Brief Answer:
Hand tremors

Detailed Answer:

Hi,

The cause of a hand tremors can be numerous and certainly in someone of your age a particular consideration of importance would be to recognize the possibility or not of some type of parkinsonism which if taken in conjunction with other clinical features could lead a clinician to diagnose a likely or possible case of Parkinson's Disease.

In this case, your physician made a general comment that he did not either find or perhaps did not hear any relevant history regarding motor issues and therefore, chose to eliminate PD from the list of possibilities.

If you went to see a neurologist and this doctor carefully examined the hand tremors and in addition measured and tested motor strength, coordination, performed an analysis of the tremor as to whether or not it had the clinical characteristics of a PARKINSONIAN tremor or some other type, and listened to your responses to questions related to the history of how things evolved and other pertinent information, and still made the decision that PD was not likely or probable then, if I were in your position I would feel satisfied with that response and follow his instructions for any treatment, physical therapy, or other suggestions to deal with the functional limitations of this tremor and how it affects you day to day without worrying that you have been missed for PD.

If the doctor was not a neurologist and did not perform those types of general examination procedures or ask you questions that would be considered pertinent to how PD might evolve in a person of your age then, I might feel that the examination or the questioning may have been incomplete in some respect which would then, prompt me to either make another appointment with the doctor to clarify issues you MAY be having with motor movements, dexterity, fluidity, smoothness of hand movements, and make sure that he understood what those issues were as well as ask him for a more complete explanation of why your features DID NOT peak his interest in PD as a more likely or probable diagnosis.

The alternative to that sort of discussion with the doctor (even if a neurologist) would be to seek a 2nd opinion of someone who could actually physically examine you and talk to you face to face since there is no much more in a PERSONAL and UP CLOSE examination that is hands on when making a probable diagnosis of PD than to just go on description as we are doing right now. I would seek the services of such a neurologist and maybe even try and locate one who was a MOVEMENT DISORDERS SPECIALIST (even a PARKINSONOLOGIST- one who only sees cases of PD) and hear their opinion.

You should also be aware of the fact, that even in the best of hands there are times (about 25% of cases) where people with PD are actually diagnosed with something else...even when seeing a specialist as I described. That is because PD, at the outset, can look like many different things and sometimes it can take as long as several years for the symptoms to evolve enough in the patient so as to really look like textbook classic PD.....and vice versa.....a person who may look like CLASSIC PD who evolves over a period of months or years to eventually develop some other form of movement disorder that turns out to be caused by something entirely different and opposite from everybody thought what surely must be PD. You see? It goes in both directions.

To answer the question of whether or not tremors can be caused a vitamin deficiency the answer is YES....but this is a much rarer cause of ANY TYPE of tremor in an 83 year old. Nonetheless, the 3 most common vitamin deficiencies associated with tremors or shakiness of the hands or other parts of the body are: B1 (thiamine), B6 (pyridoxine), and B12 (cobalamin). There are even more obscure links with tremors and other vitamin or nutritional deficiencies as well as numerous metabolic causes such as HYPO or HYPERTHYROIDISM, hyperadrenalism, and other things.

But, why not stick with common things first and then, eliminate the more obscure and isolated zebras....you'll get the biggest bang for your buck and look like a REAL SLEUTH who tends to consider the most probable things first and the least probable last.....Remember the old saying, "If it sounds like Horses....then, it probably ain't zebras."

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Brief Answer:
Please see above explanation on vitamin/chemicals and tremors.

Detailed Answer:

Hi,

I will copy from the above response the paragraph I had written on the known vitamin/chemical causes for tremors for convenience and easy reference:

"To answer the question of whether or not tremors can be caused a vitamin deficiency the answer is YES....but this is a much rarer cause of ANY TYPE of tremor in an 83 year old. Nonetheless, the 3 most common vitamin deficiencies associated with tremors or shakiness of the hands or other parts of the body are: B1 (thiamine), B6 (pyridoxine), and B12 (cobalamin). There are even more obscure links with tremors and other vitamin or nutritional deficiencies as well as numerous metabolic causes such as HYPO or HYPERTHYROIDISM, hyperadrenalism, and other things."

As stated above the 3 most commonly discovered vitamin deficiencies known to be associated with tremors/twitches/shakes of some sort in the body are B1, B6, and B12. In addition, I mentioned condition involving hormones such as thyroid and cortisol. There is no easy way I know of to readily identify SYMPTOMS in an otherwise, healthy, active person that could isolate which of those vitamin deficiencies would be most likely where hand tremors were also present.

The most direct way of establishing such vitamin deficiencies as a cause to the tremors would be to assay the blood for B1 (thiamine), B6 (pyridoxine), and B12 (cobalamin) and if found to be in low concentrations, begin supplementation to see if the tremor improved or abated. If it did then, vitamin deficiency would be the probable/likely cause. If not then, there would be no causation and I might still return to the original argument of having the tremor evaluated by either a neurologist or movement disorders specialist since the likelihood of the problem falling into the category of action or rest tremor remains high based upon the foregoing explanations and epidemiological data we know exist...notwithstanding your doctor's evaluation of your hand/wrist flexibility as being "exceptionally high mobility."

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