Abstract
BACKGROUND: Medication adherence in essential tremor (ET) remains poorly characterized. This real world study aimed to investigate adherence rates, clinical correlates, and predictors among ET patients in China. METHODS: A prospective cohort of 318 ET patients (116 pure ET, 202 ET-plus) was followed for a mean of 22.91 ± 3.86 months. Standardized assessments included the Tremor Research Group Essential Tremor Rating Assessment Scale (TETRAS), Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Non-Motor Symptoms Scale (NMSS). Adherence was defined as daily use of prescribed tremor medications. Logistic regression identified predictors. RESULTS: Only 27.4% (87/318) maintained daily adherence. ET-plus patients showed higher adherence than pure ET (32.2% vs 19.0%, P = 0.011). Arotinolol was the most common medication. Compared to non-adherent patients, adherent patients showed higher urban residency (P = 0.026), head tremor prevalence (P = 0.002), mild cognitive impairment (P = 0.038), higher TETRAS-I (P = 0.047) and TETRAS-II scores (P = 0.008), as well as lower MoCA scores (P = 0.021). Multivariable analysis showed better medication adherence was significantly associated with higher TETRAS-II score (OR = 1.041, 95% CI = 1.001-1.082, P = 0.047), urban residence (OR = 1.775, 95% CI = 1.066-2.957, P = 0.028), and the presence of head tremor (OR = 1.936, 95% CI = 1.125-3.332, P = 0.017). No significant association was found between ET subtypes and adherence (P > 0.05). CONCLUSION: Medication adherence is alarmingly low in Chinese ET patients, especially in pure ET. Greater tremor severity, presence of head tremor, and urban residence were independently associated with better medication adherence. HIGHLIGHT: Medication adherence among Chinese essential tremor (ET) patients remains suboptimal (only 27.4% in our cohort). ET plus patients showed higher adherence (32.2%) than pure ET (19.0%). Predictors of adherence included severe tremor (TETRAS-II), urban residence, and head tremor. Arotinolol was the predominant treatment. Findings emphasize the need for personalized interventions.