Ask the Doctor: ‘We fear my mother’s tremor may be an early sign of Parkinson’s. What should we do?’

“My elderly mother has recently developed a tremor. I am terrified that this may be Parkinson’s. When I Google this, Parkinson’s always comes up as the cause. What should we do and how do we know if it is Parkinson’s?”

Answer from Assoc Prof Anhar Hassan, Consultant Neurologist Beacon Hospital.

A tremor is a rhythmic movement of a body part. It most commonly occurs in the hands, and can occur in other body parts, such as the leg, head or voice. Parkinson’s disease is a frequent association of tremor appearing in older persons, although there are several causes in this age group.

In Parkinson’s disease, tremors usually start in a leg or arm, and may spread to the other side of the body. The tremor may be most apparent when the body part is relaxed and seated. There can be stiffness, slowness of movement on one or both sides of the body, slowness of walking, smaller handwriting, reduced facial expression, or drooling.

There may be loss of smell, constipation, or vivid dreams with acting out of dreams (kicking legs or punching in sleep). Other causes of tremors to consider include essential tremor, which is the most common neurologic cause of tremor, and affects about 1 in 20 people over the age of 65. It is most apparent in the hands when doing things like using a spoon, drinking or writing. This may run in families, and it is treatable with medication. Certain medications may also cause tremor as a side effect. Tremor can also be as a result of conditions such as thyroid disorders, anxiety, excessive caffeine, COPD. Treatment is usually directed at the underlying cause.

If a tremor comes on rapidly and worsens, sometimes becoming disabling, it may be a ‘functional tremor’. These can be triggered after an illness or trauma and requires a neurologist or specialist in movement disorders to make the diagnosis. Treatment includes specialised physiotherapy, occupational therapy, and cognitive behavioral therapy.

First, your mother should see her GP for assessment, who may be able to diagnose and treat the cause of tremor. The diagnosis is typically based on examination findings. There are no specific tests to confirm Parkinson’s disease but there may be tests to rule out other causes. Sometimes referral to a neurologist may be recommended for diagnosis and treatment. Neurologists that specialise in tremor and Parkinson’s disease are movement disorders specialists.

Things to take note of for your GP include how long ago the tremor started and how it was first noticed. Has it spread to other parts of the body? Does it emerge when you are sitting or resting? Were new medications started when the tremor started? If it is Parkinson’s disease, medications can help the tremor and other related symptoms. Physical activity is an important part of treatment in Parkinson’s disease, as it can directly help some symptoms, and can potentially slow the progression of the disorder. Physiotherapy and occupational therapy may be helpful.

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