Department of Neurology, Ludwig-Maximilians University, Munich, Germany.
Department of Neurology, Kiel University, Kiel, Germany.
Mov Disord Clin Pract. 2024 Oct;11(10):1257-1265. doi: 10.1002/mdc3.14201. Epub 2024 Sep 5.
Tremor is commonly found among healthy humans or prevalently a symptom of neurological dysfunctions. However, the distinction between physiological and pathological tremor is dependent on the examiner's competence. Archimedes Spiral Rating (ASR) is a valid and reproducible semi-quantitative method to assess the severity of action tremor.
(1) To assess the range and percentiles of ASR in a large sample seemingly free of tremor-related conditions or symptoms from the population-based CHRIS-study. (2) To analyze the influence of sex, age, and the drawing hand on ASR. (3) To define ASR limits of normal. (4) To supply exemplary Archimedes spiral drawings by each rating to favor consistent and proficient clinical evaluation.
Accurately investigated participants were randomly sampled over 14 sex-age strata. 2686 paired spirals drawn with both hands by 1343 participants were expertly assessed on a tremor rating scale from 0 to 9.
ASR had a quadratic increase with age in both sexes, while it was relatively lower in the dominant compared to the non-dominant hand and in women compared to men. ASRs above sex-age specific 97.5th percentiles of 4 and 5, below and above 60 years of age, respectively, were conceivably of non-physiological nature.
In a large population-based sample we show a steeper increase of action tremor by age as age progresses. Relatively higher ratings among the elderly, males and the non-dominant hands, appear compatible with ASR limits of "normal" across sex-age groups. The current operational evidence may support practitioners differentiating physiological and pathological hand tremor.
震颤在健康人群中很常见，或者是神经功能障碍的主要症状。然而，生理震颤和病理性震颤的区别取决于检查者的能力。阿基米德螺旋评分（ASR）是一种评估动作性震颤严重程度的有效且可重复的半定量方法。
（1）评估来自基于人群的 CHRIS 研究的似乎没有震颤相关疾病或症状的大样本中 ASR 的范围和百分位数。（2）分析性别、年龄和绘图手对 ASR 的影响。（3）定义 ASR 的正常范围。（4）通过每个评分提供示例的阿基米德螺旋图，以促进一致和熟练的临床评估。
在 14 个性别-年龄层中，对准确调查的参与者进行随机抽样。由 1343 名参与者用双手绘制的 2686 对螺旋线由专家在震颤评分量表上进行评估，范围从 0 到 9。
在两性中，ASR 随年龄呈二次增加，而在惯用手与非惯用手之间，以及在女性与男性之间，ASR 相对较低。分别在 60 岁以下和以上，性别-年龄特定的第 97.5 百分位数 4 和 5 以上的 ASR 可能具有非生理性。
在一个基于人群的大型样本中，我们显示随着年龄的增长，动作性震颤的增加更为陡峭。在老年人、男性和非惯用手中，相对较高的评分与各性别-年龄组的 ASR“正常”范围一致。目前的操作证据可能支持从业者区分生理性和病理性手部震颤。
