Enfeeblement in Essential Tremor: Development and Validation of a New Psychometric Measure.

INTRODUCTION: Despite a growing body of knowledge regarding essential tremor (ET), past studies have fallen short in capturing the full impact of ET on patients and caregivers. We propose enfeeblement (i.e., having the qualities of being prematurely old, helpless, or debilitated) as a novel clinical outcome measure in ET. Due to the lack of enfeeblement scales for ET in the literature, we developed and validated an enfeeblement scale for ET. METHODS: The Essential Tremor Enfeeblement Survey (ETES) consists of eight 5-point Likert-type scale questions and is designed to be a caregiver-reported outcome. RESULTS: Enfeeblement scores showed a floor effect of 15.3%, no ceiling effects, and demonstrated good overall test-retest reliability (intraclass correlation coefficient = 0.73), favorable internal consistency (Cronbach α coefficient = 0.92) and good convergent validity. CONCLUSION: The ETES has robust properties. Aside from future studies of enfeeblement in ET, enfeeblement should be explored more broadly as a psychometric measure across other neurological disorders.

Artificial Intelligence: First Do the Long Overdue Doable.

Release of ChatGPT-4, an internet-based computer program that simulates conversation with human users using Artificial Intelligence (AI) on March 14, 2023 set off a flurry of debates regarding the role and impact of AI on human life. Influential leaders and thinkers from diverse fields have chimed in to offer their views, admonitions, and or recommendations. There seems to be a great diversity in viewpoints and visions regarding how AI would affect human destiny-right from confident optimism to stark doomsaying and all in between. However, not much attention is being paid to the insidious long-term effects on human societies, many of them being unintended consequences, that AI has the potential to create over a short period of time. Perhaps the greatest threat of AI is the potential for loss of meaning in life and human-technology-created enfeeblement in a large section of humanity. All the other threats including that of the current AI are mere epiphenomena of this basic threat. In view of the fact that the genie of AI is out of the bottle and that it cannot be put back in, the first order of business for technologists, policy makers, and the governments is to allocate resources and attention to address the problem of meaning in life and mitigation of the sentiment of overwhelming and universal helplessness. Lastly, not to be optimistic about AI while being cautious and pragmatic is not an option.

Enfeeblement in Elders with Essential Tremor: Characterizing the Phenomenon and Its Role in Caregiver Burden.

Background: Individuals with essential tremor (ET), a common movement disorder, experience functional impairment, which contributes to burden experienced by their loved ones and caregivers. Some burdened caregivers report their loved ones as seeming debilitated or prematurely old, a concept that we have called enfeeblement. Using the Essential Tremor Enfeeblement Survey (ETES), we seek to characterize enfeeblement in elders with ET and assess its contribution to caregiver burden. Methods: We administered the ETES (range = 8-40, higher scores indicating more enfeeblement) and other scales to 98 caregivers of individuals with ET. Individuals with ET were also queried regarding tremors, cognitive abilities, and overall health. We then identified demographic and clinical correlates of ETES and modeled the contribution of ETES to caregiver burden (assessed using the Zarit 12-item Burden Interview [ZBI-12]). Results: Mean ETES score was 14.2 ± 6.2 (median = 12.0, range = 8.0-32.0); 26.5% of respondents endorsed at least one of the eight ETES items. Older age, greater tremor severity and disability, more functional and gait disability, more cognitive difficulty, and more depressive symptoms were associated with higher ETES scores. ETES was the strongest contributor to caregiver burden (ZBI-12) and substantially increased the variance explained in models of caregiver burden. Discussion: Enfeeblement seems to describe a previously unexplained component of caregiver burden in elders with ET. The presence of enfeeblement may contribute to greater burden and should be factored into assessments of patient and caregiver needs.