Is procedural memory enhanced in Tourette syndrome? Evidence from a sequence learning task

Neural representations of statistical and rule-based predictions in Gilles de la Tourette syndrome

Gilles de la Tourette syndrome (GTS) is a disorder characterised by motor and vocal tics, which may represent habitual actions as a result of enhanced learning of associations between stimuli and responses (S-R). In this study, we investigated how adults with GTS and healthy controls (HC) learn two types of regularities in a sequence: statistics (non-adjacent probabilities) and rules (predefined order). Participants completed a visuomotor sequence learning task while EEG was recorded. To understand the neurophysiological underpinnings of these regularities in GTS, multivariate pattern analyses on the temporally decomposed EEG signal as well as sLORETA source localisation method were conducted. We found that people with GTS showed superior statistical learning but comparable rule-based learning compared to HC participants. Adults with GTS had different neural representations for both statistics and rules than HC adults; specifically, adults with GTS maintained the regularity representations longer and had more overlap between them than HCs. Moreover, over different time scales, distinct fronto-parietal structures contribute to statistical learning in the GTS and HC groups. We propose that hyper-learning in GTS is a consequence of the altered sensitivity to encode complex statistics, which might lead to habitual actions.

Resting network architecture of theta oscillations reflects hyper-learning of sensorimotor information in Gilles de la Tourette syndrome

Gilles de la Tourette syndrome is a neurodevelopmental disorder characterized by motor and vocal tics. It is associated with enhanced processing of stimulus-response associations, including a higher propensity to learn probabilistic stimulus-response contingencies (i.e. statistical learning), the nature of which is still elusive. In this study, we investigated the hypothesis that resting-state theta network organization is a key for the understanding of superior statistical learning in these patients. We investigated the graph-theoretical network architecture of theta oscillations in adult patients with Gilles de la Tourette syndrome and healthy controls during a statistical learning task and in resting states both before and after learning. We found that patients with Gilles de la Tourette syndrome showed a higher statistical learning score than healthy controls, as well as a more optimal (small-world-like) theta network before the task. Thus, patients with Gilles de la Tourette syndrome had a superior facility to integrate and evaluate novel information as a trait-like characteristic. Additionally, the theta network architecture in Gilles de la Tourette syndrome adapted more to the statistical information during the task than in HC. We suggest that hyper-learning in patients with Gilles de la Tourette syndrome is likely a consequence of increased sensitivity to perceive and integrate sensorimotor information leveraged through theta oscillation-based resting-state dynamics. The study delineates the neural basis of a higher propensity in patients with Gilles de la Tourette syndrome to pick up statistical contingencies in their environment. Moreover, the study emphasizes pathophysiologically endowed abilities in patients with Gilles de la Tourette syndrome, which are often not taken into account in the perception of this common disorder but could play an important role in destigmatization.

A scoping review of oral language and social communication abilities in children with Tourette syndrome

BACKGROUND

Children with Tourette syndrome (TS) have historically experienced problems in academic and social settings, yet their language and communication abilities have not been extensively researched.

AIMS

This scoping review maps the literature on the oral language and social communication abilities of children with TS in order to describe the nature of the current literature, present a summary of major findings and identify where gaps exist.

METHODS

A scoping review was completed to identify studies measuring the oral language or social communication abilities of children with TS. A systematic search of six electronic databases was conducted to obtain published and unpublished literature. All English studies measuring the oral language or social communication abilities of children with TS were included. Information was extracted from records and knowledge was synthesised in a narrative summary.

MAIN CONTRIBUTION

We identified 56 records for inclusion. Almost all records were located in journals within the fields of psychology and psychiatry. Skills most often studied were verbal IQ and verbal fluency. The literature suggests an increased prevalence of language disorders and social communication problems in children with TS; however, literature comprehensively detailing these challenges was scarce. Language strengths were identified in verbal intelligence, story/sentence recall, categorisation and performance on tasks at the single-word level.

CONCLUSIONS

Oral language and social communication skills are important for academic and social success. This review brings scattered literature together to provide up-to-date information about language in children with TS and highlights that there are considerable gaps in our knowledge about language and communication in this population. This scoping review can inform future research and support speech language pathologists in the assessment of young people with TS.

WHAT THIS PAPER ADDS

What is already known on the subject Speech-language pathologists (SLPs) working in various contexts (e.g., schools, mental health teams) are likely to encounter children with Tourette syndrome (TS); however, the description of this population and potential communication characteristics is not well represented in the SLP literature. Previous literature reviews have reported strengths in verbal fluency and morphological processing. Challenges in expressive language, higher order language, social cognition and a propensity towards autistic traits have also been identified. What this paper adds to existing knowledge This review differs from previous narrative reviews by employing a systematic approach to searching for literature. As a result, we identified 25 additional studies that had not been cited in previous reviews and additional relevant findings in 23 previously reviewed studies. This review confirms several previous conclusions about language in children with TS and extends or clarifies several others, thereby providing the most current information on oral language and social communication abilities. The use of current taxonomies of language and social communication helps to organise this literature for clinicians and researchers in speech-language pathology and identifies a need for further research from the SLP perspective. What are the potential or actual clinical implications of this work? These results imply that SLPs should screen children with TS for language disorders and investigate social communication and social interaction development. Clinicians can expect greater challenges in language and communication development for children with complex forms of TS (i.e., those who exhibit co-occurring conditions such as attention-deficit/hyperactivity disorder). The multidisciplinary nature of the current literature implies that clinical collaboration with other disciplines will be of particular benefit to serving this group of children.

The complexity of measuring reliability in learning tasks: An illustration using the Alternating Serial Reaction Time Task

Despite the fact that reliability estimation is crucial for robust inference, it is underutilized in neuroscience and cognitive psychology. Appreciating reliability can help researchers increase statistical power, effect sizes, and reproducibility, decrease the impact of measurement error, and inform methodological choices. However, accurately calculating reliability for many experimental learning tasks is challenging. In this study, we highlight a number of these issues, and estimate multiple metrics of internal consistency and split-half reliability of a widely used learning task on a large sample of 180 subjects. We show how pre-processing choices, task length, and sample size can affect reliability and its estimation. Our results show that the Alternating Serial Reaction Time Task has respectable reliability, especially when learning scores are calculated based on reaction times and two-stage averaging. We also show that a task length of 25 blocks can be sufficient to meet the usual thresholds for minimally acceptable reliability. We further illustrate how relying on a single point estimate of reliability can be misleading, and the calculation of multiple metrics, along with their uncertainties, can lead to a more complete characterization of the psychometric properties of tasks.

The retrogenesis of age-related decline in declarative and procedural memory

The retrogenesis hypothesis proposes that the order of breakdown of cognitive abilities in older adults is the reverse of the developmental order of children. Declarative and procedural memory systems, however, have been empirically understudied regarding this issue. The current study aimed to investigate whether retrogenesis occurs in the developmental and decline order of the declarative and procedural memory systems. Besides, we further investigated whether retrogenesis occurs in declarative memory, which was tested through the recognition of familiar and unfamiliar items. Both questions were investigated by looking at 28 Chinese younger adults and 27 cognitively healthy Chinese older adults. The recognition memory task and the Serial Reaction Time Task were administered on two consecutive days in order to measure their declarative and procedural memory, respectively. The results showed older adults performed significantly worse than younger adults for both tasks on both days, suggesting a decline in both declarative and procedural memory. Moreover, older adults exhibited relatively preserved declarative memory compared to procedural memory. This does not follow the expectations of the retrogenesis hypothesis. However, older adults demonstrated superior performance and a steeper rate of forgetting for recognizing familiar items than unfamiliar items. This reverses the developmental order of different patterns in the declarative memory system. Overall, we conclude that retrogenesis occurs in the declarative memory system, while does not in the decline order of the two memory systems; this understanding can better help inform our broader understanding of memory aging.

Do temporal factors affect whether our performance accurately reflects our underlying knowledge? The effects of stimulus presentation rates on the performance versus competence dissociation

Ample evidence shows that the momentary performance can dissociate from the underlying knowledge (competence). Under what circumstances such dissociation occurs, however, remains unclear. Here we tested how temporal factors, and more specifically, the elapsed time between subsequent events affects the dissociation between performance and competence by systematically manipulating the stimulus presentation rates during and after learning. Participants completed a probabilistic sequence learning task with a fast (120 msec) or a slow (850 msec) response-to-stimulus-interval (RSI) during the Learning phase and they were tested with both RSIs 24 h later (Testing phase). We also tested whether they gained explicit knowledge about the sequence or their knowledge remained implicit. Our results revealed higher reaction time learning scores when tested with the fast RSI, irrespective of the RSI during learning, suggesting that faster presentation rates can help better express the acquired knowledge, leading to increased performance measures. For accuracy, participants showed higher learning scores when tested with the same presentation rate as the one that they encountered during learning. The acquired knowledge remained implicit in both groups, suggesting that the observed findings were not confounded by differences in awareness gained in the two groups. Overall, our study highlights that the momentary performance does not always accurately reflect the underlying knowledge, and temporal factors seem to influence this dissociation. Our findings have theoretical, methodological, and translational implications that likely extend beyond learning and memory to other functions and domains as well, including aspects of decision-making, perception, theory of mind, and language.

Tracking human skill learning with a hierarchical Bayesian sequence model

Humans can implicitly learn complex perceptuo-motor skills over the course of large numbers of trials. This likely depends on our becoming better able to take advantage of ever richer and temporally deeper predictive relationships in the environment. Here, we offer a novel characterization of this process, fitting a non-parametric, hierarchical Bayesian sequence model to the reaction times of human participants' responses over ten sessions, each comprising thousands of trials, in a serial reaction time task involving higher-order dependencies. The model, adapted from the domain of language, forgetfully updates trial-by-trial, and seamlessly combines predictive information from shorter and longer windows onto past events, weighing the windows proportionally to their predictive power. As the model implies a posterior over window depths, we were able to determine how, and how many, previous sequence elements influenced individual participants' internal predictions, and how this changed with practice. Already in the first session, the model showed that participants had begun to rely on two previous elements (i.e., trigrams), thereby successfully adapting to the most prominent higher-order structure in the task. The extent to which local statistical fluctuations in trigram frequency influenced participants' responses waned over subsequent sessions, as participants forgot the trigrams less and evidenced skilled performance. By the eighth session, a subset of participants shifted their prior further to consider a context deeper than two previous elements. Finally, participants showed resistance to interference and slow forgetting of the old sequence when it was changed in the final sessions. Model parameters for individual participants covaried appropriately with independent measures of working memory and error characteristics. In sum, the model offers the first principled account of the adaptive complexity and nuanced dynamics of humans' internal sequence representations during long-term implicit skill learning.

White matter alterations in drug-naïve children with Tourette syndrome and obsessive-compulsive disorder

Tourette syndrome (TS) and early-onset obsessive-compulsive disorder (OCD) are frequently associated and conceptualized as distinct phenotypes of a common disease spectrum. However, the nature of their relationship is still largely unknown on a pathophysiological level. In this study, early structural white matter (WM) changes investigated through diffusion tensor imaging (DTI) were compared across four groups of drug-naïve children: TS-pure (n = 16), TS+OCD (n = 14), OCD (n = 10), and 11 age-matched controls. We analyzed five WM tracts of interest, i.e., cortico-spinal tract (CST), anterior thalamic radiations (ATR), inferior longitudinal fasciculus (ILF), corpus callosum (CC), and cingulum and evaluated correlations of DTI changes to symptom severity. Compared to controls, TS-pure and TS+OCD showed a comparable pattern of increased fractional anisotropy (FA) in CST, ATR, ILF and CC, with FA changes displaying negative correlation to tic severity. Conversely, in OCD, FA decreased in all WM tracts (except for the cingulum) compared to controls and negatively correlated to symptoms. We demonstrate different early WM microstructural alterations in children with TS-pure/TS+OCD as opposed to OCD. Our findings support the conceptualization of TS+OCD as a subtype of TS while suggesting that OCD is characterized by independent pathophysiological mechanisms affecting WM development.

European clinical guidelines for Tourette syndrome and other tic disorders-version 2.0. Part I: assessment

In 2011 a working group of the European Society for the Study of Tourette Syndrome (ESSTS) has developed the first European assessment guidelines for Tourette syndrome (TS). Now, we present an updated version 2.0 of these European clinical guidelines for Tourette syndrome and other tic disorders, part I: assessment. Therefore, the available literature has been thoroughly screened, supplemented with national guidelines across countries and discussions among ESSTS experts. Diagnostic changes between DSM-IV and DSM-5 classifications were taken into account and new information has been added regarding differential diagnoses, with an emphasis on functional movement disorders in both children and adults. Further, recommendations regarding rating scales to evaluate tics, comorbidities, and neuropsychological status are provided. Finally, results from a recently performed survey among ESSTS members on assessment in TS are described. We acknowledge that the Yale Global Tic Severity Scale (YGTSS) is still the gold standard for assessing tics. Recommendations are provided for scales for the assessment of tics and psychiatric comorbidities in patients with TS not only in routine clinical practice, but also in the context of clinical research. Furthermore, assessments supporting the differential diagnosis process are given as well as tests to analyse cognitive abilities, emotional functions and motor skills.

A Metacontrol Perspective on Neurocognitive Atypicality: From Unipolar to Bipolar Accounts

Standard clinical and psychiatric thinking follows a unipolar logic that is centered at "normal" conditions characterized by optimal performance in everyday life, with more atypical conditions being defined by the (degree of) absence of "normality." A similar logic has been used to describe cognitive control, assuming that optimal control abilities are characterized by a strong focus on the current goal and ignorance of goal-irrelevant information (the concept of willpower), while difficulties in focusing and ignoring are considered indications of the absence of control abilities. However, there is increasing evidence that willpower represents only one side of the control coin. While a strong focus on the current goal can be beneficial under some conditions, other conditions would benefit from a more open mind, from flexibility to consider alternative goals and information related to them. According to the metacontrol model, people can vary in their cognitive processing style, on a dimension with the extreme poles of "persistence" on the one hand and "flexibility" on the other. Whereas a high degree of persistence corresponds to the original idea of cognitive control as willpower, with a strong focus on one goal and the information related to it, a high degree of flexibility is characterized by a more integrative, less selective and exclusive processing style, which facilitates switching between tasks, ideas, and actions, and taking into consideration a broader range of possibilities. We argue that this approach calls for a more bipolar account in the clinical sciences as well. Rather than considering individuals as typical or atypical, it would theoretically and practically make more sense to characterize their cognitive abilities in terms of underlying dimensions, such as the persistence/flexibility dimension. This would reveal that possible weaknesses with respect to one pole, such as persistence, and tasks relying thereupon, may come with corresponding strengths with respect to the other pole, such as flexibility, and respective tasks. We bolster our claim by discussing available evidence suggesting that neurodevelopmental atypicality often comes with weaknesses in tasks related to one pole but strengths in tasks related to the other.

A Process-Oriented View of Procedural Memory Can Help Better Understand Tourette's Syndrome

Tourette's syndrome (TS) is a neurodevelopmental disorder characterized by repetitive movements and vocalizations, also known as tics. The phenomenology of tics and the underlying neurobiology of the disorder have suggested that the altered functioning of the procedural memory system might contribute to its etiology. However, contrary to the robust findings of impaired procedural memory in neurodevelopmental disorders of language, results from TS have been somewhat mixed. We review the previous studies in the field and note that they have reported normal, impaired, and even enhanced procedural performance. These mixed findings may be at least partially be explained by the diversity of the samples in both age and tic severity, the vast array of tasks used, the low sample sizes, and the possible confounding effects of other cognitive functions, such as executive functions, working memory or attention. However, we propose that another often overlooked factor could also contribute to the mixed findings, namely the multiprocess nature of the procedural system itself. We propose that a process-oriented view of procedural memory functions could serve as a theoretical framework to help integrate these varied findings. We discuss evidence suggesting heterogeneity in the neural regions and their functional contributions to procedural memory. Our process-oriented framework can help to deepen our understanding of the complex profile of procedural functioning in TS and atypical development in general.

Access to Procedural Memories After One Year: Evidence for Robust Memory Consolidation in Tourette Syndrome

Tourette syndrome is a childhood-onset neurodevelopmental disorder characterized by motor and vocal tics. On the neural level, tics are thought to be related to the disturbances of the cortico-basal ganglia-thalamo-cortical loops, which also play an important role in procedural learning. Several studies have investigated the acquisition of procedural information and the access to established procedural information in TS. Based on these, the notion of procedural hyperfunctioning, i.e., enhanced procedural learning, has been proposed. However, one neglected area is the retention of acquired procedural information, especially following a long-term offline period. Here, we investigated the 5-hour and 1-year consolidation of two aspects of procedural memory, namely serial-order and probability-based information. Nineteen children with TS between the ages of 10 and 15 as well as 19 typically developing gender- and age-matched controls were tested on a visuomotor four-choice reaction time task that enables the simultaneous assessment of the two aspects. They were retested on the same task 5 hours and 1 year later without any practice in the offline periods. Both groups successfully acquired and retained the probability-based information both when tested 5 hours and then 1 year later, with comparable performance between the TS and control groups. Children with TS did not acquire the serial-order information during the learning phase; hence, retention could not be reliably tested. Our study showed evidence for short-term and long-term retention of one aspect of procedural memory, namely probability-based information in TS, whereas learning of serial-order information might be impaired in this disorder.

Lower-level associations in Gilles de la Tourette syndrome: Convergence between hyperbinding of stimulus and response features and procedural hyperfunctioning theories

Gilles de la Tourette syndrome (GTS) can be characterized by enhanced cognitive functions related to creating, modifying and maintaining connections between stimuli and responses (S-R links). Specifically, two areas, procedural sequence learning and, as a novel finding, also event file binding, show converging evidence of hyperfunctioning in GTS. In this review, we describe how these two enhanced functions can be considered as cognitive mechanisms behind habitual behaviour, such as tics in GTS. Moreover, the presence of both procedural sequence learning and event file binding hyperfunctioning in the same disorder can be treated as evidence for their functional connections, even beyond GTS. Importantly though, we argue that hyperfunctioning of event file binding and procedural learning are not interchangeable: they have different time scales, different sensitivities to potential impairment in action sequencing and distinguishable contributions to the cognitive profile of GTS. An integrated theoretical account of hyperbinding and hyperlearning in GTS allows to formulate predictions for the emergence, activation and long-term persistence of tics in GTS.

Neurophysiological and functional neuroanatomical coding of statistical and deterministic rule information during sequence learning

Humans are capable of acquiring multiple types of information presented in the same information stream. It has been suggested that at least two parallel learning processes are important during learning of sequential patterns-statistical learning and rule-based learning. Yet, the neurophysiological underpinnings of these parallel learning processes are not fully understood. To differentiate between the simultaneous mechanisms at the single trial level, we apply a temporal EEG signal decomposition approach together with sLORETA source localization method to delineate whether distinct statistical and rule-based learning codes can be distinguished in EEG data and can be related to distinct functional neuroanatomical structures. We demonstrate that concomitant but distinct aspects of information coded in the N2 time window play a role in these mechanisms: mismatch detection and response control underlie statistical learning and rule-based learning, respectively, albeit with different levels of time-sensitivity. Moreover, the effects of the two learning mechanisms in the different temporally decomposed clusters of neural activity also differed from each other in neural sources. Importantly, the right inferior frontal cortex (BA44) was specifically implicated in visuomotor statistical learning, confirming its role in the acquisition of transitional probabilities. In contrast, visuomotor rule-based learning was associated with the prefrontal gyrus (BA6). The results show how simultaneous learning mechanisms operate at the neurophysiological level and are orchestrated by distinct prefrontal cortical areas. The current findings deepen our understanding on the mechanisms of how humans are capable of learning multiple types of information from the same stimulus stream in a parallel fashion.

Regularity detection under stress: Faster extraction of probability-based regularities

Acute stress can crucially influence learning and memory processes. One of the key processes underlying human learning and memory is the ability of our brain to rapidly detect and extract regularities from sensory input across time and space leading to effective predictive processing. Here, we aimed to get an in-depth look into the effect of stress on the acquisition of two aspects of regularity extraction. We examined whether and how stress affects the learning (1) of probability-based regularities and (2) of serial order-based regularities in the same experimental design, and (3) the explicit access to the acquired information. Considering that the acquisition of probability-based regularities is a relatively rapid process, we primarily focused on the early phase of the task. We induced stress with the Socially Evaluated Cold Pressor Test in 27 young adults, while 26 participants were enrolled in the control group. Salivary cortisol levels and subjective ratings of affective states showed successful stress induction. After the stress induction, we measured regularity extraction with the cued Alternating Serial Reaction Time task. We found that stress promoted the extraction of probability-based regularities measured by the learning performance in the early phase of the task and did not alter the learning of serial order-based regularities. Post-block reports showed weaker explicit access to the serial order-based regularities in the stress group. Our results can contribute to a process-level understanding on how stress alters learning and memory functions related to predictive processes.

Statistical and sequence learning lead to persistent memory in children after a one-year offline period

Extraction of environmental patterns underlies human learning throughout the lifespan and plays a crucial role not only in cognitive but also perceptual, motor, and social skills. At least two types of regularities contribute to acquiring skills: (1) statistical, probability-based regularities, and (2) serial order-based regularities. Memory performance of probability-based and/or serial order-based regularities over short periods (from minutes to weeks) has been widely investigated across the lifespan. However, long-term (months or year-long) memory performance of such knowledge has received relatively less attention and has not been assessed in children yet. Here, we aimed to test the long-term memory performance of probability-based and serial order-based regularities over a 1-year offline period in neurotypical children between the age of 9 and 15. Participants performed a visuomotor four-choice reaction time task designed to measure the acquisition of probability-based and serial order-based regularities simultaneously. Short-term consolidation effects were controlled by retesting their performance after a 5-h delay. They were then retested on the same task 1 year later without any practice between the sessions. Participants successfully acquired both probability-based and serial order-based regularities and retained both types of knowledge over the 1-year period. The successful retention was independent of age. Our study demonstrates that the representation of probability-based and serial order-based regularities remains stable over a long period of time. These findings offer indirect evidence for the developmental invariance model of skill consolidation.

Language evolution: examining the link between cross-modality and aggression through the lens of disorders

We demonstrate how two linguistic phenomena, figurative language (implicating cross-modality) and derogatory language (implicating aggression), both demand a precise degree of (dis)inhibition in the same cortico-subcortical brain circuits, in particular cortico-striatal networks, whose connectivity has been significantly enhanced in recent evolution. We examine four cognitive disorders/conditions that exhibit abnormal patterns of (dis)inhibition in these networks: schizophrenia (SZ), autism spectrum disorder (ASD), synaesthesia and Tourette's syndrome (TS), with the goal of understanding why the two phenomena altered reactive aggression and altered cross-modality cluster together in these disorders. Our proposal is that enhanced cross-modality (necessary to support language, in particular metaphoricity) was a result, partly a side-effect, of self-domestication (SD). SD targeted the taming of reactive aggression, but reactive impulses are controlled by the same cortico-subcortical networks that are implicated in cross-modality. We further add that this biological process of SD did not act alone, but was engaged in an intense feedback loop with the cultural emergence of early forms of language/grammar, whose high degree of raw metaphoricity and verbal aggression also contributed to increased brain connectivity and cortical control. Consequently, in conjunction with linguistic expressions serving as approximations/'fossils' of the earliest stages of language, these cognitive disorders/conditions serve as confident proxies of brain changes in language evolution, helping us reconstruct certain crucial aspects of early prehistoric languages and cognition, as well as shed new light on the nature of the disorders. This article is part of the theme issue 'Reconstructing prehistoric languages'.

On the functional role of striatal and anterior cingulate GABA+ in stimulus-response binding

Successful response selection relies on constantly updating stimulus-response associations. The Theory of Event Coding (TEC) proposes that perception and action are conjointly coded in event files, for which fronto-striatal networks seem to play an important role. However, the exact neurobiochemical mechanism behind event file coding has remained unknown. We investigated the functional relevance of the striatal and anterior cingulate (ACC) GABAergic system using magnetic resonance spectroscopy (MRS). Specifically, the striatal and ACC concentrations of GABA+ referenced against N-acetylaspartate (NAA) were assessed in 35 young healthy males, who subsequently performed a standard event file task. As predicted by the TEC, the participants' responses were modulated by pre-established stimulus response bindings in event files. GABA+/NAA concentrations in the striatum and ACC were not correlated with the overall event binding effect. However, higher GABA+/NAA concentrations in the ACC were correlated with stronger event file binding processes in the early phase of the task. This association disappeared by the end of the task. Taken together, our findings show that striatal GABA+ levels does not seem to modulate event file binding, while ACC GABA+ seem to improve event file binding, but only as long as the participants have not yet gathered sufficient task experience. To the best of our knowledge, this is the first study providing direct evidence for the role of striatal and ACC GABA+ in stimulus-response bindings and thus insights into the brain structure-specific neurobiological aspects of the TEC.

A neural noise account of Gilles de la Tourette syndrome

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A neural noise account on Tourette syndrome is conceptualized.

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We outline how neurophysiological methods can be used to test this account.

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The neural noise account may lead to novel treatment options.

Tics, often preceded by premonitory urges, are the clinical hallmark of Tourette syndrome. They resemble spontaneous movements, but are exaggerated, repetitive and appear misplaced in a given communication context. Given that tics often go unnoticed, it has been suggested that they represent a surplus of action, or motor noise. In this conceptual position paper, we propose that tics and urges, but also patterns of the cognitive profile in Tourette syndrome might be explained by the principle of processing of neural noise and adaptation to it during information processing. We review evidence for this notion in the light of Tourette pathophysiology and outline why neurophysiological and imaging approaches are central to examine a possibly novel view on Tourette syndrome. We discuss how neurophysiological data at multiple levels of inspections, i.e., from local field potentials using intra-cranial recording to scalp-measured EEG data, in combination with imaging approaches, can be used to examine the neural noise account in Tourette syndrome. We outline what signal processing methods may be suitable for that. We argue that, as a starting point, the analysis of 1/f neural noise or scale-free activity may be suitable to investigate the role of neural noise and its adaptation during information processing in Tourette syndrome. We outline, how the neural noise perspective, if substantiated by further neurophysiological studies and re-analyses of existing data, may pave the way to novel interventions directly targeting neural noise levels and patterns in Tourette syndrome.

Implicit anticipation of probabilistic regularities: Larger CNV emerges for unpredictable events

Anticipation of upcoming events plays a crucial role in automatic behaviors. It is, however, still unclear whether the event-related brain potential (ERP) markers of anticipation could track the implicit acquisition of probabilistic regularities that can be considered as building blocks of automatic behaviors. Therefore, in a four-choice reaction time (RT) task performed by young adults (N = 36), the contingent negative variation (CNV) as an ERP marker of anticipation was measured from the onset of a cue stimulus until the presentation of a target stimulus. Due to the probability structure of the task, target stimuli were either predictable or unpredictable, but this was unknown to participants. The cue did not contain predictive information on the upcoming target. Results showed that the CNV amplitude during response preparation was larger before the unpredictable than before the predictable target stimuli. In addition, although RTs increased, the P3 amplitude decreased for the unpredictable as compared with the predictable target stimuli, possibly due to the stronger response preparation that preceded stimulus presentation. These results suggest that enhanced attentional resources are allocated to the implicit anticipation and processing of unpredictable events. This might originate from the formation of internal models on the probabilistic regularities of the stimulus stream, which primarily facilitates the processing of predictable events. Overall, we provide ERP evidence that supports the role of implicit anticipation and predictive processes in the acquisition of probabilistic regularities.

Retrieval of a well-established skill is resistant to distraction: Evidence from an implicit probabilistic sequence learning task

The characteristics of acquiring new sequence information under dual-task situations have been extensively studied. A concurrent task has often been found to affect performance. In real life, however, we mostly perform a secondary task when the primary task is already well acquired. The effect of a secondary task on the ability to retrieve well-established sequence representations remains elusive. The present study investigates whether accessing well-acquired probabilistic sequence knowledge is affected by a concurrent task. Participants acquired non-adjacent regularities in an implicit probabilistic sequence learning task. After a 24-hour offline period, participants were tested on the same probabilistic sequence learning task under dual-task or single-task conditions. Here, we show that although the secondary task significantly prolonged the overall reaction times in the primary (sequence learning) task, access to the previously learned probabilistic representations remained intact. Our results highlight the importance of studying the dual-task effect not only in the learning phase but also during memory access to reveal the robustness of the acquired skill.

Speed or Accuracy Instructions During Skill Learning do not Affect the Acquired Knowledge

A crucial question in skill learning research is how instruction affects the performance or the underlying representations. Little is known about the effects of instructions on one critical aspect of skill learning, namely, picking-up statistical regularities. More specifically, the present study tests how prelearning speed or accuracy instructions affect the acquisition of non-adjacent second-order dependencies. We trained 2 groups of participants on an implicit probabilistic sequence learning task: one group focused on being fast and the other on being accurate. As expected, we detected a strong instruction effect: accuracy instruction resulted in a nearly errorless performance, and speed instruction caused short reaction times (RTs). Despite the differences in the average RTs and accuracy scores, we found a similar level of statistical learning performance in the training phase. After the training phase, we tested the 2 groups under the same instruction (focusing on both speed and accuracy), and they showed comparable performance, suggesting a similar level of underlying statistical representations. Our findings support that skill learning can result in robust representations, and they highlight that this form of knowledge may appear with almost errorless performance. Moreover, multiple sessions with different instructions enabled the separation of competence from performance.

Impairment of visually guided associative learning in children with Tourette syndrome

The major symptoms of Tourette syndrome are motor and vocal tics, but Tourette syndrome is occasionally associated with cognitive alterations as well. Although Tourette syndrome does not affect the majority of cognitive functions, some of them improve. There is scarce evidence on the impairment of learning functions in patients with Tourette syndrome. The core symptoms of Tourette syndrome are related to dysfunction of the basal ganglia and the frontostriatal loops. Acquired equivalence learning is a kind of associative learning that is related to the basal ganglia and the hippocampi. The modified Rutgers Acquired Equivalence Test was used in the present study to observe the associative learning function of patients with Tourette syndrome. The cognitive learning task can be divided into two main phases: the acquisition and test phases. The latter is further divided into two parts: retrieval and generalization. The acquisition phase of the associative learning test, which mainly depends on the function of the basal ganglia, was affected in the entire patient group, which included patients with Tourette syndrome with attention deficit hyperactivity disorder, obsessive compulsive disorder, autism spectrum disorder, or no comorbidities. Patients with Tourette syndrome performed worse in building associations. However, the retrieval and generalization parts of the test phase, which primarily depend on the function of the hippocampus, were not worsened by Tourette syndrome.

Frontal-midline theta frequency and probabilistic learning: A transcranial alternating current stimulation study

Probabilistic learning is a fundamental cognitive ability that extracts and represents regularities of our environment enabling predictive processing during perception and acquisition of perceptual, motor, cognitive, and social skills. Previous studies show competition between neural networks related to executive function/working memory vs. probabilistic learning. Theta synchronization has been associated with the former while desynchronization with the latter in correlational studies. In the present paper our aim was to test causal relationship between fronto-parietal midline theta synchronization and probabilistic learning with non-invasive transcranial alternating current (tACS) stimulation. We hypothesize that theta synchronization disrupts probabilistic learning performance by modulating the competitive relationship. Twenty-six young adults performed the Alternating Serial Reaction Time (ASRT) task to assess probabilistic learning in two sessions that took place one week apart. Stimulation was applied in a double-blind cross-over within-subject design with an active theta tACS and a sham stimulation in a counter-balanced order between participants. Sinusoidal current was administered with 1 mA peak-to-peak intensity throughout the task (approximately 20 min) for the active stimulation and 30 s for the sham. We did not find an effect of fronto-parietal midline theta tACS on probabilistic learning comparing performance during active and sham stimulation. To influence probabilistic learning, we suggest applying higher current intensity and stimulation parameters more precisely aligned to endogenous brain activity for future studies.

Comprehensive Behavioral Intervention for Tics reduces perception-action binding during inhibitory control in Gilles de la Tourette syndrome

Gilles de la Tourette Syndrome (GTS) is a developmental disorder. Empirical studies and an emerging cognitive framework on GTS suggest that GTS is a disorder of abnormally strong ‘perception-action binding’. Theoretical considerations imply that the effectiveness of long-established behavioral interventions might be related to a normalization of increased binding in GTS. This has not been tested yet. We examined the effect of a standardized Comprehensive Behavior Intervention for Tics (CBIT) in N = 21 adolescent GTS patients and N = 21 healthy controls on perception-action binding in an inhibitory control paradigm. Prior to CBIT, GTS patients showed compromised performance compared to controls, specifically when inhibitory control was triggered by uni-modal visual compared to bi-modal stimuli. After CBIT intervention, GTS patient’s performance was at the same level as healthy controls. This is supported by a Bayesian data analysis. CBIT specifically affected inhibitory control in a condition where reconfigurations of perception-action bindings are necessary to perform inhibitory control. A power of 95% was evident for these effects. CBIT reduces increased ‘binding’ between perception and action in GTS and thereby increases the ability to perform response inhibition. The results are the first to provide insights as to why CBIT is effective by relating elements of this intervention to overarching cognitive theoretical frameworks on perception-action bindings.

The Neurocognition of Developmental Disorders of Language

Developmental disorders of language include developmental language disorder, dyslexia, and motor-speech disorders such as articulation disorder and stuttering. These disorders have generally been explained by accounts that focus on their behavioral rather than neural characteristics; their processing rather than learning impairments; and each disorder separately rather than together, despite their commonalities and comorbidities. Here we update and review a unifying neurocognitive account—the Procedural circuit Deficit Hypothesis (PDH). The PDH posits that abnormalities of brain structures underlying procedural memory (learning and memory that rely on the basal ganglia and associated circuitry) can explain numerous brain and behavioral characteristics across learning and processing, in multiple disorders, including both commonalities and differences. We describe procedural memory, examine its role in various aspects of language, and then present the PDH and relevant evidence across language-related disorders. The PDH has substantial explanatory power, and both basic research and translational implications.

Sequence learning in the human brain: A functional neuroanatomical meta-analysis of serial reaction time studies

Sequence learning underlies numerous motor, cognitive, and social skills. Previous models and empirical investigations of sequence learning in humans and non-human animals have implicated cortico-basal ganglia-cerebellar circuitry as well as other structures. To systematically examine the functional neuroanatomy of sequence learning in humans, we conducted a series of neuroanatomical meta-analyses. We focused on the serial reaction time (SRT) task. This task, which is the most widely used paradigm for probing sequence learning in humans, allows for the rigorous control of visual, motor, and other factors. Controlling for these factors (in sequence-random block contrasts), sequence learning yielded consistent activation only in the basal ganglia, across the striatum (anterior/mid caudate nucleus and putamen) and the globus pallidus. In contrast, when visual, motor, and other factors were not controlled for (in a global analysis with all sequence-baseline contrasts, not just sequence-random contrasts), premotor cortical and cerebellar activation were additionally observed. The study provides solid evidence that, at least as tested with the visuo-motor SRT task, sequence learning in humans relies on the basal ganglia, whereas cerebellar and premotor regions appear to contribute to aspects of the task not related to sequence learning itself. The findings have both basic research and translational implications.

Tracking the implicit acquisition of nonadjacent transitional probabilities by ERPs

The implicit acquisition of complex probabilistic regularities has been found to be crucial in numerous automatized cognitive abilities, including language processing and associative learning. However, it has not been completely elucidated how the implicit extraction of second-order nonadjacent transitional probabilities is reflected by neurophysiological processes. Therefore, this study investigated the sensitivity of event-related brain potentials (ERPs) to these probabilistic regularities embedded in a sequence of visual stimuli without providing explicit information on the structure of the stimulus stream. Healthy young adults (N = 32) performed a four-choice RT task that included a sequential regularity between nonadjacent trials yielding a complex transitional probability structure. ERPs were measured relative to both stimulus and response onset. RTs indicated the rapid acquisition of the sequential regularity and the transitional probabilities. The acquisition process was also tracked by the stimulus-locked and response-locked P3 component: The P3 peak was larger for the sequence than for the random stimuli, while the late P3 was larger for less probable than for more probable short-range relations among the random stimuli. According to the RT and P3 effects, sensitivity to the sequential regularity is assumed to be supported by the initial sensitivity to the transitional probabilities. These results suggest that stimulus-response contingencies on the probabilistic regularities of the ongoing stimulus context are implicitly mapped and constantly revised. Overall, this study (1) highlights the role of predictive processes during implicit memory formation, and (2) delineates a potential to gain further insight into the dynamics of implicit acquisition processes.

Different levels of statistical learning - Hidden potentials of sequence learning tasks

In this paper, we reexamined the typical analysis methods of a visuomotor sequence learning task, namely the ASRT task (J. H. Howard & Howard, 1997). We pointed out that the current analysis of data could be improved by paying more attention to pre-existing biases (i.e. by eliminating artifacts by using new filters) and by introducing a new data grouping that is more in line with the task's inherent statistical structure. These suggestions result in more types of learning scores that can be quantified and also in purer measures. Importantly, the filtering method proposed in this paper also results in higher individual variability, possibly indicating that it had been masked previously with the usual methods. The implications of our findings relate to other sequence learning tasks as well, and opens up opportunities to study different types of implicit learning phenomena.

Implicit Learning Abilities in Adolescents Born Very Preterm

Very preterm birth is associated with neurodevelopmental impairments and outcomes have not improved over the last decades. Insight in learning processes is important for the development of effective interventions. Implicit learning is of particular interest because of its independence from working memory processes that are affected by preterm birth. This study examined implicit learning abilities in 49 very preterm and 61 full-term 13-year-old adolescents. The degree of implicit learning was not different between groups. This indicates intact implicit learning abilities in adolescents born very preterm. Implicit learning strategies may be beneficial for skill learning in very preterm born children.