Tremor as a factor in prolonged reaction times of parkinsonian patients

Prolonged reaction times and tremor are symptoms of Parkinson's disease (PD). Recently, we showed the existence of a systematic phase relationship between tremor-at-rest and the onset of voluntary motor responses in PD patients. In the present study we investigated whether this phase relationship contributes to the prolongation of reaction time in PD. Eight PD patients with prominent tremor-at-rest and five age-matched controls performed rapid stimulus-evoked index finger abductions under isometric conditions. Force and surface electromyogram (EMG) signals from first dorsal interosseus muscle were recorded and analyzed off-line by means of automatic routines. Reaction times of PD patients exhibited a significant dependence of mean values and variability on the current tremor phase at the onset of the voluntary motor response. Responses with an onset of contraction during the beginning of an EMG tremor burst were substantially delayed (on average 50 ms) and showed more variability in comparison to responses initiated at later times in the tremor cycle. This effect can be modeled by a simple gating process splitting the tremor cycle into two different system states that supports and inhibits the initiation of voluntary motor responses, respectively. We conclude that attraction of voluntary motor initiation to the tremor oscillator clearly contributes to prolongation of reaction time in PD.