Essential tremor patients experience significant burden beyond tremor: A systematic literature review

BackgroundEssential tremor (ET) is among the most common movement disorders in adults. While ET is diagnosed and primarily characterized by the presence of tremor, it also can impact cognition, sleep, mood, and motor functioning more broadly. The manifestations of ET can have various consequences, including difficulty with activities of daily living (ADL), embarrassment, and overall decline in health-related quality of life, which have not been fully explored in prior studies.ObjectiveWe performed a systematic literature review to comprehensively characterize the burden experienced by patients with ET from the clinical and humanistic perspectives, focusing on outcomes beyond tremor.MethodsThis systematic literature review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches in PubMed, Embase, and Cochrane Library identified original, observational studies of the clinical and humanistic burden in adult patients with ET published in English between 2010 and 2020. Studies assessing epidemiology, treatment patterns, or disease management were excluded. Search results were screened according to pre-determined eligibility criteria. Data from included studies were collected, independently verified, and qualitatively synthesized.ResultsFollowing the screening of 2,303 records and 145 full-text articles, 39 studies were identified. There was significant heterogeneity in study designs, statistical approaches, and patient cohorts across the included studies. Patients with ET in these studies exhibited more severe disabilities and reduced independence compared to healthy individuals, and they often struggled to perform ADL and relied on caregivers for physical and emotional support. Patients also experienced various issues with movement and balance, increased risk of falls, depression, anxiety, poor sleep quality, and psychosocial consequences including embarrassment, apathy, and enfeeblement.ConclusionA systematic literature review of non-tremor manifestations and/or consequences of ET identified far-reaching negative impacts on patients' ability to function independently and revealed accompanying psychosocial effects, including social fear and embarrassment. The reduced function and psychosocial deficits observed in patients with ET result in significant clinical and humanistic burdens, decreasing quality of life. Future studies should evaluate this condition beyond the tremor itself to provide an improved understanding of the multi-dimensional burden of the disease, thereby highlighting the need to diagnose and appropriately manage patients with ET

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Mean arterial pressure and mortality in patients with distributive shock: a retrospective analysis of the MIMIC-III database

Background: Maintenance of mean arterial pressure (MAP) at levels sufficient to avoid tissue hypoperfusion is a key tenet in the management of distributive shock. We hypothesized that patients with distributive shock sometimes have a MAP below that typically recommended and that such hypotension is associated with increased mortality. Methods: In this retrospective analysis of the Medical Information Mart for Intensive Care (MIMIC-III) database from Beth Israel Deaconess Medical Center, Boston, USA, we included all intensive care unit (ICU) admissions between 2001 and 2012 with distributive shock, defined as continuous vasopressor support for ≥ 6 h and no evidence of low cardiac output shock. Hypotension was evaluated using five MAP thresholds: 80, 75, 65, 60 and 55 mmHg. We evaluated the longest continuous episode below each threshold during vasopressor therapy. The primary outcome was ICU mortality. Results: Of 5347 patients with distributive shock, 95.7%, 91.0%, 62.0%, 36.0% and 17.2%, respectively, had MAP  0 to < 2 h, odds ratio (OR) 1.76, p = 0.005; ≥ 6 to < 8 h, OR 2.90, p < 0.0001; ≥ 20 h, OR 7.10, p < 0.0001]. When hypotension was defined as MAP < 60 or < 55 mmHg, the associations between duration and mortality were generally stronger than when hypotension was defined as MAP < 65 mmHg. There was no association between hypotension and mortality when hypotension was defined as MAP < 80 mmHg. Conclusions: Within the limitations due to the nature of the study, most patients with distributive shock experienced at least one episode with MAP  2 h. Episodes of prolonged hypotension were associated with higher mortality.Medicine, Faculty ofOther UBCNon UBCCritical Care Medicine, Division ofMedicine, Department ofReviewedFacult

Spatial and object visualization cognitive styles: Validation studies in 3800 individuals

The well-established dissociation between the ventral object and dorsal spatial processing streams within the visual system suggests a contrast between object and spatial visual cognitive styles. We assessed the validity of this distinction using a self-report questionnaire in a sample of 3839 online participants, and laboratory cognitive tests in a subsample of 196. We found that (1) object and spatial processing preferences were virtually uncorrelated (r = –.05); (2) men, science majors, and people with videogame experience preferred spatial visualization, whereas women, humanities majors, and people with visual arts experience preferred object visualization; and (3) spatial visualizers performed better on tests of mental rotation and virtual maze navigation, whereas object visualizers performed better on a difficult test of picture recognition. Interestingly, the associations among the spatial measures were stronger than those among the object measures, suggesting that spatial visualization may be the more unitary cognitive ability and style

Spatial and Object Visualization Cognitive Styles: Validation Studies in 3839 Individuals

The well-established dissociation between the ventral object and dorsal spatial processing streams within the primate visual system suggests a contrast between object and spatial cognitive styles. We assessed the validity of this distinction using a self-report questionnaire in a sample of 3839 online participants, and laboratory cognitive tests in a subsample of 196. We found that (1) object and spatial processing preferences were virtually uncorrelated (r = –.05); (2) men, science majors, and people with videogame experience preferred spatial visualization, whereas women, humanities majors, and people with visual arts experience preferred object visualization; and (3) spatial visualizers performed better on tests of mental rotation and virtual maze navigation, whereas object visualizers performed better on a difficult test of picture recognition. The associations among the spatial measures were stronger than those among the object measures, which suggests that spatial visualization may be the more unitary cognitive ability and style. Individual differences in cognitive style may have implications for education

Prevalence of stressful life events and their association with post-traumatic stress disorder among youth attending secondary school in Haiti

The association between earthquakes and youth post-traumatic stress disorder (PTSD) has been well described, but little is known about the relationship between other stressful life events (SLEs) and PTSD among earthquake-affected youth. This study examines a variety of SLEs, including earthquake, and their association with PTSD among school-going Haitian youth following a major earthquake in 2010. In 2013, we assessed 120 students ages 18-22 for PTSD and other SLEs using a modified Structured Clinical Interview for DSM-IV (SCID)-based interview and the Stressful Life Events Checklist (SLE Checklist). Only 51.7% of participants on the SLE Checklist and 31.7% in the interview endorsed being affected by the earthquake or another disaster. Sexual assault showed the strongest association with PTSD in multivariable logistic regression. Contrary to our hypothesis, exposure to earthquake or another disaster was not significantly associated with current PTSD. In this population, exposure to interpersonal violence may have had a greater impact on PTSD risk than exposure to natural disaster. These data underscore the need to examine and reduce both acute and chronic stressors among disaster-affected youth

A validation study of the Zanmi Lasante Depression Symptom Inventory (ZLDSI) in a school-based study population of transitional age youth in Haiti

Abstract Background The Zanmi Lasante Depression Symptom Inventory (ZLDSI) is a screening tool for major depression used in 12 primary care clinics in Haiti’s Central Plateau. Although previously validated in a clinic-based sample, the present study is the first to evaluate the validity and clinical utility of the ZLDSI for depression screening in a school-based population in central Haiti. Methods We assessed depressive symptoms in a school-based sample of transitional age youth (18–22 years; n = 120) with the ZLDSI. Other mental health-related assessments included a modified Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID) for current Major Depressive Episode, the Center for Epidemiologic Studies Depression Scale, and selected items adapted from the Global School-Based Health Survey mental health module. Diagnostic assignments of major depressive episode (MDE) were based on modified SCID interviews. Results The ZLDSI demonstrated good overall accuracy in identifying current MDE (Area under the Curve = .92, 95% CI = .86, .98, p < .001). We ascertained ≥12 as the optimal cut-off point to screen for depression with a sensitivity of 100% and a specificity of 73.9%. In addition, the ZLDSI was associated with other measures of depressive symptoms, suggesting that it demonstrates construct validity. Conclusions Study findings support that the ZLDSI has clinical utility for screening for depression among school-going transitional age youth.http://deepblue.lib.umich.edu/bitstream/2027.42/173675/1/13031_2020_Article_250.pd