Louis Elan D, Cosentino Stephanie, Huey Edward D
Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, LCI 710, 15 York Street, PO Box 208018, New Haven, CT 06520-8018 USA ; Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT USA ; Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT USA.
Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY USA ; Division of Geriatric Psychiatry, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY USA.
J Clin Mov Disord. 2016 Jul 15;3:11. doi: 10.1186/s40734-016-0039-6. eCollection 2016.
Embarrassment can be a considerable problem for patients with essential tremor (ET) and is a major motivator for treatment. Depression is also a common feature of ET; as many as 35 % of patients report moderate to severe depressive symptoms. Our goal was to assess the associations between these motor and psychosocial factors (tremor, depression, embarrassment) in ET, with a particular interest in more fully assessing the possible association between depression and embarrassment.
Ninety one ET cases (age 70.4 ± 12.8 years) enrolled in a prospective, clinical-epidemiological study. Depressive symptoms were assessed with the Center for Epidemiological Studies Depression Scale (CESD-10, 0-30 [maximum]), embarrassment, with the Essential Tremor Embarrassment Assessment (ETEA, 0-70 [maximum]), and action tremor, with a detailed in-person neurological examination.
Higher CESD-10 score was significantly associated with higher ETEA score (p = 0.005), but not with increasing tremor severity (p = 0.94). In stratified analyses, cases with no or minimal depressive symptoms had the lowest ETEA scores, cases with moderate depressive symptoms had intermediate ETEA scores, and cases with severe depressive symptoms had the highest ETEA scores (p = 0.01). Furthermore, at each level of tremor severity, cases with more depressive symptoms had more embarrassment.
Depressive symptoms seem to be more than a secondary response to the tremor in ET; they seem to amplify the level of embarrassment and, in addition to their own importance, seem to be a driver of other important clinical outcomes. Earlier treatment of depressive symptoms in ET patients could lessen the burden of secondary embarrassment.
尴尬对特发性震颤（ET）患者而言可能是一个相当严重的问题，并且是治疗的主要推动因素。抑郁也是ET的一个常见特征；多达35%的患者报告有中度至重度抑郁症状。我们的目标是评估ET中这些运动和心理社会因素（震颤、抑郁、尴尬）之间的关联，尤其关注更全面地评估抑郁与尴尬之间可能存在的关联。
91例ET患者（年龄70.4±12.8岁）纳入一项前瞻性临床流行病学研究。使用流行病学研究中心抑郁量表（CESD - 10，0 - 30[最大值]）评估抑郁症状，使用特发性震颤尴尬评估量表（ETEA，0 - 70[最大值]）评估尴尬程度，并通过详细的面对面神经学检查评估动作性震颤。
较高的CESD - 10评分与较高的ETEA评分显著相关（p = 0.005），但与震颤严重程度增加无关（p = 0.94）。在分层分析中，无或仅有轻微抑郁症状的患者ETEA评分最低，中度抑郁症状的患者ETEA评分中等，重度抑郁症状的患者ETEA评分最高（p = 0.01）。此外，在每个震颤严重程度水平上，抑郁症状较多的患者尴尬程度更高。
抑郁症状似乎不仅仅是ET中震颤的继发反应；它们似乎会加剧尴尬程度，并且除了自身的重要性外，似乎还是其他重要临床结果的驱动因素。早期治疗ET患者的抑郁症状可能会减轻继发尴尬的负担。
