64 http://neuro.psychiatryonline.org J Neuropsychiatry Clin Neurosci 18:1, Winter 2006 Frontal Functions in Young Patients With Essential Tremor: A Case Comparison Study Hu ¨ seyin A. S ¸ ahin, M.D. Murat Terzi, M.D. Sibel Uc ¸ak, M.D. Oktay Yapıcı, M.D. Tarık Bas ¸og ˘ lu, M.D. Musa Onar, M.D. Received July 6, 2004; revised November 20, 2004; accepted December 14, 2004. From the Department of Neurology, Ondokuz Mayis Uni- versity, Medical School, Kurupelit, Samsun,Turkey; and the Depart- ment of Nuclear Medicine, Ondokuz Mayis University, Medical School, Kurupelit, Samsun, Turkey. Address correspondence to Dr. Sahin, Ondokuz Mayis University, Medical School, Department of Neurology, 55139 Kurupelit, Samsun, Turkey; [email protected] (E-mail). Copyright 2006 American Psychiatric Publishing, Inc. Essential tremor (ET) is classified as a pure motor system disease. It has been previously reported that impairments in cognitive functions can be as- sociated with ET. The authors assessed cognitive functions in a relatively young patient group with ET and comparison subjects. Correlations between tremor severity and regional cerebral blood flow (rCBF) and neuropsychological test performances of ET patients and comparison subjects were in- vestigated. Sixteen patients with ET and 16 com- parison subjects were assessed by a comprehensive neuropsychological test battery designed to assess global attention, language, memory, visuospatial functions, and executive functions. In 11 of 16 patients and in nine of 16 comparison subjects, rCBF was measured by technetium-99m-hexame- thyl propylene amine oxime single photon emis- sion computed tomography (technetium-99m- HMPAO SPECT). The tremor severity was quantified using the Clinical Rating Scale for Tremor (CRST). Findings revealed that ET pa- tients differed significantly from comparison sub- jects on tests assessing visuospatial functions and verbal memory, whereas differences in other tests did not reach statistical significance. There was no significant difference between the rCBF of ET pa- tients and comparison subjects. There were statis- tically significant inverse correlations between tremor severity and executive functions. Tremor severity was inversely correlated with bilateral frontal blood flow by technetium-99m-HMPAO SPECT. Conclusions suggest that the subclinical cognitive deficits characterized by visuospatial and verbal memory impairments and executive dysfunction may be a clinical feature of ET, and the cerebello-thalamo-frontal network may play a role in the pathophysiology of this disorder. (The Journal of Neuropsychiatry and Clinical Neurosciences 2006; 18:64–72) E ssential tremor (ET) is perhaps the most common adult-onset movement disorder. 1,2 It is a sporadic or familial disorder characterized by postural-action tremor, with a frequency of 5–8 Hz. ET predominantly involves the hands but may also spread to the head, the vocal cords, the lips, and, rarely, the lower extremities. 3,4 Clinically, ET progresses slowly. In some cases in the advanced stage, daily living activities, such as eating and writing, may become impaired. 5,6 Although pos-
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