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Mild action tremor labelled physiological tremor is present in all humans. Tremor increases with age. It is unknown if mild action tremor is associated with cognitive performance in older people.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To test the hypothesis that mild\u2014mostly non-pathological\u2014action tremor is associated with reduced cognitive performance in community-dwelling older adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The Cooperative Health Research in the Region of Augsburg (KORA)-Age study assessed health-related parameters including cognition in individuals between 65 and 93\u00a0years of age. We measured tremor using semi-quantitative ratings of Archimedes-spiral drawings. Participants taking Parkinson medication, with a self-reported neurologic disease or with a spiral rating\u2009&gt;\u20095 indicating certainly pathologic tremor were excluded. The modified Telephone Interview for Cognitive Status (TICS-m) was used to measure cognition. We analyzed the association between tremor and cognition using multivariable adjusted regression models in the whole population and after exclusion of participants with a spiral rating\u2009&gt;\u20093. We employed stepwise backward variable selection to build a final regression model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Tremor severity was associated with cognitive performance. Age, sex, Parkinson score, frailty, tremor score, physical activity, sleep-duration and previous stroke entered the final statistical model. Judged by the differences of adjusted r-squared between models, age was the most important predictor of cognition followed by sex, Parkinson score, frailty, and tremor severity. Sensitivity analyses excluding participants with likely pathological tremors did not attenuate the association between tremor severity and cognitive performance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Even mild action tremor severity is associated with reduced cognitive performance in older people. We hypothesize that aging-related brain changes are a common cause of cognitive impairment and tremor.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00415-026-14056-w","type":"journal-article","created":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T15:48:44Z","timestamp":1786463324000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between mild action tremor and cognition in community dwelling older adults: results from the KORA-Age study"],"prefix":"10.1007","volume":"273","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3262-8113","authenticated-orcid":false,"given":"Gregor","family":"Kuhlenb\u00e4umer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franziska","family":"Hopfner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00fcnther","family":"Deuschl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl-Heinz","family":"Ladwig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Birgit","family":"Linkohr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annette","family":"Peters","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Thorand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-Theres","family":"Huemer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,11]]},"reference":[{"key":"14056_CR1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.27121","author":"KP Bhatia","year":"2018","unstructured":"Bhatia KP, Bain P, Bajaj N, Elble RJ, Hallett M, Louis ED, Raethjen J, Stamelou M, Testa CM, Deuschl G, Tremor Task Force of the International P, Movement Disorder S (2018) Consensus statement on the classification of tremors. 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Birgit Linkohr, Annette Peters, Barbara Thorand and Marie-Theres Huemer are employees of the Helmholtz Zentrum M\u00fcnchen, German Research Center for Environmental Health (GmbH) which received the funding for the KORA study detailed in the section Funding. Gregor Kuhlenb\u00e4umer: Research grant, genetic basis of autoimmune encephalitis, BMFTR, Federal Ministry of Research, Technology and Space; Franziska Hopfner: Author honoraria Thieme and Kohlhammer medical publishers. Bartel Foundation, Sanofi company, CurePSP Foundation; G\u00fcnther Deuschl: Boston Scientific, Insightec, Thieme publishers; Karl-Heinz Ladwig: None; Birgit Linkohr: Employment as researcher by Helmholtz Zentrum M\u00fcnchen, German Research Center for Environmental Health (GmbH); Annette Peters: Director of the Institute of Epidemiology, Helmholtz Zentrum M\u00fcnchen, German Research Center for Environmental Health (GmbH), Chair of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universit\u00e4t M\u00fcnchen, Munich, Germany; Barbara Thorand: Employment as researcher by Helmholtz Zentrum M\u00fcnchen, German Research Center for Environmental Health (GmbH); Marie-Theres Huemer: Employment as researcher by Helmholtz Zentrum M\u00fcnchen, German Research Center for Environmental Health (GmbH).","order":1,"name":"Ethics","label":"Conflicts of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The KORA-Age study methods were approved by the Ethics Committee of the Bavarian Chamber of Physicians (EC No. 08064). The study conduct was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All participants gave their written informed consent.","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"523"}}