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Demoralization in essential tremor: prevalence, clinical correlates, and dissociation from tremor severity

Published online by Cambridge University Press:  03 April 2019

Tess E. K. Cersonsky Open the ORCID record for Tess E. K. Cersonsky [Opens in a new window] ,
Sarah Kellner ,
Sarah Morgan ,
Stephanie Cosentino ,
Brian B. Koo ,
John M. de Figueiredo  and
Elan D. Louis
Tess E. K. Cersonsky
Affiliation:
Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
Sarah Kellner
Affiliation:
Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
Sarah Morgan
Affiliation:
Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
Stephanie Cosentino
Affiliation:
Department of Neurology, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York, USA
Brian B. Koo
Affiliation:
Center for Neuroepidemiology and Clinical Neurological Research & Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
John M. de Figueiredo
Affiliation:
Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
Elan D. Louis*
Affiliation:
Center for Neuroepidemiology and Clinical Neurological Research & Division of Movement Disorders, Department of Neurology, Yale School of Medicine & Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, Connecticut, USA
*
*Address correspondence to: Elan D. Louis, Yale Neurology, Division of Movement Disorders, LCI 710, 15 York Street, PO Box 208018, New Haven, CT 06520-8018, USA. (Email: [email protected])
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Abstract

Objective.

Essential tremor (ET) is associated with psychological difficulties, including anxiety and depression. Demoralization (feelings of helplessness, hopelessness, inability to cope), another manifestation of psychological distress, has yet to be investigated in ET. Our objectives are to (1) estimate the prevalence of demoralization in ET, (2) assess its clinical correlates, and (3) determine whether demoralization correlates with tremor severity.

Methods.

We administered the Kissane Demoralization Scale (KDS-II) and several psychosocial evaluations (ie, scales assessing subjective incompetence, resilience, and depression [eg, Geriatric Depression Scale]) to 60 ET subjects. Tremor was assessed with a disability score and total tremor score. KDS-II >8 indicated demoralization.

Results.

Among 60 ET subjects (mean age = 70.2 ± 6.8 years), the prevalence of demoralization was 13.3%, 95% confidence interval = 6.9–24.2%. Although there was overlap between demoralization and depression (10% of the sample meeting criteria for both), 54% of depressed subjects were not demoralized, and 25% of demoralized subjects were not depressed. Demoralization correlated with psychological factors, but demoralized subjects did not have significantly higher total tremor scores, tremor disability scores, or years with tremor.

Conclusions.

Demoralization has a prevalence of 13.3% in ET, similar to that in other chronic or terminal illnesses (eg, cancer 13–18%, Parkinson’s disease 18.1%, coronary heart disease 20%). Demoralization was not a function of increased tremor severity, suggesting that it is a separable construct, which could dictate how a patient copes with his/her disease. These data further our understanding of the psychological and psychosocial correlates of ET.

Keywords

Demoralizationdepressionessential tremormovement disordersresiliencetremor severity
Type
Original Research
Information
CNS Spectrums , Volume 25 , Issue 1 , February 2020 , pp. 16 - 23
Copyright
© Cambridge University Press 2019

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Footnotes

This work was supported by the National Institutes of Health (grant number NINDSR01NS086736). This funding body played no role in the design of the study, the collection, analysis, and interpretation of data, or the writing of the manuscript. None of the authors had conflicts of interest.

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