Quantifying postural tremor in workers exposed to low levels of manganese

The aim of this study was: (1) To determine the minimum number of characteristics necessary to discriminate between postural tremor recorded in control subjects (CO), in subjects exposed to manganese (MN), and in patients with Parkinson's disease (PD), and (2) to examine the continuum of changes between the three groups examined. Workers previously exposed to Mn (n = 10), patients with PD (n = 10), and control subjects (CO) (n = 11) underwent a clinical examination. Blood Mn was measured at the end of exposure time for the MN group and 12 months later at the beginning of the experiment for all groups. Postural tremor with visual feedback was recorded in the index finger with a laser system. Statistical criteria were used to reduce computed tremor characteristics to a minimal set of reliable discriminating variables. Two variables were retained namely corrected wobble (CW), describing the morphology of the tremor oscillations, and variability ratio (VR), describing proportional power of tremor. Both variables had an overall correct classification rate of 77.4%. Blood Mn levels at the time of the experiment were similar for all groups and had insignificant correlation with tremor variables. However, blood Mn levels in workers which were also measured at the end of exposure time (i.e., 12 months before) showed significant correlation (Spearman's rank coefficient) with both harmonic index (rho = 0.70, P = 0.03) and first maximum of the autocorrelation function (rho = 0.89, P = 0.001). We conclude that (1) the tremor of workers exposed to Mn could be adequately described with only two variables; (2) a continuum of changes between tremor recorded in control subjects, in subjects exposed to Mn and in patients with PD was observed, with the MN group always found in between the control (CO) and the PD groups; (3) while blood Mn levels in workers were back at control levels at the time of the experiment, the effect of Mn on postural tremor was still detected. Thus our method has the potential to detect the effect of Mn on tremor with only two variables even after Mn level in the blood is back to normal values.