Objective: This study aims to assess the prognosis of baseline leg tremor-onset in autopsy-verified Parkinson’s Disease (PD) patients.

Background: PD is a chronic neurological condition with a multifactorial etiology composed of genetic, environmental, and age-related influences. It is diagnosed clinically according to the presence of typical parkinsonian features with a diagnostic accuracy of approximately 80% at first assessment. A definite diagnosis requires neuropathological confirmation via postmortem autopsy. Clinical criteria have been used to classify patients into various PD motor subtypes including tremor-dominant, akinetic-rigid, and mixed. Patients with tremor-dominant PD experience slower disease progression, fewer non-motor symptoms, increased response to levodopa, and higher survival rates. Most of these patients present with upper-limb tremor at baseline. There is, however, a paucity of literature investigating the prognosis associated with baseline leg tremor-onset in autopsy-verified PD patients

Method: Data from 230 autopsy-verified PD patients was stratified into four baseline onset groups: Upper Limb tremor, Lower Limb tremor, Upper and Lower Limb tremor, and Other (bradykinesia, rigidity, postural instability onset). Association between Leg tremor-onset PD and: 1) response to levodopa, 2) development of dementia 3) freezing of gait and 4) mortality were examined. Statistical analysis included descriptive statistics, Fishers Exact Test for categorical variables, Kruskal-Willis test for continuous variables, and univariable logistic regression. Survival was assessed using Kaplan-Meier curves and log-rank test

Results: Mean age of clinical onset was 65.3 yrs (SD 9.9 yrs) with a mean survival duration of 15.2 yrs (SD 7.4 yrs). Thirty-four (14.8%) patients presented with Lower Limb onset, of these, twenty patients had baseline leg-tremor onset (8.7%). We found no association between Lower limb tremor-onset PD and our outcome variables. Additionally, there was no survival difference between the four baseline onset groups in the Kaplan-Meier curve (log-rank test p-value= 0.91).

Conclusion: There is no association between lower limb tremor onset PD and 1) response to levodopa, 2) development of dementia 3) freezing of gait and 4) mortality in our sample of autopsy-verified PD patients. These results should be interpreted in the context of study limitations.

Kaplan-Meier plot

References: 1. Willis AW, Roberts E, Beck JC, Fiske B, Ross W, Savica R, Van Den Eeden SK, Tanner CM, Marras C, Parkinson’s Foundation P4 Group Alcalay Roy Schwarzschild Michael Racette Brad Chen Honglei Church Tim Wilson Bill Doria James M. Incidence of Parkinson disease in North America. npj Parkinson’s Disease. 2022 Dec 15;8(1):170.
2. Deliz, J.R., Tanner, C.M. & Gonzalez-Latapi, P. Epidemiology of Parkinson’s Disease: An Update. Curr Neurol Neurosci Rep 24, 163–179 (2024).
3. Rajput AH, Voll A, Rajput ML, Robinson CA, Rajput A. Course in Parkinson disease subtypes: a 39-year clinicopathologic study. Neurology. 2009 Jul 21;73(3):206-12.
4. Lian TH, Guo P, Zuo LJ, Hu Y, Yu SY, Yu QJ, Jin Z, Wang RD, Li LX, Zhang W. Tremor-
dominant in Parkinson disease: the relevance to iron metabolism and inflammation. Frontiers in
neuroscience. 2019 Mar 27;13:255.
5. Abusrair AH, Elsekaily W, Bohlega S. Tremor in Parkinson’s disease: from pathophysiology to advanced therapies. Tremor and Other Hyperkinetic Movements. 2022;12.
6. Rajput AH, Rajput ML, Ferguson LW, Rajput A. Baseline motor findings and Parkinson
disease prognostic subtypes. Neurology. 2017 Jul 11;89(2):138-43.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/tremor-onset-parkinsons-disease-does-leg-tremor-portend-a-poor-prognosis/