Tourette's - A review of the neuropsychological dimensions of Tourette syndrome

20 important questions on Tourette's - A review of the neuropsychological dimensions of Tourette syndrome

Introduction: towards a distinctive neuropsychological profile of TS

  • there is need for a disentanglement of TS and comorbidities
  • ADHD and OCD are reoprted in 20% of TS patients, but the number may be larger.
  • an influence to the results of neuropsychological studies are

TS: intellectual abilities

  • global lower IQ of 12 points but very heterogeneous
  • lower verbal comprehension, and performance
  • different findings in the IQ score for subjects with TS and OCD or ADHD. some note higher IQ scores, and others lower scores. This may be due to the use of different IQ assessment methods
  • early onset of tics is associated with a lower IQ
  • little is known about the intellectual abilities in adults with TS

TS: orienting and shifting attention

  • dichotic listening task, TS and controls did not differ in shifting attention to right ear
  • performance decreased when shifting to left ear in TS, suggesting altered corpus callosum functioning in TS
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TS: selective attention

  • orienting and selective attention use different brain regions
  • in D2 letter cancellation task, TS performed slower but more accurate
  • studies suggest possibly impaired error monitoring or processing speed

TS: Sustained attention

  • is associated with poorer tic suppression skills
  • sustained attention deficits are common in TS, mainly as omission errors and longer CPT reaction times
  • ADHD and OCD may be important confounding factor, TS+ADHD made more omission errors, but some attention deficits may be inherent to TS
  • impairments in adults with TS were found in highly demanding tasks

TS: attention capacities of TS patients

  • slight impairments in attentional capabilities, but may be caused by tics, or effort used to inhibit tics
  • intact attentional performance was often reported in patients without ADHD
  • TS+ADHD comes with marked impairments in attentional capabilities
  • deficits in sustained attention may be a marker of TS+OCD

TS: working memory

  • working memory deficits may exist in non-comorbid TS patients as indicated by the forward digit span
  • visual and visuospatial working memory could be impaired in children with TS as indicated by the 8-box task, but not in other tasks, comorbid ADHD may be the cause for the impairment in the 8-box task
  • working memory is generally intact in children and adults with TS, but severity and comorbid disorders may explain different findings

TS: long-term verbal and nonverbal memory

  • nonverbal memory deficit could be present in TS, which might be related to more general right hemisphere dysfunction.
  • there is not enough data to draw a conclusion for long-term verbal memory

TS: recognition memory

  • impaired memory processing for nonverbal material with intact verbal memory
  • impaired performance in spatial recognition memory in children

TS: implicit memory

  • normal performence in children with TS

TS: global memory

  • no widespread impairments
  • suggestions of deficits in nonverbal memory

TS: motor skills

  • conflicted findings regarding the motor skills of subjects with TS
  • discrepancies may be caused by comorbidities and medication, since medication can influence motor skill performance.
  • Children with TS showed shorter movements which may indicate an urge to move, and this is consistent with reported impulsivity 

TS: Visual motor integration and visuoconstructive abilities

  • visuomotor skills may exist in a small subset of the TS population
  • discrepancies exist in the visuoconstructive abilities as normal and impaired performance has been found.
  • motor dysfunctions (tics) are not related to visuoconstruction

TS: expressive language and speech

  • categorical fluency is intact in pure TS, but TS symptoms are a good predictor of verbal fluency
  • phonological and morphological processing seems intact in TS Patients
  • slight impairments in speech fluency exist in patients with TS

TS: language comprehension

  • impairments have been found in nonliteral remarks like sarcasm and metaphors
  • impairments were only found in the more subtle indirect-sarcasm
  • impairments may also emerge from deficits in social cognition 

TS: cognitive flexibility

  • no difference in cognitive flexibility when controlled for comorbid disorders
  • tested with TMT and WCST
  • comorbid OCD impairs cognitive flexibility, but ADHD could be problematic in some instances as well.
  • deficits may appear if the task complexity increases

TS: Planning skills

  • no significant deficit found in children with TS with the tower of london/hanoi
  • comorbid disorders may decrease performance in the tasks
  • all small test groups


  • normal skills in adults with TS


clinical questionnaires often report different organizational planning in TS 

TS: extent of EF impairment in TS

  • impairments are specific instead of widespread
  • most impairments in inhibition and cognitive flexibility

TS: social cognition

  • social responsiveness is impaired, but impairments may be because of  specific tics
  • mild deficit in generating and rating solution aimed at resolving tricky social situations
  • small differences in interpretation of facial expressions
  • intact emotional self-disclosure
  • use emotion suppression strategy more than controls
  • small deficit in children with TS in taking others perspective 

TS: learning difficulties

  • if disabilities exist, then difficulty with mathematics and written language
  • not clear if school problems emerge from TS itself or an associated learning disorder.

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