{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,10]],"date-time":"2026-05-10T11:15:52Z","timestamp":1778411752313,"version":"3.51.4"},"reference-count":48,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2021,1,27]],"date-time":"2021-01-27T00:00:00Z","timestamp":1611705600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objectives<\/jats:title>\n<jats:p>To compare non-motor symptoms (NMSs) among patients with essential tremor (ET), Parkinson\u2019s disease (PD) subtypes (akinetic-rigid type (ART) and tremor-dominant type (TDT)), and healthy controls.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Patients and methods<\/jats:title>\n<jats:p>This retrospective study included 129 participants, 72 PD (33 PD-ART, 33 PD-TDT, and 6 Mixed), 29 ET patients, and 28 controls. PD patients were assessed by the unified Parkinson\u2019s disease rating scale (UPDRS), Hoehn, and Yahr scale (H&amp;Y), while ET patients were evaluated by the Fahn Tolosa Marin Tremor Rating Scale. All subjects were evaluated by non-motor symptoms scale (NMSS) for NMSs and Beck depression inventory (BDI) for depression.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>PD subtypes groups, ET, and controls were age and gender-matched. Compared to controls, all PD, PD subtypes, and ET showed significantly worse most of NMSs (p&lt;0.001) and depression. Compared to ET, all PD and PD-ART had significantly worse gastrointestinal (p = 0.002), urinary symptoms (p = 0.001, p = 0.003) and depression (p = 0.002) and PD-TDT worse depression, while ET patients showed worse memory\/attention than PD subtypes. Total NMSS of ET is highly correlated to depression and moderately to tremor severity and age of onset, while total of NMSS is highly correlated to depression, disease severity, and disability.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The current study demonstrated several comparable domains of NMSs of PD subtypes and ET, except worse gastrointestinal and urinary symptoms among PD-ART. Identifying different NMSs profiles is important for predicting, better assessing, and tailoring management of ET and PD subtypes.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0245918","type":"journal-article","created":{"date-parts":[[2021,1,27]],"date-time":"2021-01-27T18:25:41Z","timestamp":1611771941000},"page":"e0245918","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":27,"title":["Non-motor symptoms in essential tremor, akinetic rigid and tremor-dominant subtypes of Parkinson\u2019s disease"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7012-5907","authenticated-orcid":true,"given":"Ali S.","family":"Shalash","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eman","family":"Hamid","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hanan","family":"Elrassas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6168-9134","authenticated-orcid":true,"given":"Eshak I.","family":"Bahbah","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alia H.","family":"Mansour","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hadeer","family":"Mohamed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mahmoud","family":"Elbalkimy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,1,27]]},"reference":[{"key":"pone.0245918.ref001","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1002\/mds.22838","article-title":"How common is the most common adult movement disorder? Update on the worldwide prevalence of essential tremor","volume":"25","author":"E.D. Louis","year":"2010","journal-title":"Mov. Disord"},{"key":"pone.0245918.ref002","article-title":"Epidemiology of Parkinson\u2019s Disease\u2014East Versus West","author":"M.M. Abbas","year":"2018","journal-title":"Mov. Disord. Clin. Pract"},{"key":"pone.0245918.ref003","article-title":"The relationship between essential tremor and Parkinson\u2019s disease","author":"M.A. Thenganatt","year":"2016","journal-title":"Park. Relat. Disord"},{"key":"pone.0245918.ref004","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2018.00357","article-title":"Non-motor symptoms as predictors of quality of life in Egyptian patients with Parkinson\u2019s disease: A cross-sectional study using a culturally adapted 39-item Parkinson\u2019s disease questionnaire","volume":"9","author":"A.S. Shalash","year":"2018","journal-title":"Front. Neurol"},{"key":"pone.0245918.ref005","article-title":"Clinical Profile of Non-Motor Symptoms in Patients with Essential Tremor: Impact on Quality of Life and Age-Related Differences","volume":"9","author":"A.S. Shalash","year":"2019","journal-title":"Tremor Other Hyperkinet. Mov. (N. Y)"},{"key":"pone.0245918.ref006","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/j.jns.2015.01.012","article-title":"Nonmotor symptoms in essential tremor: Comparison with Parkinson\u2019s disease and normal control","volume":"349","author":"S.M. Lee","year":"2015","journal-title":"J. Neurol. Sci"},{"key":"pone.0245918.ref007","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.1002\/mds.20513","article-title":"Clinical characteristics in early Parkinson\u2019s disease in a central California population-based study","volume":"20","author":"G.A. Kang","year":"2005","journal-title":"Mov. Disord"},{"key":"pone.0245918.ref008","article-title":"Parkinson\u2019s Disease Motor Subtypes Show Different Responses to Long-Term Subthalamic Nucleus Stimulation","volume":"12","author":"C. Xu","year":"2018","journal-title":"Front. Hum. Neurosci"},{"key":"pone.0245918.ref009","article-title":"Essential tremor and parkinson\u2019s disease: Exploring the relationship","author":"A. Tarakad","year":"2019","journal-title":"Tremor and Other Hyperkinetic Movements"},{"key":"pone.0245918.ref010","article-title":"The overlap between Essential tremor and Parkinson disease","author":"M. Algarni","year":"2018","journal-title":"Park. Relat. Disord"},{"key":"pone.0245918.ref011","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.jns.2015.12.016","article-title":"Comparison of motor and non-motor features between essential tremor and tremor dominant Parkinson\u2019s disease","volume":"361","author":"K.Y. Kwon","year":"2016","journal-title":"J. Neurol. Sci"},{"key":"pone.0245918.ref012","article-title":"Patient-reported Needs, Non-motor Symptoms, and Quality of Life in Essential Tremor and Parkinson\u2019s Disease","author":"S.K. Lageman","year":"2014","journal-title":"Tremor and Other Hyperkinetic Movements"},{"key":"pone.0245918.ref013","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.parkreldis.2013.09.004","article-title":"Do non-motor symptoms in Parkinson\u2019s disease differ from essential tremor before initial diagnosis? A clinical and scintigraphic study","volume":"20","author":"M. Giorelli","year":"2014","journal-title":"Parkinsonism Relat. Disord"},{"key":"pone.0245918.ref014","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1136\/jnnp.55.3.181","article-title":"Accuracy of clinical diagnosis of idiopathic Parkinson\u2019s disease: a clinico-pathological study of 100 cases","volume":"55","author":"A.J. Hughes","year":"1992","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"pone.0245918.ref015","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1002\/mds.27121","article-title":"Consensus Statement on the classification of tremors. from the task force on tremor of the International Parkinson and Movement Disorder Society","volume":"33","author":"K.P. Bhatia","year":"2018","journal-title":"Mov. Disord"},{"key":"pone.0245918.ref016","volume-title":"Park. Dis. Mov. Disord.","author":"S. Fahn","year":"1993"},{"key":"pone.0245918.ref017","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1001\/archpsyc.1961.01710120031004","article-title":"An inventory for measuring depression","volume":"4","author":"A.T. BECK","year":"1961","journal-title":"Arch. Gen. Psychiatry"},{"key":"pone.0245918.ref018","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1111\/j.1468-1331.2008.02212.x","article-title":"Quantitation of non-motor symptoms in Parkinson\u2019s disease","volume":"15","author":"K.R. Chaudhuri","year":"2008","journal-title":"Eur. J. Neurol"},{"key":"pone.0245918.ref019","article-title":"Internal consistency of an Arabic adaptation of the beck depression inventory in four Arab countries","author":"A.M. Abdel-Khalek","year":"1998","journal-title":"Psychol. Rep"},{"key":"pone.0245918.ref020","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.parkreldis.2015.10.617","article-title":"Prevalence and clinical features of non-motor symptoms of essential tremor in Shanghai rural area","volume":"22","author":"Y. Wu","year":"2016","journal-title":"Parkinsonism Relat. Disord"},{"key":"pone.0245918.ref021","article-title":"Distinct Non\u2010motor Features of Essential Tremor with Head Tremor Patients","author":"J. Peng","year":"2020","journal-title":"Acta Neurol. Scand"},{"key":"pone.0245918.ref022","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1007\/s13760-014-0408-6","article-title":"A comparison between rate of nonmotor symptom development in essential tremor and Parkinson\u2019s disease","volume":"115","author":"Y. Sengul","year":"2015","journal-title":"Acta Neurol. Belg"},{"key":"pone.0245918.ref023","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.jns.2015.12.016","article-title":"Comparison of motor and non-motor features between essential tremor and tremor dominant Parkinson\u2019s disease","volume":"361","author":"K.-Y. Kwon","year":"2016","journal-title":"J. Neurol. Sci"},{"key":"pone.0245918.ref024","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1016\/j.parkreldis.2012.06.008","article-title":"Autonomic function, as self-reported on the SCOPA-autonomic questionnaire, is normal in essential tremor but not in Parkinson\u2019s disease","volume":"18","author":"A. Damian","year":"2012","journal-title":"Parkinsonism Relat. Disord"},{"key":"pone.0245918.ref025","doi-asserted-by":"crossref","first-page":"1429","DOI":"10.1007\/s00702-015-1405-5","article-title":"Neuropathobiology of non-motor symptoms in Parkinson disease","volume":"122","author":"K.A. Jellinger","year":"2015","journal-title":"J. Neural Transm"},{"key":"pone.0245918.ref026","doi-asserted-by":"crossref","first-page":"e00781","DOI":"10.1002\/brb3.781","article-title":"Depression and social phobia in essential tremor and Parkinson\u2019s disease","volume":"7","author":"L. Smeltere","year":"2017","journal-title":"Brain Behav"},{"key":"pone.0245918.ref027","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1002\/mds.21376","article-title":"Depression symptoms in movement disorders: Comparing Parkinson\u2019s disease, dystonia, and essential tremor","volume":"22","author":"K.M. Miller","year":"2007","journal-title":"Mov. Disord"},{"key":"pone.0245918.ref028","article-title":"A Comparison Study of Cognitive and Neuropsychiatric Features of Essential Tremor and Parkinson\u2019s Disease","volume":"6431","author":"V. Puertas-Mart\u00edn","year":"2016","journal-title":"Tremor Other Hyperkinet. Mov. (N. Y)"},{"key":"pone.0245918.ref029","doi-asserted-by":"crossref","first-page":"e1095","DOI":"10.1212\/WNL.0000000000005215","article-title":"The nature of postural tremor in Parkinson disease","volume":"90","author":"M.F. Dirkx","year":"2018","journal-title":"Neurology"},{"key":"pone.0245918.ref030","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1001\/archneur.60.3.405","article-title":"Rest Tremor in Patients With Essential Tremor","volume":"60","author":"O. Cohen","year":"2003","journal-title":"Arch. Neurol"},{"key":"pone.0245918.ref031","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1212\/WNL.41.2_Part_1.234","article-title":"Essential tremor: Clinical correlates in 350 patients","volume":"41","author":"J.-S. Lou","year":"1991","journal-title":"Neurology"},{"key":"pone.0245918.ref032","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.parkreldis.2016.12.012","article-title":"Re-emergent tremor in Parkinson\u2019s disease","volume":"36","author":"D. Belvisi","year":"2017","journal-title":"Parkinsonism Relat. Disord"},{"key":"pone.0245918.ref033","doi-asserted-by":"crossref","first-page":"162","DOI":"10.5334\/tohm.176","article-title":"Increased Prevalence of Non-motor Symptoms in Essential Tremor","volume":"4","author":"A. Lacerte","year":"2014","journal-title":"Tremor Other Hyperkinet. Mov. (N. Y)"},{"key":"pone.0245918.ref034","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/j.parkreldis.2011.11.004","article-title":"Sleep in essential tremor: A comparison with normal controls and Parkinson\u2019s disease patients","volume":"18","author":"M. Gerbin","year":"2012","journal-title":"Parkinsonism Relat. Disord"},{"key":"pone.0245918.ref035","doi-asserted-by":"crossref","first-page":"1600","DOI":"10.1002\/mds.22567","article-title":"Torpedoes in Parkinson\u2019s disease, Alzheimer\u2019s disease, essential tremor, and control brains","volume":"24","author":"E.D. Louis","year":"2009","journal-title":"Mov. Disord"},{"key":"pone.0245918.ref036","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1016\/j.parkreldis.2011.05.008","article-title":"Significance of cerebellar Purkinje cell loss to pathogenesis of essential tremor","volume":"17","author":"A.H. Rajput","year":"2011","journal-title":"Parkinsonism Relat. Disord"},{"key":"pone.0245918.ref037","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.parkreldis.2018.02.032","article-title":"Climbing fiber-Purkinje cell synaptic pathology across essential tremor subtypes","volume":"51","author":"D. Lee","year":"2018","journal-title":"Parkinsonism Relat. Disord"},{"key":"pone.0245918.ref038","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1007\/s00401-016-1626-1","article-title":"Climbing fiber-Purkinje cell synaptic pathology in tremor and cerebellar degenerative diseases","volume":"133","author":"S.-H. Kuo","year":"2017","journal-title":"Acta Neuropathol"},{"key":"pone.0245918.ref039","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1002\/mds.25845","article-title":"Essential tremor is not associated with cerebellar Purkinje cell loss","volume":"29","author":"C. Symanski","year":"2014","journal-title":"Mov. Disord"},{"key":"pone.0245918.ref040","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1016\/j.parkreldis.2012.01.013","article-title":"Essential tremor is not dependent upon cerebellar Purkinje cell loss","volume":"18","author":"A.H. Rajput","year":"2012","journal-title":"Parkinsonism Relat. Disord"},{"key":"pone.0245918.ref041","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1002\/mds.26510","article-title":"Nonmotor features of Parkinson\u2019s disease subtypes","volume":"31","author":"C. Marras","year":"2016","journal-title":"Mov. Disord"},{"key":"pone.0245918.ref042","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.parkreldis.2018.04.021","article-title":"Comparison of two motor subtype classifications in de novo Parkinson\u2019s disease","volume":"54","author":"S.-M. Choi","year":"2018","journal-title":"Parkinsonism Relat. Disord"},{"key":"pone.0245918.ref043","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1002\/mds.26077","article-title":"The Onset of Nonmotor Symptoms in Parkinson\u2019s disease (The ONSET PDStudy)","volume":"30","author":"C. Pont-Sunyer","year":"2015","journal-title":"Mov. Disord"},{"key":"pone.0245918.ref044","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.jns.2018.01.013","article-title":"Comparison of clinical features among Parkinson\u2019s disease subtypes: A large retrospective study in a single center","volume":"386","author":"T. Konno","year":"2018","journal-title":"J. Neurol. Sci"},{"key":"pone.0245918.ref045","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1016\/j.clineuro.2012.07.032","article-title":"Prevalence of non motor features in a cohort of Parkinson\u2019s disease patients","volume":"115","author":"E.M. Khedr","year":"2013","journal-title":"Clin. Neurol. Neurosurg"},{"key":"pone.0245918.ref046","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1136\/jnnp-2018-319008","article-title":"Cognitive decline in Parkinson\u2019s disease: The impact of the motor phenotype on cognition","volume":"90","author":"J. Wojtala","year":"2019","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"pone.0245918.ref047","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1002\/mds.27386","article-title":"Motor and Nonmotor Complications of Levodopa: Phenomenology, Risk Factors, and Imaging Features","volume":"33","author":"K. Ray Chaudhuri","year":"2018","journal-title":"Mov. Disord"},{"key":"pone.0245918.ref048","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1007\/s00702-016-1667-6","article-title":"Parkinson\u2019s: a syndrome rather than a disease?","volume":"124","author":"N. Titova","year":"2017","journal-title":"J. Neural Transm"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0245918","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,1,27]],"date-time":"2021-01-27T18:25:55Z","timestamp":1611771955000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0245918"}},"subtitle":[],"editor":[{"given":"Osama Ali","family":"Abulseoud","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,1,27]]},"references-count":48,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,1,27]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0245918","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,27]]}}}