Sen. Susan Collins announced her campaign for a sixth term in the Senate in February by recording a video unboxing a pair of New Balance sneakers. On social media, many commenters focused on something else: Her hands.

As she opened the box and looked at the camera, Collins’ hands and head were trembling.

“She’s literally shaking,” one YouTube commenter wrote.

“Your body is giving out on you,” said another.

“Get yourself into an old folks’ home,” wrote a third.

Months later, the 73-year-old Republican said “cruel comments online” compelled her to disclose that she had been diagnosed decades prior with an essential tremor — a neurological condition that causes one’s hands, head and other body parts to shake uncontrollably.

“This benign condition, which affects approximately 1 in 20 people over the age of 40, does not interfere at all with my ability to do my job,” Collins said at the time in a statement to the Portland Press Herald.

The senator’s description of the condition as “benign” doesn’t quite match the medical community’s recent understanding of essential tremors.

While the condition is not inherently connected to neurodegenerative diseases like Parkinson’s disease or dementia, medical professionals stopped referring to the condition as “benign” about a decade ago. It can have very real effects on a person’s life, according to Dr. Priyanka Shekhawat, who sits on the executive council of the Maine Neurological Society.

“We don’t call it benign because it can be very disabling for patients,” she said. “It’s not dangerous. It’s not life-threatening. But there’s a reason a patient would be coming to see us.”

Trembling hands can make activities like writing and eating difficult. Quivering legs sometimes make walking a challenge. And a shaking voice can embarrass those suffering from the condition in social settings. So the condition is now simply called an “essential tremor,” Shekhawat said.

“Some people find it debilitating, while a lot of patients will live a productive, independent and active life for decades,” she added. “It’s very individualized.”

Collins’ announcement in May about her tremor stoked fresh concerns from some online pundits about her age. Independent journalist Ken Klippenstein criticized Collins for “vibrating like an electric toothbrush” days before the senator first disclosed her diagnosis.

Voters in Maine, however, appear split over Collins’ age. A slim majority of likely voters, about 55%, said Collins is “too old to be an effective senator,” according to a Portland Press Herald/New York Times/Siena Research Institute poll in June.

Maine’s senate race, as with many others in 2026, was already something of an intergenerational battle.

Collins initially faced a challenge from 41-year-old Democrat Graham Platner, who has withdrawn but would have been one of the youngest members of Congress had he been elected. His progressive policy platform was similar to that of many other young political upstarts across the country, such as Zohran Mamdani in New York City and Abdul El-Sayed in Michigan.

The race’s dynamic shifted after Platner abruptly dropped out following an allegation of rape from a former romantic partner, which he denies. He was replaced by former state Senate President Troy Jackson.

While Jackson’s progressive policy platform echoes younger candidates nationwide, he is 58, notably older than Platner. Jackson has had health issues of his own, too. In 2013, Jackson said he nearly died due to chest complications. He had his fifth pacemaker implanted in April.

Collins, on the other hand, is about 10 years older than the average senator and would be nearing 80 at the end of her term. Maine’s other senator, independent Angus King, 82, is among the oldest sitting senators. King has survived several battles with cancer, including one during his time in the Senate.

Voters have been paying more mind to candidates’ age and health since 2024, when Joe Biden’s presidential campaign was harpooned by a disastrous debate performance that highlighted concerns about his age and cognitive abilities. Donald Trump became the oldest person to ever win the presidency later that year, and some have raised concerns about his mental faculties as well.

“I think we’ve reached a breaking point in terms of open discussions about a candidate’s health,” said John Cluverius, an associate professor of political science at University of Massachusetts Lowell. “Age is an increasingly relevant issue to voters.”

Collins’ tremor is a visible example of her age. And though it’s likely not connected to any sort of cognitive decline, its visibility allows political pundits, social media commentators and armchair doctors to diagnose Collins with conditions she may not even have. That speculation alone may be enough to sway some voters away from her, Cluverius said.

“Some people use age as a shorthand toward infirmity, and I don’t think those are necessarily the same thing,” he said. “The fact they get jumbled is indicative of this political moment we’re in.”

An essential tremor is characterized by uncontrollable shaking in the hands, head and other extremities. It is one of the most prevalent movement disorders, according to the National Institutes of Health. It affects an estimated 7 million Americans.

The exact cause of the condition is unknown. It’s not uncommon for symptoms to begin presenting themselves in adolescence and slowly worsen over the course of decades. Many aren’t diagnosed with essential tremor until their 40s or 50s, said Shekhawat with the Maine Neurological Society.

There are no cures for essential tremors, though they can be treated with medication, physical therapy, Botox injections or electrical stimulation to parts of the brain associated with movement. Collins has said she treats her tremors with medication.

The condition can be exacerbated by stress or specific actions like raising one’s arms or using utensils, Shekhawat said. And while it can appear similar to Parkinson’s, most people with essential tremors do not suffer the cognitive impairment associated with that disease.

“I think that’s the part that’s very misunderstood about essential tremors,” Shekhawat said. “It may be on a spectrum of whether it’s impairing someone’s life or not, but there are no known cognitive impairments associated with this tremor.”

Collins has said she has had an essential tremor during her entire time in Congress. A Portland Press Herald analysis of C-SPAN videos dating to her first term shows the tremor has become more visible over time.

In 1997, when a 44-year-old Collins delivered her first speech on the Senate floor, neither her voice nor hands appeared shaky. That started to change toward the end of her second term.

In 2006, a video shows Collins’ hands beginning to tremble slightly. It became more visible as the years progressed. In 2013, her hands shook as she held a microphone during a leadership forum. By 2017, her head and voice quivered similarly during an ABC News interview. In the years since, it has grown more visible.

Collins has said her tremor doesn’t affect her work, noting that she has never missed a roll-call vote since taking office in 1997. She achieved the milestone of casting 10,000 consecutive votes earlier this year.

A spokesperson for Collins declined to comment on her condition beyond the senator’s statements in May.

AGE IN POLITICS

Candidates’ age and health issues were seldom factored into voters’ decisions on how to cast their ballots until the first 2024 presidential debate, according to Jeffrey Selinger, an associate professor of government at Bowdoin College. It was the first time Biden’s apparent cognitive decline was on full display before millions of Americans.

While Biden’s campaign chalked his debate performance up to jet lag and a lingering cold, voters began thinking differently about how old their elected officials should be as they watched the then-president stumble through his answers and trail off midway through his sentences, Selinger said.

That skepticism was initially most pronounced among Republicans, he said. But the sentiment has begun percolating among the left in the years since as Trump began seemingly dozing off during Cabinet meetings, made efforts to cover up bruising on his hands and posted long winded, late-night “Truths” on his own social media platform, Truth Social.

With the past two presidents’ cognitive function facing harsh scrutiny from the public, Selinger said “there’s every reason to believe” age will be a factor in Maine’s Senate race.

“This is the same conversation we had about Janet Mills before she dropped out,” Selinger said.

Mills, 78, would have been the oldest freshman senator in history if she were elected. She suspended her candidacy in April as Democratic voters made it clear they sought generational change within the party.

“They want a change agent. They want something different, they want to shake things up, they want to turn the system upside down,” Selinger said. “I think there’s a through line there.”

That notion is backed up by polling data. A survey of Maine voters conducted by Cluverius, the UMass Lowell professor, and YouGov found wide support for age limits on federal positions. Nearly 70% of people polled, including majorities of Democrats and Republicans, said they would support a constitutional amendment barring people over 70 from holding federal office.

And that’s despite Maine’s population being the oldest, on average, in the country at 45. Nearly a quarter of the state’s residents are over 65, according to Census data.

“Voters’ level of trust has been drastically lowered in the last six or seven years,” Cluverius said. “There is a sort of extreme conditioning of the public to not only not trust politicians, but to also not trust the doctors and the medical information that is being given about elected leaders.”

Cluverius noted that several congresspeople have recently been absent for extended periods with no explanation.

Former Rep. Kay Granger, a Republican from Texas, stopped coming to work for months before it was uncovered in 2023 that she’d been living with a dementia diagnosis in an assisted living facility. She died Sunday at 83.

In June, Kentucky Sen. Mitch McConnell, 84, was hospitalized without explanation. Nearly a month later, McConnell said he had suffered from a fall at his home. But he hasn’t been seen in public since his initial hospitalization.

Were she to win reelection in November, Collins has said it would be her last term in the Senate — though she previously promised during her first run for national office in 1996 that she would only serve two terms.

WILL VOTERS CARE?

Despite harsh online scrutiny of Collins’ age and tremor, most Maine voters interviewed by the Press Herald said they aren’t paying much mind to the senator’s health.

Patrick Hart, a 45-year-old from Falmouth, has voted for Collins before but supported Platner prior to his withdrawal from the race. He views Collins as more partisan and less independent than she used to be, but not any less capable of doing her job.

“Her age doesn’t really concern me,” said Hart, adding, “I think she’s been in office long enough.”

Harry Nelson, a 72-year-old North Yarmouth Democrat, similarly said he doesn’t hold Collins’ age or tremor against her. His opposition to her candidacy is based solely on the issues, he said.

“She’s had (the tremor) for a long time,” Nelson said. “I know that I’ve lost a little bit over the years.”

Still, Collins’ age and presentation could sway voters in an almost subconscious way, according to Selinger, at Bowdoin.

Candidates’ physical attributes (their height, their hair and their overall “vibe”) can sway voters in ways they may not even realize, according to Selinger. Old age is “establishment-coded,” he said. The fact she is much older than her opponent and has a visible tremor may be enough to put some voters off, he said.

“People often aren’t conscious of the ways in which certain visual and audio cues affect their processing of the strengths and weaknesses of candidates — but they do matter,” said Selinger.

Staff Writer Ethan Wolin contributed to this story.