Mortality in People with Action Tremor: Findings from Three Population‐Based Cohort Studies
Katrine Lawaetz Kristensen, Jacob Krabbe Pedersen, Gregor Kuhlenbäumer, Dorte Ejg Jarbøl, Kaare Christensen, Günther DeuschlAbstract
Background
Action tremor is common in adults and increases with age. Although essential tremor (ET) is a major subgroup, action tremor comprises heterogeneous phenotypes, and its prognostic implications remain uncertain.
Objectives
Our aim was to examine the association between action tremor and all‐cause mortality using complementary population‐based cohorts.
Methods
We triangulated data from three Danish cohorts: a nationwide register‐based cohort of 3487 individuals with outpatient hospital‐diagnosed ET, each matched to 10 controls; the Longitudinal Study of Aging Danish Twins (LSADT), including spiral‐based tremor assessment on 2029 individuals and a neurologist‐examined subgroup; and the Danish Symptom Cohort, including 2472 individuals with self‐reported tremor, each matched to four controls. Mortality follow‐up was obtained through nationwide registers. Cox regression models were applied with age as the time variable.
Results
In the outpatient cohort, hospital‐diagnosed ET was associated with increased mortality (hazard ratio [HR], 1.37, 95% confidence interval, 1.27–1.46). In LSADT, subjects with high Archimedes scores indicating symptomatic action tremor (scores 5–7 vs. 0–2) yielded HR, 1.67 (1.42–1.97). Additionally, higher spiral scores were associated with progressively lower survival. In the Danish Symptom Cohort, even self‐reported tremor was associated with increased mortality (HR, 1.56, 1.38–1.75), robust to adjustment for alcohol use.
Conclusions
In three population‐based cohorts, action tremor was consistently associated with increased mortality. We showed that our clinically diagnosed ET‐cohort, a cohort with spiral score validated action tremor, and a cohort with self‐diagnosed symptomatic action tremor, all showed increased mortality. Action tremor may represent a marker of underlying health vulnerability rather than a benign motor sign. © 2026 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.