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Parkinson's Disease

PD, old age unsteadiness, essential tremor?

05/21/2008

Question:

I’m a healthy, active 63 y.o. w.m. with no significant hx of major dx, bar kidney stones. In the last 5 mos., I noticed my fingers mildly quivering while doing “fine” work like finely separating the pages of a newspaper, or balancing a spoon between my 1st and 2nd fingers while eating, or trying to put a screw (already on the end of a magnetic screwdriver) into a pre-drilled hole and even closing the loop on the letter “o” while writing (as perfectly as I use to). It`s a fairly mild finger shakiness but nonetheless one I didn`t notice until 5-6 months ago. The only other incident I noticed was a one-time one, whereby I was racing my grandkids to shade-in a chalk figure on the sidewalk and while frantically moving my right hand back and forth with the chalk, the other hand involuntarily twitched back and forth once or twice. That was about 6 months ago and hasn’t happened again and can’t be replicated, so it may not be relevant. There is no problem with any involuntary movement at rest. There are absolutely no coordination problems (I can still close my eyes and have my fingers exactly meet at a distance in front of my face and then bring them in and touch my nose, etc.); no gait or balance problems, no headaches or vision problems – everything else seems fine.

My question is twofold: 1) is there a difference between “getting older and not being steady” versus something like essential tremors; and 2) could this still be PD; and in any case, absent any other symptoms or changes/progression – can mentioning this to a doctor most likely wait until my yearly check-up in two months? Thank you for your kind assistance and any comments or observations you can offer in differentiating PD, old age tremors, essential tremors and any other dx entity that has similar characteristics.

Answer:

This forum is not intended to provide specific diagnosis or advice. However, here is some information you may find helpful.

People with essential tremor can find increase in tremor with age. This type of tremor is most pronounced when doing tasks such as manipulating objects. A parkinsonian tremor is commonly described as one that occurs at rest and decreases with any action. However, there are people with Parkinson's disease who have tremor more pronounced with action. Parkinson's disease is not diagnosed based on tremor alone. This is a diagnosis that is made clinically based on history and examination findings of 4 cardinal features:

I suggest you contact your doctor for further evaluation of your tremor.

For more information:

Go to the Parkinson's Disease health topic, where you can:

Response by:

Punit  Agrawal, DO Punit Agrawal, DO
Assistant Professor of Neurology
College of Medicine
The Ohio State University