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October 2022; 12 (5) Research Article

Clinicopathologic Correlations of Jaw Tremor in a Longitudinal Aging Study

Sana Aslam, Nan Zhang, Charles H. Adler, Thomas G. Beach, Erika Driver-Dunckley, Shyamal H. Mehta, Holly Shill
First published September 9, 2022, DOI: https://doi.org/10.1212/CPJ.0000000000200072
Sana Aslam
Department of Neurology (SA, HS), Barrow Neurological Institute, Phoenix, AZ; Department of Neurology (NZ, CHA, ED-D, SHM), Mayo Clinic, Scottsdale, AZ; and Banner Sun Health Research Institute (TGB), Sun City, AZ.
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Nan Zhang
Department of Neurology (SA, HS), Barrow Neurological Institute, Phoenix, AZ; Department of Neurology (NZ, CHA, ED-D, SHM), Mayo Clinic, Scottsdale, AZ; and Banner Sun Health Research Institute (TGB), Sun City, AZ.
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Charles H. Adler
Department of Neurology (SA, HS), Barrow Neurological Institute, Phoenix, AZ; Department of Neurology (NZ, CHA, ED-D, SHM), Mayo Clinic, Scottsdale, AZ; and Banner Sun Health Research Institute (TGB), Sun City, AZ.
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Thomas G. Beach
Department of Neurology (SA, HS), Barrow Neurological Institute, Phoenix, AZ; Department of Neurology (NZ, CHA, ED-D, SHM), Mayo Clinic, Scottsdale, AZ; and Banner Sun Health Research Institute (TGB), Sun City, AZ.
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Erika Driver-Dunckley
Department of Neurology (SA, HS), Barrow Neurological Institute, Phoenix, AZ; Department of Neurology (NZ, CHA, ED-D, SHM), Mayo Clinic, Scottsdale, AZ; and Banner Sun Health Research Institute (TGB), Sun City, AZ.
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Shyamal H. Mehta
Department of Neurology (SA, HS), Barrow Neurological Institute, Phoenix, AZ; Department of Neurology (NZ, CHA, ED-D, SHM), Mayo Clinic, Scottsdale, AZ; and Banner Sun Health Research Institute (TGB), Sun City, AZ.
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Holly Shill
Department of Neurology (SA, HS), Barrow Neurological Institute, Phoenix, AZ; Department of Neurology (NZ, CHA, ED-D, SHM), Mayo Clinic, Scottsdale, AZ; and Banner Sun Health Research Institute (TGB), Sun City, AZ.
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Citation
Clinicopathologic Correlations of Jaw Tremor in a Longitudinal Aging Study
Sana Aslam, Nan Zhang, Charles H. Adler, Thomas G. Beach, Erika Driver-Dunckley, Shyamal H. Mehta, Holly Shill
Neurol Clin Pract Oct 2022, 12 (5) e85-e92; DOI: 10.1212/CPJ.0000000000200072

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Abstract

Background and Objectives The aim of this study is to assess clinical and pathologic correlations of jaw tremor in 3 cohorts enrolled in a long-term aging study. Jaw/lip tremor has been described in various movement disorders but the impact of seeing a jaw tremor on clinician diagnosis and whether the presence of isolated jaw tremor is correlated with subsequent phenoconversion to a different movement disorder are unclear.

Methods Data from the Arizona Study of Aging and Neurodegenerative Disease, a longitudinal clinicopathologic study, were used. Control subjects (n = 708) did not have any tremor or parkinsonism. At initial evaluation, 276 subjects who had jaw tremor were categorized as isolated jaw tremor (jaw tremor without limb action tremor or parkinsonism), suspect/possible PD (1 or 2 cardinal features of PD without a history of dopaminergic treatment), parkinsonism (probable PD and other parkinsonian disorders), or nonparkinsonian tremor (e.g., essential tremor). Initial clinical diagnosis was compared with “final diagnosis” based on longitudinal assessments and with clinicopathologic diagnosis when available.

Results In subjects with jaw tremor, we identified 45 isolated jaw tremor, 92 nonparkinsonian tremor, 56 suspect/possible PD, and 83 parkinsonism cases at baseline and followed longitudinally. Neuropathologic diagnosis was available for 137 cases. The mean time from initial to final assessment or autopsy was 6.8 years (SD 4.4). Of the subjects with follow-up data, only 15.4% of those with isolated jaw tremor (6/39) and 8.8% of those with nonparkinsonian tremor (6/68) evolved into a clinical parkinsonian disorder. Neither of these groups was associated with clinicopathologic PD: isolated jaw tremor (1/18) and nonparkinsonian tremor (1/43). Those with jaw tremor initially classified into a parkinsonian group were more highly associated with clinicopathologic PD: 27 of 51 subjects with parkinsonism other and 4 of 25 possible PD.

Discussion The presence of either jaw tremor in isolation or associated with nonparkinsonian tremor does not portend a neurodegenerative diagnosis.

Footnotes

  • Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.

  • Submitted and externally peer reviewed. The handling editors were Former Associate Editor Richard Barbano, MD, PhD, FAAN, and Associate Editor John P. Ney, MD, MPH.

  • Received July 21, 2021.
  • Accepted July 19, 2022.
  • © 2022 American Academy of Neurology
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