Common causes of uncontrollable shaking in the elderly
Essential tremor
Essential tremor (ET) is the most common type of movement disorder and is more prevalent in people over 65. Unlike the resting tremor associated with Parkinson's disease, essential tremor typically occurs during movement (kinetic tremor) or when holding a position against gravity (postural tremor). The tremor may be mild initially but can progress over time, affecting the hands, head, voice, and even legs. While the exact cause is unknown, a genetic link is strongly suspected in many cases.
Characteristics of Essential Tremor:
- Shaking that worsens with voluntary movement or posture.
- Can affect the hands, head, voice, and other body parts.
- Often bilateral, though one side may be more affected.
- Can be exacerbated by stress, caffeine, fatigue, and temperature extremes.
Parkinson's disease
Parkinson's disease is another common cause of tremors in older adults, affecting an estimated one percent of people over 60. The hallmark of Parkinson's is a resting tremor, which is most noticeable when the affected limb is at rest and typically subsides with purposeful movement. This tremor often begins on one side of the body, starting in a hand with a characteristic "pill-rolling" motion, and may spread to other limbs as the disease progresses. Parkinson's is caused by a loss of dopamine-producing cells in the brain and is often accompanied by other motor symptoms like slowness of movement (bradykinesia) and muscle stiffness.
Characteristics of Parkinson's Disease Tremor:
- Primarily a resting tremor, subsiding with movement.
- Often asymmetrical, starting on one side.
- Frequently involves a "pill-rolling" motion of the fingers.
- Associated with other symptoms such as slowed movement, rigidity, and balance issues.
Medications and lifestyle factors
A number of common medications can induce or worsen tremors, a side effect known as drug-induced tremor. This can be a significant factor in the elderly, who often take multiple prescriptions. Lifestyle factors also play a role.
Medications that can cause tremors include:
- Asthma medications (e.g., albuterol)
- Certain antidepressants (e.g., SSRIs, tricyclics)
- Immunosuppressants
- Mood stabilizers (e.g., lithium)
- Stimulants and excessive caffeine intake
Lifestyle triggers:
- Emotional stress and anxiety can activate or worsen tremors.
- Fatigue and insufficient sleep.
- Excessive caffeine or alcohol consumption and withdrawal.
- Extreme temperatures.
Other medical conditions
Uncontrollable shaking can also be a symptom of other underlying health issues. These conditions affect the nervous system and can interfere with motor control.
- Stroke: Damage to certain brain regions, such as the basal ganglia or cerebellum, can lead to post-stroke tremors.
- Multiple Sclerosis (MS): This autoimmune disease damages the protective sheath covering nerves, and tremors can occur if the cerebellum is affected.
- Hyperthyroidism: An overactive thyroid can increase metabolic rate and cause shaky hands.
- Hypoglycemia: Low blood sugar levels can trigger the release of stress hormones, causing tremors.
- Alcohol abuse or withdrawal: Long-term alcohol use can damage the cerebellum, leading to tremors, and abrupt cessation can cause withdrawal tremors.
Distinguishing between essential tremor and Parkinson's disease
| Feature | Essential Tremor (ET) | Parkinson's Disease (PD) |
|---|---|---|
| Onset | Most often begins in middle age or later; sometimes familial. | Typically begins after age 60, though can start earlier. |
| Tremor Type | Primarily an action tremor, occurring with voluntary movement or posture. | Primarily a resting tremor, decreasing with voluntary movement. |
| Tremor Location | Usually affects both hands and arms, often the head and voice. | Often begins unilaterally (one side), typically a hand, and can involve legs, chin, and jaw. |
| Associated Symptoms | Can cause handwriting difficulties and balance issues in later stages. | Accompanied by other motor symptoms, including bradykinesia (slowed movement) and rigidity. |
| Progression | Slowly progressive, but can remain mild for many years. | Progressive and chronic, with symptoms worsening over time. |
| Response to Stress | Worsens with stress, fatigue, or caffeine. | Worsens with stress or strong emotion. |
Diagnosis and management
Accurate diagnosis by a healthcare provider is essential, as treatment depends on the underlying cause. Diagnosis typically involves a physical exam, a review of medical history and medications, and, in some cases, imaging or blood tests.
Management strategies can include:
- Addressing the root cause: If a medication or medical condition like hyperthyroidism is responsible, treating the underlying issue can resolve the tremor.
- Medication: For essential tremor, beta-blockers or anti-seizure medications may be prescribed. For Parkinson's, dopaminergic medications like levodopa are used.
- Lifestyle modifications: Avoiding triggers like caffeine, alcohol, and high stress levels can help manage symptoms. Ensuring adequate rest is also important.
- Physical and occupational therapy: Therapists can help improve muscle control and coordination. Occupational therapists can recommend adaptive devices, such as weighted utensils, wider pens, or specialized wristbands, to assist with daily tasks.
- Surgical options: For severe tremors unresponsive to other treatments, surgical procedures like Deep Brain Stimulation (DBS) or Focused Ultrasound Thalamotomy may be considered.
Conclusion
Uncontrollable shaking in the elderly is not a normal part of aging but a symptom that requires attention from a healthcare professional. While the most common culprits are essential tremor and Parkinson's disease, other medical conditions, medications, and lifestyle factors can also be to blame. By understanding the distinct characteristics of different tremors, undergoing a proper medical evaluation, and exploring a range of treatment options, seniors can effectively manage their symptoms and significantly improve their quality of life. An accurate diagnosis is the first and most critical step toward finding relief.
American Parkinson Disease Association: Other Causes of Tremor
