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Wetherell MA, Lau SH, Maxion RA. The effect of socially evaluated multitasking stress on typing rhythms. Psychophysiology 2023; 60:e14293. [PMID: 36938968 DOI: 10.1111/psyp.14293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 02/03/2023] [Accepted: 02/28/2023] [Indexed: 03/21/2023]
Abstract
Individuals have unique typing rhythms characterized by specific keystroke dynamics. Changes in state and cardiovascular responding are well documented manifestations of the fight-flight response to stress. However, as stress also leads to changes in muscle tone and motor control, typing rhythms may also be impacted. We aim to determine which individuals are experiencing stress through their typing rhythms and identify universal keystroke markers of stress. Participants (N = 116) typed 80 repetitions of a 6-word, 30-character phrase before and after 15 min of critically evaluated multitasking stress. Cardiovascular, hemodynamic, and state variables were compared across baseline, stress, and recovery periods and measures of typing rhythm were derived for each period and classified using machine-learning algorithms. Critically evaluated multitasking led to significant changes in all stress measures, demonstrating highly robust stress reactivity. Machine learning algorithms accurately classified stressed typing for each individual based on their typing rhythms; however, no universal keystroke markers of stress were identified. Using typing rhythms. We were able to determine whether an individual was stressed or not, but the markers used for classification differed between individuals. These individual changes may provide opportunities for identifying stressful periods through keystroke monitoring, as well as the potential for early identification of disorders which may impact fine motor control. Typing rhythms could therefore be used to monitor health and well-being in individuals who use keyboards in various situations. This is the first rigorous assessment of stress and typing rhythms and has led to the development of a feasible and highly reproducible research protocol.
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Affiliation(s)
- Mark A Wetherell
- Psychobiology of Stress & Wellbeing Group, Department of Psychology, Northumbria University Newcastle, Newcastle upon Tyne, UK
| | - Shing-Hon Lau
- Software Engineering Institute, Carnegie Mellon University, Pittsburgh, USA
| | - Roy A Maxion
- Computer Science & Machine Learning, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
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Riboldi GM, Frucht SJ. Is essential tremor a family of diseases or a syndrome? A family of diseases. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2022; 163:7-29. [PMID: 35750371 DOI: 10.1016/bs.irn.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
It is now well-established that essential tremor (ET) can manifest with different clinical presentations and progressions (i.e., upper limb tremor, head tremor, voice tremor, lower limb tremor, task- or position-specific tremor, or a combination of those). Common traits and overlaps are identifiable across these different subtypes of ET, including a slow rate of progression, a response to alcohol and a positive family history. At the same time, each of these manifestations are associated with specific demographic, clinical and treatment-response characteristics suggesting a family of diseases rather than a spectrum of a syndrome. Here we summarize the most important clinical, demographic, neuropathological and imagingfeatures of ET and of its subtypes to support ET as a family of identifiable conditions. This classification has relevance for counseling of patients with regard to disease progression and treatment response, as well as for the design of therapeutic clinical trials.
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Affiliation(s)
- Giulietta M Riboldi
- The Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, New York University Langone Health, New York, NY, United States
| | - Steven J Frucht
- The Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, New York University Langone Health, New York, NY, United States.
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Bhidayasiri R, Maytharakcheep S, Phumphid S, Maetzler W. Improving functional disability in patients with tremor: A clinical perspective of the efficacies, considerations, and challenges of assistive technology. J Neurol Sci 2022; 435:120197. [DOI: 10.1016/j.jns.2022.120197] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/06/2021] [Accepted: 02/17/2022] [Indexed: 11/24/2022]
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Louis ED, Dowd HN, Elkurd M. The spiral axis: A comparison of unaffected first-degree relatives of essential tremor cases vs. controls. J Neurol Sci 2021; 422:117330. [PMID: 33529854 DOI: 10.1016/j.jns.2021.117330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 01/05/2021] [Accepted: 01/22/2021] [Indexed: 10/22/2022]
Abstract
We previously observed that during a spiral drawing task, in essential tremor (ET) cases, the tremor wave forms align along a single predominant axis. This interesting clinical feature can distinguish ET from dystonia cases. We now investigate whether the unaffected relatives of ET cases also express this trait, albeit perhaps in a milder form. To address our aim, we assessed the spiral axis in 237 unaffected first-degree relatives of ET cases (FD-ET), comparing them to 105 controls (Co). A movement disorder neurologist assessed four hand drawn spirals for the presence of a single identifiable tremor orientation axis. A spiral axis score (range = 0-4 [a single axis on 4 spirals]) was assigned to each enrollee. FD-ET had higher spiral axis scores than Co. In a contingency table, the distribution of spiral axis scores differed in the two groups: FD-ET (highest) and Co (lowest) (ordinal chi-square test p = 0.014). Furthermore, when spiral axis scores were examined as a continuous measure, the groups differed (Mann-Whitney test p = 0.03) - with the means being 0.51 (FD-ET) and 0.26 (Co). These data have scientific implications. They (1) show that such axes are more common in relatives of ET cases than controls, and (2) raise the possibility that the spiral axis may be an early subclinical feature of ET.
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Affiliation(s)
- Elan D Louis
- Department of Neurology, University of Texas Southwestern, Dallas, TX, USA.
| | - Hollie N Dowd
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Mazen Elkurd
- Department of Neurology, University of Texas Southwestern, Dallas, TX, USA
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Louis ED, Ferrer M, Eliasen EH, Gaini S, Petersen MS. Tremor in normal adults: A population-based study of 1158 adults in the Faroe Islands. J Neurol Sci 2019; 400:169-174. [PMID: 30954661 DOI: 10.1016/j.jns.2019.03.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 02/25/2019] [Accepted: 03/20/2019] [Indexed: 12/27/2022]
Abstract
There are virtually no population-based data on tremor in normal individuals. Using a population-based sample of 1158 normal adults ages 40-98 years in the Faroe Islands, we characterized the extent of normal action tremor across age and gender strata. Participants drew two Archimedes spirals with each hand, and tremor was systematically quantified by a senior movement disorder neurologist using a reliable and valid ordinal rating scale (ratings = 0-3). Tremor was nearly universal - 1145 (98.9%) participants had a total mean spiral score > 0. Older age was associated with more tremor (p < .001) and spiral scores were higher in males than females (p < .001). The proportion of individuals with a spiral rating ≥ 1.5 (i.e., more than mild tremor) was low (1.8% - 8.5%); however, this value reached 19.6% in left-hand spirals of males ≥70 years old. In this population-based study of more than one thousand normal adults, the vast bulk (i.e., 98.9%) had tremor on spiral drawing. In general, the tremor was mild. The proportion of individuals with tremor above the mild range varied across age and gender strata. These extensive data may be used as a gold standard for defining normal levels of tremor within adult populations.
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Affiliation(s)
- Elan D Louis
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA; Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA; Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, USA.
| | - Monica Ferrer
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Eina H Eliasen
- Department of Occupational Medicine and Public Health, The Faroese Hospital System, Tórshavn, Faroe Islands
| | - Shahin Gaini
- Infectious Diseases Division, National Hospital Faroe Islands, Tórshavn, Faroe Islands; Department of Infectious Diseases, Odense University Hospital/University of Southern Denmark, Odense, Denmark; Centre for Health Science, Faculty of Health Sciences, University of the Faroe Islands, Tórshavn, Faroe Islands
| | - Maria Skaalum Petersen
- Department of Occupational Medicine and Public Health, The Faroese Hospital System, Tórshavn, Faroe Islands; Centre for Health Science, Faculty of Health Sciences, University of the Faroe Islands, Tórshavn, Faroe Islands
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Eliasen EH, Ferrer M, Gaini S, Louis ED, Petersen MS. Prevalence of Essential Tremor in the Faroe Islands: A Population-Based Study. Neuroepidemiology 2019; 52:227-236. [PMID: 30889566 DOI: 10.1159/000499070] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 02/22/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND No studies of the prevalence of one of the most common movement disorders, essential tremor (ET), have been undertaken in the Faroe Islands. Given the potential for founder effects in the Islands, and the highly genetic nature of ET, the Faroe Islands provide a particularly interesting setting in which to study the prevalence of ET. OBJECTIVE To estimate the prevalence of ET and study its characteristics. METHODS We used a 2-phase, population-based design, screening 1,328 randomly selected Faroese individuals aged ≥40 years. A subsample of 282 individuals who had returned the spirals and questionnaire was selected to participate in an in-person clinical evaluation. Tremor was systematically quantified by a senior movement disorder neurologist with particular specialization in tremor using a reliable and valid clinical rating scale followed by the application of rigorous diagnostic criteria used by tremor investigators internationally. RESULTS The overall crude prevalence was 2.9%. The age-adjusted prevalence was 3.1%. There was an age-associated rise in prevalence; by age ≥70, prevalence reached 4.8%. Twenty six of 27 (96.2%) were previously undiagnosed. CONCLUSIONS This is the first population-based study of the prevalence of ET in the Faroe Islands. The estimated prevalence was similar to studies using the same or comparable methodologies.
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Affiliation(s)
- Eina H Eliasen
- Department of Occupational Medicine and Public Health, The Faroese Hospital Systems, Tórshavn, Faeroe Islands,
| | - Monica Ferrer
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Shahin Gaini
- Centre for Health Science, Faculty of Health Sciences, University of the Faroe Islands, Tórshavn, Faeroe Islands.,Infectious Diseases Division, National Hospital Faroe Islands, Tórshavn, Faeroe Islands.,Department of Infectious Diseases, Odense University Hospital/University of Southern Denmark, Odense, Denmark
| | - Elan D Louis
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, Connecticut, USA.,Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, Connecticut, USA.,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Maria Skaalum Petersen
- Department of Occupational Medicine and Public Health, The Faroese Hospital Systems, Tórshavn, Faeroe Islands.,Centre for Health Science, Faculty of Health Sciences, University of the Faroe Islands, Tórshavn, Faeroe Islands
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Hoogendam YY, van der Lijn F, Vernooij MW, Hofman A, Niessen WJ, van der Lugt A, Ikram MA, van der Geest JN. Older age relates to worsening of fine motor skills: a population-based study of middle-aged and elderly persons. Front Aging Neurosci 2014; 6:259. [PMID: 25309436 PMCID: PMC4174769 DOI: 10.3389/fnagi.2014.00259] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 09/10/2014] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION In a population-based study of 1,912 community-dwelling persons of 45 years and older, we investigated the relation between age and fine motor skills using the Archimedes spiral-drawing test. Also, we studied the effect of brain volume on fine motor skills. METHODS Participants were required to trace a template of a spiral on an electronic drawing board. Clinical scores from this test were obtained by visual assessment of the drawings. Quantitative measures were objectively determined from the recorded data of the drawings. As tremor is known to occur increasingly with advancing age, we also rated drawings to assess presence of tremor. RESULTS We found presence of a tremor in 1.3% of the drawings. In the group without tremor, we found that older age was related to worse fine motor skills. Additionally, participants over the age of 75 showed increasing deviations from the template when drawing the spiral. Larger cerebral volume and smaller white matter lesion volume were related to better spiral-drawing performance, whereas cerebellar volume was not related to spiral-drawing performance. CONCLUSION Older age is related to worse fine motor skills, which can be captured by clinical scoring or quantitative measures of the Archimedes spiral-drawing test. Persons with a tremor performed worse on almost all measures of the spiral-drawing test. Furthermore, larger cerebral volume is related to better fine motor skills.
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Affiliation(s)
- Yoo Young Hoogendam
- Department of Epidemiology, Erasmus MC University Medical Center , Rotterdam , Netherlands ; Department of Radiology, Erasmus MC University Medical Center , Rotterdam , Netherlands
| | - Fedde van der Lijn
- Department of Radiology, Erasmus MC University Medical Center , Rotterdam , Netherlands ; Department of Medical Informatics, Erasmus MC University Medical Center , Rotterdam , Netherlands
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus MC University Medical Center , Rotterdam , Netherlands ; Department of Radiology, Erasmus MC University Medical Center , Rotterdam , Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus MC University Medical Center , Rotterdam , Netherlands
| | - Wiro J Niessen
- Department of Radiology, Erasmus MC University Medical Center , Rotterdam , Netherlands ; Department of Medical Informatics, Erasmus MC University Medical Center , Rotterdam , Netherlands ; Faculty of Applied Sciences, Delft University of Technology , Delft , Netherlands
| | - Aad van der Lugt
- Department of Radiology, Erasmus MC University Medical Center , Rotterdam , Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Center , Rotterdam , Netherlands ; Department of Radiology, Erasmus MC University Medical Center , Rotterdam , Netherlands ; Department of Neurology, Erasmus MC University Medical Center , Rotterdam , Netherlands
| | - Jos N van der Geest
- Department of Neuroscience, Erasmus MC University Medical Center , Rotterdam , Netherlands
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Stamelou M, Edwards MJ, Bhatia KP. Late onset rest-tremor in DYT1 dystonia. Parkinsonism Relat Disord 2013; 19:136-7. [DOI: 10.1016/j.parkreldis.2012.05.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 04/18/2012] [Accepted: 05/18/2012] [Indexed: 10/28/2022]
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Louis ED, Cubo E, Trejo-Gabriel-Galán JM, Villaverde VA, Benito VD, Velasco SS, Vicente JM, Guevara JC, Benito-León J. Tremor in school-aged children: a cross-sectional study of tremor in 819 boys and girls in Burgos, Spain. Neuroepidemiology 2011; 37:90-5. [PMID: 21894047 DOI: 10.1159/000330352] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 06/16/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Mild hand tremor occurs in most normal adults. There are no surveys of the prevalence or clinical correlates of such tremor among children. METHODS A cross-sectional study of tics, tremor and other neurological disorders was conducted in Spanish children; thus, 819 schoolchildren in Burgos, Spain, drew Archimedes spirals with each hand. Tremor in spirals was rated (0-2) by a blinded neurologist and an overall tremor rating (0-4) was assigned. RESULTS The mean age was 10.9 ± 3.1 years. A tremor rating of 1 (mild tremor) was present in either hand in 424 (51.7%) children, and in both hands in 88 (10.7%) children. Higher tremor ratings were very uncommon. The overall tremor rating was higher in boys than girls (1.31 ± 0.41 vs. 1.22 ± 0.34, p = 0.002) and correlated weakly yet significantly with age (ρ = 0.09, p = 0.01). Within subjects, the left hand spiral rating was greater than the right (p < 0.001). CONCLUSIONS In this cross-sectional study of 819 Spanish schoolchildren, mild tremor was commonly observed. As in adults, males had more tremor than females, tremor scores increased with age, and tremor scores were higher in the left than right arm, demonstrating that these clinical correlations seem to be more broadly generalizable to children. The functional significance of tremor in children, particularly as it relates to handwriting proficiency, deserves additional scrutiny.
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Affiliation(s)
- Elan D Louis
- GH Sergievsky Center, Columbia University, New York, NY, USA.
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