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Tremors Are Common in Dementia

There are different types of tremors in dementia, each with its own cause.

Key points

  • Everyone has a physiologic tremor that comes out when they carry something heavy, are nervous, or have too much caffeine.
  • The most common tremor is called essential tremor; it often runs in families.
  • Parkinsonian tremors are described as "pill rolling" because the thumb and forefinger may move rhythmically back and forth.
  • Tremors can be improved with heavy mugs, glasses, and silverware when drinking and eating.

There are a number of different types of tremors that may be seen in individuals with dementia. Tremors are also commonly seen in people without dementia. If your loved one has a tremor, a neurologist should be able to help determine which type it is, and whether it is related to their dementia. Some types of tremors are due to medication side effects, and other tremors may be treated by specific medications, so it is important to sort out which type of tremor your loved one has.

The tremor that occurs in dementia with Lewy bodies and Parkinson’s disease is generally described as “pill rolling” because the thumb and forefinger may move rhythmically back and forth as if the individual was rolling a pill or a pea in their hand. This type of tremor is also sometimes seen in vascular dementia.

There is a normal tremor that everyone has that comes out when they are carrying a heavy box and their arms begin to shake, or if they are nervous when giving a speech and their voice shakes. We use the term “enhanced physiologic tremor” to indicate when this normal tremor is amplified by something. Caffeine is probably the most common cause of an enhanced physiologic tremor, but there are many prescription medications that can also cause it. So, if your loved one developed a tremor when a medication was started or the dose increased, discuss with their doctor whether the medication could be the cause.

Your loved one may be experiencing coarse, jerky shaking that is sometimes called a tremor. It is not a true tremor because it is not rhythmic; instead it is a lot of tiny, little movements that occur in rapid succession. These movements may be associated with some unusual types of dementia, but they are more often seen when someone is over-medicated or has an illness in the body such as an infection, liver failure, or kidney disease. Make sure you let the doctor know if your loved one has this type of tremor.

Lastly, the most common tremor—although probably not associated with dementia or other disorders—is “essential tremor.” It is the type of tremor the actress Katherine Hepburn developed in her later years. Essential tremor often runs in families. Although I would never recommend that someone drink alcohol for tremors or other problems, if you notice that your loved one’s tremor improves after a modest amount of alcohol (such as a single drink), it makes it more likely that they have essential tremor.

Tremors may make simple activities such as drinking from a cup or eating soup difficult or impossible. Although medications can be tried, they rarely eliminate the tremor entirely. Because people with tremors experience more difficulty using light objects (such as a Styrofoam cup) compared with heavy ones (such as a thick ceramic mug), we recommend that those with tremors use heavy mugs, glasses, and silverware when drinking and eating. These weighted items tend to dampen the effects of the tremor, making it easier to eat and drink. Heavy mugs and glasses can generally be easily found. To obtain weighted cutlery, search the internet for “heavy silverware for tremor.” You will see that many different styles of weighted utensils are available, including some that look identical to regular silverware and others that are purely utilitarian.

© Andrew E. Budson, M.D., 2021, all rights reserved.


Budson AE, O’Connor MK. Seven Steps to Managing Your Memory: What’s Normal, What’s Not, and What to Do About It, New York: Oxford University Press, 2017.

Budson AE, O’Connor MK. Six Steps to Managing Alzheimer’s Disease and Dementia: A Guide for Families, New York: Oxford University Press, 2021.

Budson AE, Solomon PR. Memory Loss, Alzheimer’s Disease, & Dementia: A Practical Guide for Clinicians, 3rd Edition, Philadelphia: Elsevier Inc., 2021.

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