Cognitive tics in Gilles de la Tourette syndrome

2020 ◽  
Author(s):  
Anna Dunalska ◽  
Piotr Janik ◽  
Natalia Szejko ◽  
Andrzej Jakubczyk
Keyword(s):  
Anxiety Disorder ◽  
Tourette Syndrome ◽  
Statistical Significance ◽  
Age At Onset ◽  
Multivariable Analysis ◽  
Age Groups ◽  
Substantial Impact ◽  
Age Related ◽  
Tic Severity ◽  
Vocal Tics

Abstract BACKGROUND Gilles de la Tourette syndrome (GTS) is characterized by motor and vocal tics. Cognitive tics (CTs) have been rarely recognized as part of GTS symptomatology and their prevalence and associates have not been systematically investigated. OBJECTIVES The aim of the study was to assess the incidence and clinical associations of CTs in a group of patients with GTS. METHODS We examined 227 consecutive GTS patients aged 5–50 years old (78.4% males). The median duration of GTS was 4 years (IQR: 3–7) in children and 18 years (IQR: 12–23) in adults. The patients were evaluated for GTS and comorbid mental disorders according to the DSM-IV-TR and DSM-5. CTs were defined as brief, sudden, recurring involuntary thoughts, analogous to typically recognized complex vocal tics and diagnosed during the interview. Correlations between CTs and clinical variables were evaluated in two analyses, lifetime and current. Children and adult groups were compared. RESULTS Lifetime CTs were reported by 48 patients (21.1%), in 33 of the cases at the time of evaluation. The median age at onset of CTs was 13.5 years (IQR 9.3–16). Five mental phenomena were evaluated: echolalia (n = 17), coprolalia (n = 16), palilalia (n = 13), counting (n = 11), repeating of words in mind (n = 7). In the multivariable analysis of lifetime CTs, tic severity (p = 0.025) and significant social skill problems (p = 0.050) demonstrated correlation, while for current CTs only tic severity (p = 0.028) and anxiety disorder (p = 0.028) remained significant. In logistic regression model for age groups, in children only age was a factor significantly associated with lifetime CTs (p = 0.033), whereas in adults there were no statistically significant associations with lifetime CTs. For current CTs, none of the variables reached statistical significance in children, while only anxiety disorder was a predictor of current CTs in adults (p = 0.018). CONCLUSIONS CTs are a part of tic spectrum with a substantial impact of comorbid psychiatric disorders. CTs are a late and age-related symptom of GTS.

scholarly journals Cognitive Tic-Like Phenomena in Gilles de la Tourette Syndrome

2021 ◽  
Vol 10 (13) ◽  
pp. 2749
Author(s):  
Piotr Janik ◽  
Anna Dunalska ◽  
Natalia Szejko ◽  
Andrzej Jakubczyk
Keyword(s):  
Anxiety Disorder ◽  
Tourette Syndrome ◽  
Age At Onset ◽  
Substantial Impact ◽  
Age Related ◽  
Related Symptom ◽  
Clinical Associations ◽  
The Mind ◽  
Vocal Tics

Coprolalia and echophenomena repeated in the patients’ mind (CTPh—cognitive tic-like phenomena) have been rarely recognized as part of Gilles de la Tourette syndrome (GTS) symptomatology and their assignment to tics, OCD or other psychopathologies has not been settled. The aim of the paper was to assess the incidence and clinical associations of CTPh in GTS, and to establish if CTPh belong to the tic spectrum. We performed a prospective, one-registration study on a cohort of 227 consecutive patients with GTS. CTPh were diagnosed during the interview and defined as brief, sudden, involuntary thoughts that had corresponding complex vocal tics. CTPh occurred at some point in the lives of 34 (15.0%) patients. The median age at onset of CTPh was 14.5 years (IQR: 10.5–17.5). CTPh were found more frequently in adults, with the most frequent onset in adolescence (44.1%). Four mental phenomena resembling tics were recognized: echolalia (n = 17), coprolalia (n = 16), palilalia (n = 13) and repeating of words in the mind (n = 7). The older the age of patients, the more severe tics, and anxiety disorder significantly correlated with CTPh. CTPh may be considered as a part of tic spectrum with a substantial impact of anxiety disorder. CTPh are a late and age-related symptom of GTS.

scholarly journals Neural Plasticity in Functional and Anatomical MRI Studies of Children with Tourette Syndrome

2013 ◽  
Vol 27 (1) ◽  
pp. 33-45 ◽  
Author(s):  
Heike Eichele ◽  
Kerstin J. Plessen
Keyword(s):  
Tourette Syndrome ◽  
Neural Plasticity ◽  
Developmental Disorders ◽  
Age Groups ◽  
Regulatory Control ◽  
Cross Sectional ◽  
Tic Severity ◽  
Adaptive Processes ◽  
Cross Sectional Design ◽  
Anatomical Mri

Background:Tourette syndrome (TS) is a neuropsychiatric disorder with childhood onset characterized by chronic motor and vocal tics. The typical clinical course of an attenuation of symptoms during adolescence in parallel with the emerging self-regulatory control during development suggests that plastic processes may play an important role in the development of tic symptoms.Methods:We conducted a systematic search to identify existing imaging studies (both anatomical and functional magnetic resonance imaging [fMRI]) in young persons under the age of 19 years with TS.Results:The final search resulted in 13 original studies, which were reviewed with a focus on findings suggesting adaptive processes (using fMRI) and plasticity (using anatomical MRI). Differences in brain activation compared to healthy controls during tasks that require overriding of prepotent responses help to understand compensatory pathways in children with TS. Along with alterations in regions putatively representing the origin of tics, deviations in several other regions most likely represent an activity-dependent neural plasticity that help to modulate tic severity, such as the prefrontal cortex, but also in the corpus callosum and the limbic system.Discussion:Factors that potentially influence the development of adaptive changes in the brain of children with TS are age, comorbidity with other developmental disorders, medication use, IQ along with study-design or MRI techniques for acquisition, and analysis of data. The most prominent limitation of all studies is their cross-sectional design. Longitudinal studies extending to younger age groups and to children at risk for developing TS hopefully will confirm findings of neural plasticity in future investigations.

scholarly journals Neural Substrates of Self-Regulatory Control in Children and Adults with Tourette Syndrome

2009 ◽  
Vol 54 (9) ◽  
pp. 579-588 ◽  
Author(s):  
Amir Raz ◽  
Hongtu Zhu ◽  
Shan Yu ◽  
Ravi Bansal ◽  
Zhishun Wang ◽  
...  
Keyword(s):  
Tourette Syndrome ◽  
Self Regulation ◽  
Age Groups ◽  
Cortical Activation ◽  
Regulatory Control ◽  
Tic Disorder ◽  
Compulsive Disorder ◽  
Control Subjects ◽  
Age Related ◽  
Axis I

Objective: To identify the neural substrate of self-regulatory control in children and adults with Tourette syndrome (TS). Method: We used event-related functional magnetic resonance imaging (fMRI) to study the neural correlates of cognitive self-regulation during the Simon task. Forty-two people from The Tic Disorder Specialty Clinic who met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for diagnosis with TS (24 children; 18 adults) were compared with 37 control subjects (19 children; 18 adults). Patients with TS were excluded from participation if they had any Axis I psychiatric disorder other than obsessive–compulsive disorder (OCD) or attention-deficit hyperactivity disorder (ADHD) prior to the onset of TS. Control participants were excluded if they reported a history of tic disorder, OCD, ADHD, or if they met diagnostic criteria for any Axis I disorder at the time of interview. Results: We detected greater overall fMRI activation in adults than in children across both diagnostic groups, primarily in frontal and striatal regions. In both groups we also detected an age-related shift away from more general cortical activation toward a more specific reliance on frontostriatal activity, a developmental correlate that was exaggerated in the TS group despite behavioural performances similar to those of control subjects. Moreover, the severity of tics correlated positively with frontal activations across age groups. Conclusion: Frontostriatal circuits support cognitive and behavioural control. These circuits likely contribute both to optimal performance in this self-regulatory task and to the regulation of the severity of tics. Adults with persistent TS likely possess deficient activity in these circuits, attributable to either a failure of prefrontal plasticity or to disturbances in striatal functioning.

scholarly journals Children and Adolescent Obesity Associates with Pressure-Dependent and Age-Related Increase in Carotid and Femoral Arteries’ Stiffness and Not in Brachial Artery, Indicative of Nonintrinsic Arterial Wall Alteration

2016 ◽  
Vol 2016 ◽  
pp. 1-11 ◽  
Author(s):  
Victoria García-Espinosa ◽  
Santiago Curcio ◽  
Juan Manuel Castro ◽  
Maite Arana ◽  
Gustavo Giachetto ◽  
...  
Keyword(s):  
Arterial Stiffness ◽  
Brachial Artery ◽  
Arterial Wall ◽  
Statistical Significance ◽  
Age Groups ◽  
Normal Weight ◽  
Children And Adolescent ◽  
Age Related ◽  
Wall Stiffness ◽  
Related Increase

Aim. To analyze if childhood obesity associates with changes in elastic, transitional, and/or muscular arteries’ stiffness.Methods. 221 subjects (4–15 years, 92 females) were assigned to normal weight (NW,n=137) or obesity (OB,n=84) groups, considering their body mass indexz-score. Age groups were defined: 4–8; 8–12; 12–15 years old. Carotid, femoral, and brachial artery local stiffness was determined through systodiastolic pressure-diameter and stress-strain relationships. To this end, arterial diameter and peripheral and aortic blood pressure (BP) levels and waveforms were recorded. Carotid-femoral, femoropedal, and carotid-radial pulse wave velocities were determined to evaluate aortic, lower-limb, and upper-limb regional arterial stiffness, respectively. Correlation analysis between stiffness parameters and BP was done.Results. Compared to NW, OB subjects showed higher peripheral and central BP and carotid and femoral stiffness, reaching statistical significance in subjects aged 12 and older. Arterial stiffness differences disappeared when levels were normalized for BP. There were no differences in intrinsic arterial wall stiffness (elastic modulus), BP stiffness relationships, and regional stiffness parameters.Conclusion. OB associates with BP-dependent and age-related increase in carotid and femoral (but not brachial) stiffness. Stiffness changes would not be explained by intrinsic arterial wall alterations but could be associated with the higher BP levels observed in obese children.

Abstract TP244: Age-Related Disparities in Door-to-Needle Times: It’s Not What You Think

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Christian J Burrell ◽  
Kristin P Guilliams ◽  
Jennifer A Williams ◽  
Laura Heitsch ◽  
Peter Panagos ◽  
...  
Keyword(s):  
Older Adults ◽  
Young Adults ◽  
Adult Population ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Age Groups ◽  
Retrospective Chart Review ◽  
Stroke Mimics ◽  
Age Related ◽  
Forward Stepwise

Introduction: Delays in door-to-needle time (DNT) for tPA administration are associated with worse outcomes after acute ischemic stroke (AIS). Studies suggest tPA is safe and effective in young adults, though the effect of age on timeliness of tPA decision making is unknown. In the young adult population, lower frequency of stroke and higher frequency of stroke mimics may lead to DNT delays. We tested the hypothesis that DNT are longer in young adults with AIS. Methods: From 1/2009 to 3/2016, patient demographics and tPA metrics were prospectively collected on all tPA-treated patients at a large, urban academic hospital. Discharge diagnosis (including stroke mimics) and symptomatic intracranial hemorrhage (sICH) rates were collected by retrospective chart review. DNT was compared between young (age ≤ 45) and older adults (age > 45) and across four age groups: ≤45, 46-65, 66-85, and ≥86. Univariate analysis evaluated associations between DNT and baseline characteristics (age, race, sex, admission year, onset-to-arrival time, and admission NIHSS), followed by forward stepwise linear regression including variables with P<0.2 on univariate analysis. Results: Of 560 patients treated with tPA, 63 (11%) were age ≤45 and 497 (89%) were age > 45. Mean DNT was 63 minutes in young adults compared to 50 minutes in older adults (P=0.002). Across four age groups, DNTs were longer in young adults (P=0.027, Figure). In multivariable analysis, age ≤45 (P=0.012), lower NIHSS (P=0.006), and more remote admission year (P=0.001) independently predicted longer DNT. Stroke mimics were more frequent in young adults: 32% vs 7% (P<0.001), though mean DNT remained longer in young adults after excluding mimics: 63 vs 49 min (P=0.008). sICH rate was similar in both groups: 0% vs 4.2% (p=0.10). Conclusions: Despite established safety and efficacy of tPA in young adults, we found DNT delays in this population. Further studies are needed to confirm this finding and address age-related disparities in DNT.

Is Age Related Fibrinogen Affected by Warfarin?.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4117-4117
Author(s):  
Roger C. Munro ◽  
Lisa J. Wakeman ◽  
Saad Al-Ismail
Keyword(s):  
Statistical Significance ◽  
Plasma Concentrations ◽  
Age Groups ◽  
Warfarin Group ◽  
Published Evidence ◽  
Age Related ◽  
Age Gap ◽  
Significant Difference ◽  
Warfarin Treatment ◽  
The Difference

Abstract Introduction: There is published evidence which indicates that advancing age may be associated with higher plasma concentrations of fibrinogen. There is also evidence that derived fibrinogen values are significantly higher than Clauss measurements and that this discrepancy is greater in patients receiving warfarin. The purpose of this study was to determine whether age related derived fibrinogen levels are similar in both warfarin and non-warfarin groups. Methods: Venous samples were collected into siliconised glass B-D Vacutainers containing tri-sodium citrate (Ref: 367691) from 1000 patients receiving long term warfarin treatment and an equal number of age-matched patients not receiving warfarin. Genders were equally represented in both groups. Patients in both groups were categorized into 5 years age bands as follows: &lt;40 n=23: 40–44 n=20: 45–49 n=43; 50–54 n=74: 55–59 n=113: 60–64 n=155: 65–69 n=178: 70–74 n=191: 75–79 n=124; 80–84 n=56: 85–89 n=23. Derived fibrinogen was measured in each patient on an ACL300R coagulometer (I L) within 1 hour of collection using IL PT-FIB HS Plus reagent and following the manufacturer’s protocol. Appropriate CLSI guidelines were followed throughout. A normal probability plot of the data was performed to confirm that it did not deviate too much from the normal distribution. Results: The T-test for independent samples using the separate variance estimate showed that there was a statistically significant difference in the mean fibrinogen between patients on warfarin and those not on warfarin (p&lt;0.05) in each group except for the last (85–89 years). There was a statistically significant difference (ANOVA) in the fibrinogen levels of patients of different age in both warfarinised and non-warfarinised groups (p&lt;0.05). The modified least significance procedure in the ANOVA test showed that in the non-warfarin group, most of significant difference in fibrinogen between the different age groups is contributed by the difference between patients under 50 years of age. In the non-warfarin group, it requires an age gap of at least 20 years for the difference in fibrinogen to be statistically significant but in the warfarin group, it only requires an age gap of ten years (p&lt;0.05). Both Linear Regression and Cross Tabulation indicate that the relationship between fibrinogen and age does not vary whether or not the patient is on warfarin. These also show that the effect of age on fibrinogen is not affected by warfarin treatment. Conclusion: Differences or correlations detected in this analysis are of statistical significance but not necessarily clinically significant. Placing age and warfarin treatment in the same model shows that variations in fibrinogen have to be explained by other factors (e.g. technical) not included in the study as only 12% of the error in predicting fibrinogen levels can be reduced by knowing both the age and status of warfarin treatment in individual patients.

scholarly journals Influence of Age on Cardiac Surgery Outcomes in United States Veterans

2020 ◽  
Vol 23 (2) ◽  
pp. E225-E230
Author(s):  
Kyongjune Benjamin Lee ◽  
Ethan S. Rosenfeld ◽  
Michael A. Napolitano ◽  
Sheena W. Chen ◽  
Richard L. Amdur ◽  
...  
Keyword(s):  
United States ◽  
Artery Bypass ◽  
Multivariable Analysis ◽  
Age Groups ◽  
The United States ◽  
Postoperative Arrhythmia ◽  
Renal Complications ◽  
Age Related ◽  
Significant Difference ◽  
All Cause Mortality

Objective: Heart disease is still the leading cause of death for both men and women in the United States, and the rate of cardiovascular disease in veterans is even higher than in civilians. This study examines age-related outcomes for veterans undergoing cardiac surgeries at a single institution. Methods: We included all veterans undergoing coronary artery bypass grafting (CABG) and/or valve surgery between 1997 to 2017 at a single Veterans Affairs (VA) medical center. We stratified this cohort into 4 age groups: ≤59 years old, 60–69 years old, 70–79 years old, and ≥80 years old. Outcomes in age groups were compared using standard statistical methods with the ≤59 years old group as reference. Results: A total of 2,301 patients underwent open cardiac procedures at our institution. The frequency of simultaneous CABG and valve operations increased with age. Usage of cardiopulmonary bypass versus off-pump CABG and operative time was not associated with age. Increased pulmonary and renal complications as well as rates of postoperative arrhythmias all were associated with increasing age. There was no statistically significant difference in 30-day mortality. However, multivariable analysis adjusted for covariates showed all-cause mortality significantly was increased with older age groups (aHR ≥80 years old: 2.94 [2.07-4.17], P < .01; aHR 70-79 years old: 2.15 [1.63-2.83], P < 0.01, with ≤59 years old as reference). Conclusions: Older patients may have comparable perioperative mortality as their younger counterparts. However, age still is a significant predictor of all-cause mortality, pulmonary and renal complications, and postoperative arrhythmia, and should be considered as a major factor in preoperative risk assessment.

Phenotype Development in Adolescents With Tourette Syndrome: A Large Clinical Longitudinal Study

2017 ◽  
Vol 32 (13) ◽  
pp. 1047-1057 ◽  
Author(s):  
Camilla Groth ◽  
Nanette Mol Debes ◽  
Liselotte Skov
Keyword(s):  
Longitudinal Study ◽  
Tourette Syndrome ◽  
Wide Spectrum ◽  
Neurodevelopmental Disorder ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Age Related ◽  
Impairment Score ◽  
Tic Severity ◽  
Motor Tics

Tourette syndrome (TS) is a neurodevelopmental disorder characterized by frequent comorbidities and a wide spectrum of phenotype presentations. This study aimed to describe the development of phenotypes in TS and tic-related impairment in a large longitudinal study of 226 children and adolescents followed up after 6 years. The participants were clinically examined to assess tic severity and impairment, obsessive compulsive disorder (OCD), and attention-deficit/hyperactivity disorder (ADHD). The development in phenotypes changed toward less comorbidity with 40% TS-only (no OCD or ADHD) (TS without OCD or ADHD) at baseline and 55% at follow-up.Tic-related impairment was expected to improve with an age-related tic decline, but surprisingly the impairment score did not reflect the tic decline. Sex, vocal and motor tics, and OCD and ADHD severity were highly significantly correlated to the impairment score. Knowledge of TS phenotype development is used in clinical settings to guide patients and for genetic, etiological, and clinical research purposes.

Age-related changes in generalized anxiety disorder symptoms

2014 ◽  
Vol 26 (4) ◽  
pp. 565-572 ◽  
Author(s):  
Beyon Miloyan ◽  
Gerard J. Byrne ◽  
Nancy A. Pachana
Keyword(s):  
Anxiety Disorder ◽  
Generalized Anxiety Disorder ◽  
Age Groups ◽  
Binary Logistic Regression ◽  
Epidemiological Survey ◽  
Generalized Anxiety ◽  
Age Group ◽  
Regression Analyses ◽  
Age Related ◽  
The Usa

ABSTRACTBackground:Little is known about the effects of age on the symptoms of anxiety disorder. Accordingly, this study sought to investigate age-related differences in the number and kind of symptoms that distinguish between individuals with and without a diagnosis of generalized anxiety disorder (GAD).Methods:A sample of 3,486 self-reported worriers was derived from Wave 1 of the National Epidemiological Survey of Alcohol and Related Conditions (NESARC), an epidemiological survey of mental health conducted in the USA in 2001–2002. Participants were stratified into the following age groups (18–29 years, 30–44 years, 45–64 years, 65–98 years), and then divided into diagnostic groups (GAD and non-GAD worriers).Results:Binary logistic regression analyses revealed that four distinct sets of symptoms were associated with GAD in each age group, and that numerically fewer symptoms were associated with GAD in older adults. Moreover, there were graduated changes in the type and number of symptoms associated with GAD in each successive age group.Conclusions:There are graduated, age-related differences in the phenomenology of GAD that might contribute to challenges in the detection of late-life anxiety.

scholarly journals A New Benchmark to Determine What Healthy Western Skin Looks Like in Terms of Biodiversity Using Standardised Methodology

Cosmetics ◽  
2020 ◽  
Vol 7 (4) ◽  
pp. 79
Author(s):  
Christopher Wallen-Russell ◽  
Sam Wallen-Russell
Keyword(s):  
Sample Size ◽  
Statistical Significance ◽  
Age Groups ◽  
Significant Loss ◽  
Primary Objective ◽  
Western World ◽  
Skin Microbiome ◽  
Affecting Factors ◽  
Age Related ◽  
Larger Sample

A significant loss of microbial biodiversity on the skin has been linked to an increased prevalence of skin problems in the western world. The primary objective of this study was to obtain a benchmark value for the microbial diversity found on healthy western skin, using the Chao1 index. This benchmark was used to update our 2017 skin health measuring mechanism in line with standardised methodology. It used 50 human participants from Graz in Austria and at a read depth of 6600 sequences, we found the average Chao1 diversity to be ~180, with upper and lower quartiles of ~208 and ~150, respectively. Previous work with a larger sample size was unsatisfactory to use as a benchmark because different diversity indices and evaluation methodologies were used. The Medical University of Graz used the most recent version of the Chao1 index to obtain diversity results. Because of this study, we can transfer other benchmarks of skin microbiome diversity to the methodology used in this work from our 2017 study, such as “unhealthy western skin” and “caveman/perfect skin”. This could aid with the diagnostic assessment of susceptibility to cutaneous conditions or diseases and treatment. We also investigated the effect of sex and age, which are two known skin microbiome affecting factors. Although no statistical significance is seen for sex- and age-related changes in diversity, there appear to be changes related to both. Our preliminary results (10 in each of the five age groups) show adults aged 28–37 have the highest average diversity, and adults aged 48–57 have the lowest average diversity. In future work, this could be improved by obtaining benchmark diversity values from a larger sample size for any age, sex, body site, and area of residence, to which subjects can be compared. These improvements could help to investigate the ultimate question regarding which environmental factors in the western world are the main cause of the huge rise in skin problems. This could lead to future restrictions of certain synthetic chemicals or products found to be particularly harmful to the skin.

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