Do People with Tourette Syndrome Have Cognitive Deficits? A Report

This report investigates the presence of cognitive deficits in individuals with Tourette Syndrome (TS), a neuropsychiatric disorder characterized by motor and phonic tics. The report examines the clinical phenomenology of TS, including associated conditions such as ADHD and OCD, and their impact o...Read More

Do people with Tourette
syndrome have cognitive
deficits

Table of Contents
Tic and Tourette syndrome..............................................................................................................1
Methods...........................................................................................................................................1
Search Strategy............................................................................................................................1
Acceptance and rejection of the study.........................................................................................2
Clinical phenomenology of tics.......................................................................................................3
Discrepancies in the findings.......................................................................................................4
Conclusion and recommendations...................................................................................................5
REFERENCES................................................................................................................................6

Tic and Tourette syndrome
Tourette syndrome is a neuropsychiatric disorder where the individual suffers from it from
the early childhood. It can be characterized by multiple motor tics and at least one phonic and
vocal tics. Some common types of tics include, involuntary blinking of eyes, throat clearing,
sniffing, coughing and facial movements (Baldermann and et.al., 2016). Commonly tics tends to
reveal themselves at the age of 2 and 15, being the average age of 6. The probability of presence
of Tourette syndrome is higher by 2 – 3 times in case of males than of females.
Researcher states that it is not necessary that an individual suffering from Tourette syndrome
suffers from a comorbid condition. However, there are certain patients who may show symptoms
of other conditions along with phonic and motor tics. Common associated condition includes,
Attention Deficit Hyperactivity Disorder (ADHD), Obsessive Compulsive Disorder (OCD),
learning and sleeping disabilities. Disruptive behaviour with impaired thinking and cognitive
abilities is most commonly attached to Tourette Syndrome. It becomes difficult to get the
syndrome diagnosed if the prevalence of these neurotic disabilities is higher in the patient.
Undiagnosed Tourette syndrome, which is present in the patient in comorbid format can lead
to certain complications, which include, social discomfort, depression, self-injury, personality
disorder, sleep issues and conduct disorders. A direct association of cognitive control of
behaviour have been found in the patients suffering from Tourette syndrome (Tourette's
Syndrome. 2018). It has been found that it is an acute illness with adequate disruption in
memory, reading, writing and attention which is mainly localized in fronto-temporal region of
dominant hemisphere. Cognitive impairment has been found in the patients depending upon the
complexity of tics and Tourette syndrome. Combination therapy through encephabol, which
helps in increasing cerebral brain activity, and neuroleptics is found to be effective in the patients
with tic disorder (Meier and et.al., 2017).
Methods
The aim of the project is to find out, “Do people with Tourette Syndrome have cognitive
deficit?”
Search Strategy
Objective of the search: The objective during the search was to analyse the presence of cognitive
deficit in the patients suffering from cognitive syndrome.
1

Eligibility criteria: The studies that has been taken into consideration belong to the period of
2012 to 2018. These are the compilation of latest study which are reliable enough o take extract
data from them.
The search: The studies for the research have been extracted from PubMed database. All the
studies are in English language. The information collected by the researcher are in peer reviewed
journals format which will help in gathering adequate amount of knowledge in a well-defined
manner. The chosen database for the study, that is PubMed will help in gathering the data with
respect to clinical researcher being performed by other researchers on the same subject (Drury
and et.al., 2017).
In order to develop a concrete database of the results and studies, information has been
gathered on the stated topic. Initially 38 searches were searched by PubMed. In the end only 3
effective peers reviewed journal articles have been selected after picking them on the basis of
effectiveness and inclusion and exclusion criteria.
Acceptance and rejection of the study
It is important to understand that which type of study have direct relation to the research
topic and can serve best of the service. The studies that have been selected for the research are
related to prevalence of cognitive deficit in the patients suffering from Tourette syndrome.
PubMed database was systematically researchers which were published until January 2018.
Using certain search terms, such as, Tourette, Tourette Syndrome, Tic, Cognitive impairment,
Cognitive deficit, perception, prevalence, etc (Foltynie, 2016). Based upon below mentioned
criteria of inclusion and exclusion strategy, studies have been selected. Studies which do not
focus on Tourette syndrome and its relation to cognitive deficit have been excluded based on the
criteria of inadequate information. Other information related to the stated topic was manually
searched on the pool of information available online which helped in concreting the knowledge
regarding Tourette syndrome. The search gathered 38 articles in its initial searches out of which
3 researches have been used to study the topic in an effective manner.
2

Figure 1: Inclusion and Exclusion Criteria
Clinical phenomenology of tics
According to Martino, Ganos and Pringsheim (2017), clinical manifestations have reflected
that Tourette syndrome is not only limited to tics and involuntary movement of phonics and
body, it has direct relation to observed spectrum of behavioural, cognitive, sensory and sleep
related issues. A direct relation of comorbidities has been found on complexity of tic disorder in
which the individual is dwelling. As per the research conducted by the researcher, only 10% to
15% patients were found with exclusively tic disorder. Obsessive Compulsive Disorder (OCD) is
the common comorbid that has been found in the patients suffering from Tourette syndrome.
Presence of Attention Deficit Hyperactivity Disorder (ADHD), is another common determinant
that has been found as a cognitive dysfunction with Tic syndrome patients (Cavanna and
3

Rickards, 2013). They have high influence of developing disruptive behaviour. Other cognitive
results of this syndrome are, anxiety and mood disorder, impulsive disorder, spectrum of autism
disorder and psychopathic disorder at the chronic stage of Tourette syndrome. However, in
comparison to this, as per the opinion of Bergfeld and et.al. (2013), there is a prevalence of
Tourette syndrome in the patients who are facing Parkinson’s disease. Constant deterioration in
cognitive thinking of the patients has been noticed where Parkinson’s disease comorbid with
Tourette syndrome. As per the research, 26 studies reported that 130 patients suffer from one or
the other psychiatric disease. The patients consist of 56 patients with OCD, 28 patients with
major depressive disorder, 6 patients with Alzheimer’s disease 37 patients with Tourette
syndrome and other 3 patients with any other psychiatric disorder. Deep Brain Stimulation
(DBS) does not lead to cognitive decline of the people with psychiatric issues. However, the
process of Deep Brain Stimulation (DBS) has helped in improving the cognitive functions of the
individual (Robertson, 2012).
According to Channon and et.al. (2012), a study was conducted by the researcher aims to
examine the appropriateness of self-disclosures in Tourette syndrome with the help of an
emotional self-disclosure task. The study was conducted on 20 adult patients with Tourette
syndrome alone and 20 other patients with matched control. The research took place based on
two emotional self-disclosure tasks where participants were required to come up with certain
examples of autobiographical events and other was related to examination of mentalistic
judgements of participant’s behaviour. The results of the study stated that only Tourette
syndrome did not show any difference in their cognitive thinking through the observation in the
first task However, in the faux pas situation an inappropriate behaviour socially was noticed in
the patients who exclusively suffer from Tourette syndrome (Eddy and et.al., 2012). Hence,
Tourette syndrome alone is linked to preserved and impaired both type of social cognition
measures and hence require adequate amount of attention for their better behaviour.
Discrepancies in the findings
The first study raised its concern regarding the clinical spectrum of Tourette disorder beyond
tics. However, the main issue that has not been addressed in this research paper is regarding
primary data that has been collected in first hand format by the researcher. It lacks specific
results which makes the overall research bit less fruitful in comparison to the other researcher. It
also does not ascertain the intensity to which the individual has chances to suffer from other
4

disease as well apart from Tourette disorder. Hence, the overall results of the study are rather to
general and not, specific to be applied on certain section of the society (Welter and et.al., 2017).
The second study stated regarding cognitive functioning in psychiatric disorders following
deep brain stimulation (Cavanna and et.al., 2014). The main issue that can be noticed in the
research is regarding the multiple type of patients being taken in the study. Rather the researcher
would have concentrated on one type of disease so as to reach to effective conclusion. Hence, the
results just discuss regarding cognitive improvement with different cognitive disorders and did
not discuss its impact on one type of patient (Jung and et.al., 2015).
The third study has been able to consider adequate amount of specifics situation. However,
the sample size being determined is not enough and hence, it is difficult to generalize the results
on large population (Scharf and et.al., 2015).
Conclusion and recommendations
Based on the above report, it can be included that Tourette syndrome is neuropsychiatric
disorder which leads to multiple motor tics and at least one phonic and vocal tics. Three peer
reviewed journal articles have been selected by the researcher to conduct the study. Based on
exclusion and inclusion criteria, the studies have been selected. Further, discrepancies in the
studies have been stated so as to understand the limitations.
Hence, it can be recommended to the researcher that it is important for the scholar to
conduct the research in a more realistic manner (Jimenez-Shahed, 2015). Hence, it is important
to choose topic effectively considering all the strength and limitations being addressed in the
three mentioned researchers and then move forward with the core research.
5

REFERENCES
Books and journals
Baldermann, J. C. & et.al. (2016). Deep brain stimulation for tourette-syndrome: A systematic
review and meta-analysis. Brain Stimulation: Basic, Translational, and Clinical Research
in Neuromodulation. 9(2). 296-304.
Bergfeld, I. O. & et.al. (2013). Cognitive functioning in psychiatric disorders following deep
brain stimulation. Brain Stimulation: Basic, Translational, and Clinical Research in
Neuromodulation. 6(4). 532-537.
Cavanna, A. E. & et.al (2014). Premonitory urges for tics in adult patients with Tourette
syndrome. Brain and Development. 36(1). 45-50.
Cavanna, A. E., & Rickards, H. (2013). The psychopathological spectrum of Gilles de la
Tourette syndrome. Neuroscience & Biobehavioral Reviews. 37(6). 1008-1015.
Channon, S. & et.al. (2012). Judgements of social inappropriateness in adults with Tourette's
syndrome. Cognitive neuropsychiatry. 17(3). 246-261.
Drury, H. & et.al. (2017). Comprehension of direct and indirect sarcastic remarks in children and
adolescents with Tourette’s syndrome. Child Neuropsychology, 1-20.
Eddy, C. M. & et.al. (2012). The effects of comorbid obsessive-compulsive disorder and
attention-deficit hyperactivity disorder on quality of life in Tourette syndrome. The
Journal of neuropsychiatry and clinical neurosciences. 24(4). 458-462.
Foltynie, T. (2016). Vocal tics in Tourette's syndrome. The Lancet Neurology. 15(3). e1.
Jimenez-Shahed, J. (2015). Design challenges for stimulation trials of Tourette's syndrome. The
Lancet Neurology. 14(6). 563-565.
Jung, J. & et.al. (2015). Enhanced saccadic control in young people with Tourette syndrome
despite slowed pro‐saccades. Journal of neuropsychology. 9(2). 172-183.
Martino, D., Ganos, C., & Pringsheim, T. M. (2017). Tourette syndrome and chronic Tic
disorders: the clinical spectrum beyond Tics. In International review of
neurobiology (Vol. 134, pp. 1461-1490). Academic Press.
Meier, S. M. & et.al. (2017). Mortality risk in a nationwide cohort of individuals with tic
disorders and with tourette syndrome. Movement Disorders. 32(4). 605-609.
Robertson, M. M. (2012). The Gilles de la Tourette syndrome: the current status. Archives of
Disease in Childhood-Education and Practice. 97(5). 166-175.
6

Scharf, J. M. & et.al. (2015). Population prevalence of Tourette syndrome: A systematic review
and meta‐analysis. Movement Disorders. 30(2). 221-228.
Welter, M. L. & et.al. (2017). Anterior pallidal deep brain stimulation for Tourette's syndrome: a
randomised, double-blind, controlled trial. The Lancet Neurology. 16(8). 610-619.
Online
Tourette's Syndrome. 2018. [Online]. Available through
<https://www.webmd.com/brain/tourettes-syndrome#1>.
7