Is It Essential Tremor or Parkinson’s? How to Tell the Difference
Key takeaways:
Tremor is an involuntary shaking or trembling movement of a body part. It can be a symptom of several different conditions, including essential tremor and Parkinson’s disease.
Essential tremor is much more common than Parkinson’s, and its main symptom is a tremor. It commonly affects the hands and is noticeable with voluntary movement.
Parkinson’s disease causes a tremor at rest, and it usually starts on just one side of the body. Unlike essential tremor, it can also cause problems with balance, gait, and concentration.
There’s no cure for either condition, but medications can help manage symptoms and maintain function.
Table of contents
If you’ve noticed your hands, head, or other body parts shaking without your control, you might be wondering what it is. This kind of movement is called tremor. Tremor is an involuntary movement of a body part. It can be described as shaking, twitching, or trembling,
There are many different conditions that can cause a tremor, some more common than others. Here, we’ll review the differences between two common conditions that cause tremor, essential tremor, and tremor due to Parkinson’s disease.
What is essential tremor?
Essential tremor is a neurological condition that causes a type of tremor called action tremor. This means it’s an involuntary movement brought on by action. For example, your hand may shake when trying to drink from a glass or hold something. It usually starts in one hand or arm. But it can progress to involve the head and voice. It rarely affects the legs.
Essential tremor is common, affecting about 6% of adults over age 65 worldwide.
The symptoms can range in their severity. They can be frustrating for many and disabling for some. But essential tremor isn’t fatal or dangerous to your physical health. In fact, it was once called “benign essential tremor,” because “benign” means not harmful.
What causes essential tremor?
Experts aren’t sure what causes essential tremor. But at least half of people with it also have a family member with it, suggesting that genetics play a role.
The different types of tremor: Many conditions can cause tremor. Read about the different types to learn what could be causing it and what to do next.
Early signs of Parkinson’s disease: The first signs of Parkinson’s can be subtle and not related to movement.
Living with essential tremor: One man describes his path to diagnosis of essential tremor and how he manages his symptoms from day to day.
What is Parkinson’s tremor?
Parkinson’s disease is a progressive neurological disorder that affects:
Movement
Balance
Thinking
Behavior
It’s more common in men and in older age. It often starts with nonmovement symptoms before it progresses to tremor and other movement symptoms.
Parkinson's causes tremor in 80% to 90% of people with it. But it’s a rest tremor, meaning it happens without movement and is more noticeable at rest. This tremor lessens or stops when the affected limb moves voluntarily.
Parkinsonian tremor usually starts with one hand, foot, or leg. It tends to progress over time and can also affect the face.
When it affects the hand, it often causes something called a “pill-rolling tremor.” This describes a small tremor that can sometimes look like the thumb and forefingers and rubbing something together. Like essential tremor, this tremor can make it difficult for people to go about their daily activities.
In addition to tremor, Parkinson's disease causes other symptoms, including:
Sleep disturbance
Decreased sense of smell
Constipation
Shuffling gait (taking small, shuffling steps while walking)
Moving slowly
Trouble speaking or swallowing
Urinary incontinence
Concentration problems
What causes Parkinson’s disease?
Parkinson's disease is due to the degeneration of cells in a specific area of the brain. These cells are responsible for making dopamine. So the symptoms of Parkinson's are due to decreased dopamine levels in the brain. The cause is likely a combination of genetics and environmental factors.
What’s the difference?
Even though they both cause a tremor, essential tremor and Parkinson’s disease are two completely different conditions.
Some important differences include the following:
Essential tremor is more common than Parkinson's disease.
Parkinson's causes many other symptoms than a tremor. Essential tremor doesn’t cause other symptoms though.
Parkinson's is more likely to affect men than women. Essential tremor affects both sexes at similar rates.
Parkinson's is usually diagnosed after age 60. Essential tremor diagnosis occurs early in life (before age 24) or later (40s or later).
These differences are generally true, but there can be exceptions.
There are also differences in the tremor due to Parkinson's and essential tremor, as shown in the table below.
Essential tremor | Parkinsonian tremor | |
|---|---|---|
Type | With movement and/or action | At rest |
Body parts affected | Hands, head, voice | Hands, legs |
Location/symmetry | Both sides | One side |
How is essential tremor vs. Parkinson’s diagnosed?
The best way to get a diagnosis is to see a primary care provider. They can learn more about your symptoms and perform a thorough medical exam. Usually, this is enough to make a diagnosis. But sometimes additional testing can help rule out other conditions if the diagnosis isn’t clear.
Your primary care provider may also refer you to a neurologist (nervous system specialist) to confirm the diagnosis.
Essential tremor is usually diagnosed in middle age. But many people with a family history of essential tremor get their diagnosis earlier. Parkinson's is more common in older adults. Your chances of getting either condition increase as you get older.
What’s the prognosis for essential tremor vs. Parkinson’s disease?
Unfortunately, there’s no cure for either essential tremor or Parkinson's. Both tend to worsen over time.
But treatments and medications for both conditions can help people manage symptoms and maintain independence for longer.
Essential tremor that’s diagnosed later in life is more likely to progress quickly than when the condition arrives earlier. The progression of Parkinson's can vary widely from person to person, and it can take years. It’s not a fatal disease. But in later stages, mobility problems and decreased function increase the risk of medical complications.
The bottom line
Involuntary shaking or trembling of a body part can be a distressing symptom to notice. There are many different types of tremor, including essential tremor and Parkinsonian tremor. But certain characteristics can help you tell the difference. If you have a tremor that’s affecting your daily activities, consider seeing your primary care provider or a neurologist. They can provide a diagnosis and guide you through treatment options.
Why trust our experts?
References
Bhatia, K. P., et al. (2017). Consensus statement on the classification of tremors. From the task force on tremor of the international Parkinson and movement disorder society. Movement Disorders.
Hopfner, F., et al. (2016). Early- and late-onset essential tremor patients represent clinically distinct subgroups. Movement Disorders.
Louis, E. D., et al. (2021). How common is essential tremor? Update on the worldwide prevalence of essential tremor. Tremor and Other Hyperkinetic Movements.
National Institute of Neurological Disorders and Stroke. (2024). Tremor. National Institutes of Health.
Smaga, S. (2003). Tremor. American Family Physician.
Thenganatt, M. A., et al. (2012). Distinguishing essential tremor from Parkinson’s disease: Bedside tests and laboratory evaluations. Expert Reviews in Neurotherapeutics.
