Social anxiety, tremor severity, and tremor disability: a search for clinically relevant measures.

Background. While social anxiety has been reported among essential tremor (ET) patients, very little is known about the relation between self-report measures of social anxiety, tremor severity and disability, and cognition. Methods. Sixty-three individuals diagnosed with ET took part in a comprehensive study examining neurocognition and behavioral functioning. A psychiatric diagnostic interview, three social anxiety questionnaires, and an idiographic-based behavioral assessment to pinpoint anxiety provoking situations and related distress were completed. Results. Thirty percent of the participants met diagnostic criteria for social anxiety disorder (SAD). Social anxiety questionnaires were negligibly related to tremor severity and disability. Idiographic behavioral assessment of subjective distress was moderately related to resting tremor severity and disability and strongly related to social anxiety questionnaires scores. Only one cognitive variable was related to tremor severity. Conclusions. These findings suggest that (a) self-report measures of social anxiety with ET patients may underestimate distress; (b) emphasis on tremor severity may be misleading; (c) tremor disability may be a more sensitive and functional measure related to cognition and effect; (d) SAD is wide spread and does not appear to be related to dysregulated executive function; and (e) development of an ET-specific measure of social anxiety is called for.

Prevalence and reporting of near-point binocular convergence and acuity vision deficits in potential research participants.

Visual abilities at near-point distances of 200 self-reported normal vision college students were assessed. Results show that normal visual functioning with no deficits is the exception. The most common visual deficits observed involved binocular lateral posture and fusion convergence deficits. Binocular and monocular acuity deficits also had high prevalence rates, although not as prevalent as the binocular convergence deficits. In addition, 1,340 articles published in four major journals from the years 1997-2004 were examined to ascertain the extent to which authors report the visual capabilities of their participants. Reporting of research participant visual abilities by authors using visual stimuli in experiments appears to be lacking. The results are discussed in terms of the potential impact that visual deficits may have on results obtained in experiments in which visual stimuli are used and the importance of reporting the visual assessment tests and procedures used to assess the visual abilities of potential participants.

Validity of clinical and patient ratings of tremor disability among older adults.

OBJECTIVE: To evaluate the validity of the clinical tremor disability interview using a performance-based measure, patient ratings of tremor disability, and bedside tremor severity ratings of upper extremity (UE) action/intention (A/I) and postural (P) tremor. METHOD: Sixteen older adult essential tremor patients (mean age=75.4 years, sd=5.7 years) took part in a study evaluating the validity of clinical and self-rating scales of tremor disability. A neurologist obtained bedside clinical ratings of UE A/I and P tremor of each limb and completed a clinical tremor disability rating. A second investigator, blind to neurological exam results obtained a clinical disability rating using the same measure, patient rated tremor disability ratings and conducted a performance-based disability assessment. RESULTS: Clinical tremor disability ratings were not significantly related to functional performance-based or patient ratings of tremor disability. Bedside clinical ratings of tremor severity also were not associated with clinical or patient-rated tremor disability. Patient ratings were significantly correlated with performance-based ratings. CONCLUSIONS: Further research is needed to validate a brief, sensitive clinical rating scale of tremor disability among older adults. Use of bedside ratings of tremor severity may be problematic and possibly estimate tremor disability. Empirical evaluation of differences in rating methods needs to be directly addressed.