Movement disorders are a common manifestation when it comes to brain disorders. The brain is an intricate unit of wiring and nerve bundles that coordinate movements throughout the entire body. As a result, it requires a large amount of energy to function properly.
When brain degeneration begins, such as seen when a patient ages, this sophisticated network begins to fail. An elderly person is more prone to stumbling, muscle twitching, and a loss of balance because of this. When the process is accelerated by brain degeneration diseases like Alzheimer's disease, these symptoms are likely to present at a much younger age.
What is a tremor?
Irregular and unintentional movements can occur as the brain degrades. A tremor is one of these movements. To begin with, there are a few different types of tremors that can appear in a patient. Some of the most common types are known as resting tremors, action tremors, essential tremors, and physiological tremors. Different types of tremors manifest depending on the pathway of the brain that is affected.
- A resting tremor appears when a person is not moving their limbs. It will be typically seen in the upper extremities first because this is more intricate compared to the lower extremities.
- Action tremors are the opposite — they only appear when a person is trying to use their muscles. While sitting, muscle shaking may not be noticeable, but when the patient tries to drink water or eat something, they are unable to smoothly bring these items towards their mouth. As you may suspect already, this is a very frustrating type of tremor to have and patients will typically need assistance to eat and drink.
- Essential tremors are the next type of possible tremor. This is considered to be the most common type of tremor worldwide and is similar to an action tremor. Essential tremors will also worsen when a person attempts to use their arms, and is almost always bilateral and symmetric. Symptoms may first appear to be worse in their non-dominant hand but will eventually progress to be equal and severe on both sides.
- The last type of tremor we will cover is referred to as a physiological tremor. This is a tremor that can occur as a side effect of medications or from physiological dependence on drugs or alcohol. These patients may also have a worsening of this tremor if they stop doing their drug of choice. In most cases, it is seen in chronic alcoholics. Tremors will worsen if a patient is unable to drink alcohol after a few hours in some cases.
How are tremors linked with Alzheimer's disease?
There are numerous connections that you should be aware of. Due to the diffuse degradation of the brain in most patients with Alzheimer's, tremors of each variety mentioned above can be seen. Nevertheless, the most likely type of tremor in patients with Alzheimer's disease is the essential tremor, which will make carrying out even the simplest of tasks frustrating and time-consuming.
These tremors may not appear until later on in a more moderate form of Alzheimer's, however. In one study investigating the link between tremors and Alzheimer's disease, it was found that a patient would be diagnosed with a tremor 13 percent of the time in their initial visit. This stands to reason, because patients are being diagnosed at an earlier age due to advances in diagnostic studies so patients will be diagnosed at a younger age. After a five-year period had elapsed, almost 40 percent of patients in this same population were diagnosed with a tremor. As you can see, this is likely to be a symptom of the disease eventually but that does not necessarily mean that all patients with Alzheimer's will have a tremor.
What are the treatments?
Tremors may be quite likely in a patient with Alzheimer's disease, but that does not mean no treatment options can be of use to them. Because the tremor is caused by a problem along the muscle signaling pathway, drugs that help regulate this symptom can be useful.
In the early cases of the disease, patients may be able to live with the tremor without trying any additional therapy. This may be the best choice early on, because many of the therapies that we will cover soon have some side effects that may not be well-tolerated in most patients.
For essential tremors, some of the best treatment options would come in the form of beta blockers, antipsychotic medications or L-dopa, a dopamine drug. Dopamine is a drug that is typically used in patients who suffer from Parkinson's disease, but as Alzheimer's disease becomes more severe in various parts of the brain, the motor system that is significantly damaged in Parkinson's will start to have severe damage in Alzheimer's patients as well. This is why the same treatment can be helpful in these types of patients.
If oral medications do not help, patients may also try to use Botox injections to help reduce muscle twitching. Botox works mainly by paralyzing the muscle junction. This is why a patient may use it to stop wrinkling. If they are unable to use their facial muscles during frowning, they will not have the unwanted wrinkles they are trying to conceal. The same principle may work for muscle twitching in the arms and hands. A small amount of Botox here could help reduce some of the movements of the muscles and make it more comfortable for the patient to live.
Another useful technique is called deep brain stimulation. This is much more invasive than the other two options and requires surgery to implant electrodes into the brain. It should only be considered if you find that medications or Botox injections have failed to improve a patient's condition and the symptoms are becoming unbearable The electrodes will be implanted into the brain and send small electrical signals into the thalamus, a component of the brain that is responsible for coordinating muscle movement. This signal will help reduce the activation of this structure to reduce the amount of muscle twitching.