Tandem gait performance in essential tremor patients correlates with cognitive function

Background: Emerging yet separate literatures have highlighted gait/balance impairments (i.e., mild ataxia) and cognitive problems in patients with essential tremor (ET). However, the relationship between the two has not been studied. The goal of these analyses was to study the relationship between gait/balance impairments and cognitive problems in ET. One-hundred-twenty ET cases were enrolled in an epidemiological study at Columbia University Medical Center. A Telephone Interview for Cognitive Status (TICS, range = 0-41 [no deficits]) was administered and a videotaped assessment of tandem gait was performed, during which the number of missteps during 10-steps was counted. Results: The mean TICS score was 35.7 (range 25-39), and mean number of tandem mis-steps was 2.9 (range 0-10). The number of tandem mis-steps was correlated with the TICS score (Spearman's r = -0.245, p = 0.011, i.e., individuals who had more tandem gait difficulty also had more cognitive difficulty). In a multivariate analysis, tandem mis-steps were associated with TICS score (p = 0.04) independent of age and other factors. Conclusions: More cognitive difficulty was associated with more tandem gait difficulty in ET. Ambulation often requires the concurrent use of both cognitive and motor neural systems; hence it is possible that the cognitive and gait problems in ET reflect an underlying pervasive disorder affecting both cognitive and motor circuits.