Objective To investigate the non-motor symptoms (NMSs) of essential tremor (ET), and to explore the clinical and pathological features of ET.Methods A total of 60 patients with ET and 63 controls were divided into young and middle-aged control group, young and middle-aged ET group, elderly control group, and elderly ET group. Audiometry and cognitive function evaluation were performed for all groups.Results Compared with the corresponding control groups, the young and middle-aged ET group and the elderly ET group had a significant reduction in hearing (P=0.026 and 0.005); the young and middle-aged ET group had no reduction in cognitive function (P=0.061), while the elderly ET group had a significant reduction in cognitive function (P=0.003). Compared with the young and middle-aged ET group, the elderly ET group had significantly greater reductions in visual space and executive ability (P=0.012). Hearing loss in ET patients was associated with the reduction in cognitive function (P=0.005).Conclusions Among the NMSs of ET, hearing loss appears earlier and the reduction in cognitive function occurs later. Elderly ET patients have poorer visual space and executive ability than young and middle-aged ET patients. There is a certain association between hearing loss and the reduction in cognitive function. The pathological and anatomical basis for ET may be early injury of the auditory nerve-brainstem-cerebellum system, while degeneration of the hippocampus-limbic system-cortex occurs later.