Weakness and Tremors in the Elderly: A Neurology Perspective

Q: Weakness and Tremors in the Elderly: A Neurology Perspective

Hello, Sir： You mentioned that "as long as she eats... <br>the situation will improve significantly, the key is that she needs to eat every 2-3 hours." It may be necessary to consider autonomic nervous system abnormalities. <br>Generally, the autonomic nervous system is regulated

Generalized weakness and tremors?

Hello, doctor! My mother is 78 years old and started experiencing generalized weakness and trembling about a month ago.
However, her condition improves significantly after she eats and replenishes her caloric intake.
The key issue is that she needs to eat every 2-3 hours; otherwise, the aforementioned symptoms reappear.
She underwent various tests at St.
Paul’s Hospital, and the reports indicated that she is healthy, but the weakness and trembling symptoms are indeed present, which worries us as her children.
May I ask if it is appropriate for her to see a neurologist? My mother has a history of hypertension, tinnitus, and occasional headaches.
She has previously engaged in agricultural work, and her eating habits have been irregular, often consuming food just to fill her stomach.
Thank you for your assistance!

Li Huazhong, 50~59 year old female. Ask Date: 2023/04/21

Dr. Jiang Junyi reply Neurology

Hello, Sir: You mentioned that "as long as she eats...
the situation will improve significantly, the key is that she needs to eat every 2-3 hours." It may be necessary to consider autonomic nervous system abnormalities.
Generally, the autonomic nervous system is regulated by the sympathetic and parasympathetic nervous systems, where one acts as the accelerator and the other as the brake.
The sympathetic nervous system is responsible for stimulating the body, leading to increased heart rate, faster breathing, and increased sweating, while decreasing gastrointestinal motility, which can also exacerbate gastroesophageal reflux.
Once exercise stops, the parasympathetic nervous system begins to take effect, slowing down the heart rate, reducing breathing rate, and decreasing sweating, allowing gastrointestinal motility to return to normal.
Therefore, about an hour after exercising, one tends to feel very hungry.
After replenishing food and adequate hydration, it usually stimulates the parasympathetic system, alleviating tremors.
I recommend that you consult a neurologist to discuss evaluating and treating the autonomic nervous system.
Wishing you good health, peace, and joy.
Dr.
Jiang Junyi, Department of Neurology, Taoyuan Hospital, cares about you.

Reply Date: 2023/04/21

More Info

It sounds like your mother is experiencing some concerning symptoms that could be related to a variety of underlying issues. Given her age and the symptoms of weakness and tremors, it is indeed appropriate to consult a neurologist. Neurological symptoms can often be complex, and a thorough evaluation is necessary to determine the cause.

The symptoms you describe—generalized weakness and tremors that improve with food intake—could suggest several possibilities. One potential explanation is related to blood sugar levels. If your mother has not been eating regularly or has a diet that lacks sufficient nutrients, she may be experiencing fluctuations in her blood sugar. Low blood sugar (hypoglycemia) can lead to symptoms such as weakness, tremors, and even confusion. The fact that her symptoms improve after eating suggests that her body may be responding to the intake of food, which stabilizes her blood sugar levels.

Another possibility could be related to her hypertension. High blood pressure can lead to various complications, including issues with circulation and the health of blood vessels. If her blood pressure is not well-controlled, it could contribute to feelings of weakness or fatigue. Additionally, certain medications for hypertension can have side effects that might include dizziness or weakness, especially if they lower blood pressure too much.

Moreover, the history of ear ringing (tinnitus) and occasional headaches could indicate a more systemic issue. Conditions such as vestibular disorders or even neurological conditions like Parkinson's disease could present with tremors and weakness, particularly in older adults. Parkinson's disease, for instance, is characterized by tremors, rigidity, and bradykinesia (slowness of movement), and it often begins subtly.

Given that her tests at St. Paul’s Hospital came back normal, it might be beneficial to ensure that all relevant tests were conducted. Sometimes, conditions like vitamin deficiencies (such as B12 deficiency), thyroid disorders, or even neurological conditions may not be immediately apparent in standard tests. A comprehensive metabolic panel, thyroid function tests, and possibly imaging studies (like an MRI) could provide more insight.

In terms of management, it is crucial to ensure that your mother maintains a balanced diet with regular meals to prevent fluctuations in her blood sugar. Encouraging her to eat small, frequent meals that include a balance of carbohydrates, proteins, and healthy fats may help stabilize her energy levels. Additionally, monitoring her blood pressure regularly and ensuring it is well-controlled can also be beneficial.

In conclusion, consulting a neurologist is a wise decision, as they can provide a more specialized evaluation of her symptoms. They may recommend further testing or referrals to other specialists, such as an endocrinologist for blood sugar issues or a geriatrician for comprehensive elderly care. It’s essential to keep a detailed record of her symptoms, including when they occur, their duration, and any other associated factors, as this information can be invaluable for her healthcare providers in diagnosing and managing her condition effectively.

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