Prevalence and Relationship of Rest Tremor and Action Tremor in Parkinson's Disease

Background: Despite the significance of tremor in Parkinson's disease (PD) diagnosis, classification, and patient's quality of life, there is a relative lack of data on prevalence and relationship of different tremor types in PD. Methods: The presence of rest tremor (RT) and action tremor (AT; defined as combination of both postural and kinetic tremor) was determined and RT severity was defined using the Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) at baseline in the Progression Marker Initiative (PPMI, n = 423), the Fox Investigation for New Discovery of Biomarkers (BioFIND, n = 118) and the Parkinson's Disease Biomarkers Program (PDBP, n = 873) cohorts. Results: Across baseline data of all three cohorts, RT prevalence (58.2%) was higher than AT prevalence (39.0%). Patients with RT had significantly higher (Chi-square test, p < 0.05) prevalence of AT compared to patients without RT in the PPMI (40.0% versus 30.1%), BioFIND (48.0% versus 40.0%) and PDBP (49.9% versus 21.0%) cohorts. Furthermore, patients with AT had significantly (Student t-test, p < 0.05) higher RT severity that those without AT in PPMI (5.7 +/- 5.4 versus 3.9 +/- 3.3), BioFIND, 6.4 +/- 6.3 versus 3.8 +/- 4.4) and PDBP (6.4 +/- 6.6 versus 3.7 +/- 4.4) cohorts. In the BioFIND cohort, the prevalence of all types of tremor and their combinations significantly decreased from the off-state to on-state. Discussion: The RT is the most frequent tremor type and present in more than half of the PD patients. However, AT is also present in nearly one-third of the PD patients. Our results also indicate that RT and AT may have cross-interactions in PD, and that dopaminergic treatment influences both RT and AT.