¹⁹, Yase Chen^{1

2}, Xinxiang Yan^{1

2}, Jifeng Guo^{1

2}, Qian Xu^{1

2}, Zhenhua Liu^{1

2}, Lu Shen^{1

2

20}, Hong Jiang^{1

2

20}, Xinyin Wu²¹, Qin Xiao²², Haibo Chen²³, Yanming Xu³, Beisha Tang^{1

2

20}; China Essential Tremor Alliance

Affiliations

¹ Department of Neurology, Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
² National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
³ Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
⁴ Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
⁵ Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
⁶ Department of Neurology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shangxi, China.
⁷ Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
⁸ Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.
⁹ Department of Neurology, Xiang Yang No. 1 People's Hospital Affiliated to Hubei University of Medicine, Xiangyang, Hubei, China.
¹⁰ Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.
¹¹ Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, Henan, China.
¹² Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, China.
¹³ Department of Neurology, Affiliated Hospital of Hebei University, Baoding, Hebei, China.
¹⁴ Department of Neurology, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, China.
¹⁵ Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
¹⁶ Department of Neurology, The First Affiliated Hospital of University of South China, Hengyang, Hunan, China.
¹⁷ Department of Neurology, Xiangtan Central Hospital, Xiangtan, Hunan, China.
¹⁸ Department of Neurology, Hunan Provincial Brain Hospital, Changsha, Hunan, China.
¹⁹ Department of Geriatric Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
²⁰ Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, Hunan, China.
²¹ Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China.
²² Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
²³ Department of Neurology, Beijing Hospital, National Center of Gerontology, Beijing, China.

Abstract

The new term essential tremor (ET) plus was proposed in the 2018 tremor consensus criteria. The National Survey of Essential Tremor Plus in China, a large multicenter registry study, aimed to evaluate the clinical features of pure ET and ET plus and explore possible factors related to ET plus. All patients with ET underwent neurological examination and neuropsychological assessment at 17 clinical sites. The diagnosis was made according to the 2018 consensus criteria. Clinicodemographic characteristics were analyzed. A total of 1160 patients were included, including 546 patients with pure ET and 614 patients with ET plus. The proportion of females was significantly higher in the ET plus than that in the pure ET (P = 0.001). The age at onset (AAO) of pure ET showed a bimodal distribution, with peaks in the 2nd and 5th decades. However, the AAO of the ET plus group demonstrated a skewed distribution, with a single peak in the 6th decade. Female sex (OR=1.645, P<0.001), older age (OR=1.023, P<0.001), lower educational level (OR=0.934, P<0.001), head tremor (OR=1.457, P<0.001), and higher the Tremor Research Group Essential Tremor Rating Assessment Scale (TETRAS)-II scores (OR=1.134, P<0.001) were significantly associated with ET plus. Old age and female sex may contribute to ET plus development. Pure ET showed a bimodal distribution for AAO, whereas ET plus showed a unimodal distribution. It remains unclear whether pure ET and ET plus are merely different stages of a single disease or represent distinct disease entities.