Probabilistic classification learning in Tourette syndrome

The Visual Advantage Effect in Comparing Uni-Modal and Cross-Modal Probabilistic Category Learning

People rely on multiple learning systems to complete weather prediction (WP) tasks with visual cues. However, how people perform in audio and audiovisual modalities remains elusive. The present research investigated how the cue modality influences performance in probabilistic category learning and conscious awareness about the category knowledge acquired. A modified weather prediction task was adopted, in which the cues included two dimensions from visual, auditory, or audiovisual modalities. The results of all three experiments revealed better performances in the visual modality relative to the audio and audiovisual modalities. Moreover, participants primarily acquired unconscious knowledge in the audio and audiovisual modalities, while conscious knowledge was acquired in the visual modality. Interestingly, factors such as the amount of training, the complexity of visual stimuli, and the number of objects to which the two cues belonged influenced the amount of conscious knowledge acquired but did not change the visual advantage effect. These findings suggest that individuals can learn probabilistic cues and category associations across different modalities, but a robust visual advantage persists. Specifically, visual associations can be learned more effectively, and are more likely to become conscious. The possible causes and implications of these effects are discussed.

What Is the Weather Prediction Task Good for? A New Analysis of Learning Strategies Reveals How Young Adults Solve the Task

The Weather Prediction Task (WPT) was originally designed to assess probabilistic classification learning. Participants were believed to gradually acquire implicit knowledge about cue–outcome association probabilities and solve the task using a multicue strategy based on the combination of all cue–outcome probabilities. However, the cognitive processes engaged in the resolution of this task have not been firmly established, and despite conflicting results, the WPT is still commonly used to assess striatal or procedural learning capacities in various populations. Here, we tested young adults on a modified version of the WPT and performed novel analyses to decipher the learning strategies and cognitive processes that may support above chance performance. The majority of participants used a hierarchical strategy by assigning different weights to the different cues according to their level of predictability. They primarily based their responses on the presence or absence of highly predictive cues and considered less predictive cues secondarily. However, the influence of the less predictive cues was inconsistent with the use of a multicue strategy, since they did not affect choices when both highly predictive cues associated with opposite outcomes were present simultaneously. Our findings indicate that overall performance is inadequate to draw conclusions about the cognitive processes assessed by the WPT. Instead, detailed analyses of performance for the different patterns of cue–outcome associations are essential to determine the learning strategies used by participants to solve the task.

Tourette syndrome research highlights from 2020

We present here research from 2020 relevant to Tourette syndrome (TS). The authors briefly summarize a few reports they consider most important or interesting.

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.

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.

Temporal discounting in adolescents and adults with Tourette syndrome

Tourette syndrome is a neurodevelopmental disorder associated with hyperactivity in dopaminergic networks. Dopaminergic hyperactivity in the basal ganglia has previously been linked to increased sensitivity to positive reinforcement and increases in choice impulsivity. In this study, we examine whether this extends to changes in temporal discounting, where impulsivity is operationalized as an increased preference for smaller-but-sooner over larger-but-later rewards. We assessed intertemporal choice in two studies including nineteen adolescents (age: mean[sd] = 14.21[±2.37], 13 male subjects) and twenty-five adult patients (age: mean[sd] = 29.88 [±9.03]; 19 male subjects) with Tourette syndrome and healthy age- and education matched controls. Computational modeling using exponential and hyperbolic discounting models via hierarchical Bayesian parameter estimation revealed reduced temporal discounting in adolescent patients, and no evidence for differences in adult patients. Results are discussed with respect to neural models of temporal discounting, dopaminergic alterations in Tourette syndrome and the developmental trajectory of temporal discounting. Specifically, adolescents might show attenuated discounting due to improved inhibitory functions that also affect choice impulsivity and/or the developmental trajectory of executive control functions. Future studies would benefit from a longitudinal approach to further elucidate the developmental trajectory of these effects.

Gray matter abnormalities in Tourette Syndrome: a meta-analysis of voxel-based morphometry studies

Tourette syndrome (TS) is a neurobehavioral disorder for which the neurological mechanism has not been elucidated. Voxel-based morphometry (VBM) studies have revealed abnormalities in gray matter volume (GMV) in patients with TS; however, consistent results have not been obtained. The current study attempted to provide a voxel wise meta-analysis of gray matter changes using seed-based d mapping (SDM). We identified ten relevant studies that investigated gray matter alterations in TS patients and performed a meta-analysis using the SDM method to quantitatively estimate regional gray matter abnormalities. Next, we examined the relationships between GMV abnormalities and demographic and clinical characteristics. Our results demonstrated that TS patients had smaller GMV in the bilateral inferior frontal gyri and greater GMV in the cerebellum, right striatum (putamen), and bilateral thalami (pulvinar nucleus) than healthy controls. A meta-regression analysis did not identify correlations between GMV changes and demographic or clinical variables. This meta-analysis confirmed significant and consistent GMV changes in several brain regions of TS patients, primarily in the cortico-striato-thalamo-cortical network.

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.

Decreased transfer of value to action in Tourette syndrome

OBJECTIVE

Tourette syndrome is a neurodevelopmental disorder putatively associated with a hyperdopaminergic state. Therefore, it seems plausible that excessive dopamine transmission in Tourette syndrome alters the ability to learn based on rewards and punishments. We tested whether Tourette syndrome patients exhibited altered reinforcement learning and corresponding feedback-related EEG deflections.

METHODS

We used a reinforcement learning task providing factual and counterfactual feedback in a sample of 15 Tourette syndrome patients and matched healthy controls whilst recording EEG. The paradigm presented various reward probabilities to enforce adaptive adjustments. We employed a computational model to derive estimates of the prediction error, which we used for single-trial regression analysis of the EEG data.

RESULTS

We found that Tourette syndrome patients showed increased choice stochasticity compared to controls. The feedback-related negativity represented an axiomatic prediction error for factual feedback and did not differ between groups. We observed attenuated P3a modulation specifically for factual feedback in Tourette syndrome patients, representing impaired coding of attention allocation.

CONCLUSION

Our findings indicate that cortical prediction error coding is unaffected by Tourette syndrome. Nonetheless, the transfer of learned values into choice formation is degraded, in line with a hyperdopaminergic state.

Visuomotor learning and unlearning in children and adolescents with tourette syndrome

Tourette syndrome (TS) is a childhood-onset neurological condition characterised by an evolving repertoire of chronic motor tics and one or more phonic tics. Tics, like habits, are inflexible and repetitive behaviours that are acquired over a period of time. It has been proposed that tics arise in TS as a result of increased habit learning: which may bias the child to acquire automatic behaviours (i.e., tics) more readily than is normal and make it harder to unlearn maladaptive habits once they have been acquired. Using a well-established visuomotor adaptation task, we investigated motor learning in a group of children and adolescents with a clinical diagnosis of TS relative to a group of age and gender matched typically developing individuals. In particular, we quantified differences in the strength and quality of motor learning and unlearning in TS, and the consolidation of motor learning over a 24 h washout period. We demonstrated that there was a marginally significant decrease in learning rate in the individuals with TS relative to age and gender matched typically developing controls. However, this effect was not associated with tic severity and could be entirely accounted for by the severity of co-occurring ADHD symptoms. Thus, once ADHD symptoms had been accounted for, there were no between group differences in learning rate or the degree of learning observed. By contrast, and more importantly, we found that following learning the rate of forgetting (unlearning) was significantly negatively associated with motor tic severity, such that individuals with more severe tics took longer to unlearn previously learnt motor patterns of behaviour. This finding is consistent with the proposal that TS is associated with alterations in the striatal habit learning system and with the view that TS may make it harder to unlearn maladaptive motor habits once they have been acquired.

Impact of putamen stroke on task context updating: Evidence from P300 brain waves

According to the context updating theory, the oddball P300 component indexes brain activities underlying revision of the mental representation induced by incoming stimuli. It involves an attention-driven comparison process that evaluates the representation of the previous event in working memory. Delayed latencies have been reported for various types of stroke such as unilateral thalamic stroke. We investigated memory updating effects in patients with putamen stroke. Two groups of patients with putamen and thalamic stroke were recruited along with two control groups of young and old healthy participants. Auditory and visual P300 were elicited respectively in a two-stimulus oddball paradigm. The auditory P300 peak latencies were significantly longer in patients with a putamen lesion than in the aged and young control groups and the same pattern was found in the thalamus-lesioned patient. The delayed auditory P300 component in both patient groups but neither control group suggests impairment of memory updating in patients with putamen stroke comparable with thalamic stroke. Our study illustrates the important role of subcortical structures subserved in context updating.

Tourette syndrome research highlights from 2017

This is the fourth yearly article in the Tourette Syndrome Research Highlights series, summarizing research from 2017 relevant to Tourette syndrome and other tic disorders. The authors briefly summarize reports they consider most important or interesting. The  highlights from 2018 article is being drafted on the Authorea online authoring platform, and readers are encouraged to add references or give feedback on our selections using the comments feature on that page. After the calendar year ends, the article is submitted as the annual update for the Tics collection on F1000Research.

Implicit sequence learning in young people with Tourette syndrome with and without co-occurring attention-deficit/hyperactivity disorder

Impaired habit-learning has been proposed to underlie the tic symptoms of Tourette syndrome (TS). However, accounts differ in terms of how habit-learning is altered in TS, with some authors proposing habit formation is impaired due to a deficient 'chunking' mechanism, and others proposing habit-learning is overactive and tics reflect hyperlearned behaviours. Attention-deficit/hyperactivity disorder (ADHD) frequently co-occurs with TS and is known to affect cognitive function in young people with co-occurring TS and ADHD (TS + ADHD). It is unclear, however, how co-occurring ADHD symptoms affect habit-learning in TS. In this study, we investigated whether young people with TS would show deficient or hyperactive habit-learning, and assessed the effects of co-occurring ADHD symptoms on habit-learning in TS. Participants aged 9-17 years with TS (n = 18), TS + ADHD (n = 17), ADHD (n = 13), and typical development (n = 20) completed a motor sequence learning task to assess habit-learning. We used a 2 (TS-yes, TS-no) × 2 (ADHD-yes, ADHD-no) factorial analysis to test the effects of TS, ADHD, and their interaction on accuracy and reaction time indices of sequence learning. TS was associated with intact sequence learning, but a tendency for difficulty transitioning from sequenced to non-sequenced performance was suggestive of hyper-learning. ADHD was associated with significantly poorer accuracy during acquisition of the sequence, indicative of impaired habit-learning. There were no interactions between the TS and ADHD factors, indicating young people with TS + ADHD showed both TS- and ADHD-related atypicalities in habit-learning.

The Roles of Phasic and Tonic Dopamine in Tic Learning and Expression

Tourette syndrome (TS) prominently involves dopaminergic disturbances, but the precise nature of those disturbances has remained elusive. A substantial body of empirical work and recent computational models have characterized the specific roles of phasic and tonic dopamine (DA) in action learning and selection, respectively. Using insights from this work and models, we suggest that TS involves increases in both phasic and tonic DA, which produce increased propensities for tic learning and expression, respectively. We review the evidence from reinforcement-learning and habit-learning studies in TS, which supports the idea that TS involves increased phasic DA responses; we also review the evidence that tics engage the habit-learning circuitry. On the basis of these findings, we suggest that tics are exaggerated, maladaptive, and persistent motor habits reinforced by aberrant, increased phasic DA responses. Increased tonic DA amplifies the tendency to execute learned tics and also provides a fertile ground of motor hyperactivity for tic learning. We review evidence suggesting that antipsychotics may counter both the increased propensity for tic expression, by increasing excitability in the indirect pathway, and the increased propensity for tic learning, by shifting plasticity in the indirect pathway toward long-term potentiation (and possibly also through more complex mechanisms). Finally, we review evidence suggesting that low doses of DA agonists that effectively treat TS decrease both phasic and tonic DA, thereby also reducing the propensity for both tic learning and tic expression, respectively.

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

Procedural memory, which is rooted in the basal ganglia, underlies the learning and processing of numerous automatized motor and cognitive skills, including in language. Not surprisingly, disorders with basal ganglia abnormalities have been found to show impairments of procedural memory. However, brain abnormalities could also lead to atypically enhanced function. Tourette syndrome (TS) is a candidate for enhanced procedural memory, given previous findings of enhanced TS processing of grammar, which likely depends on procedural memory. We comprehensively examined procedural learning, from memory formation to retention, in children with TS and typically developing (TD) children, who performed an implicit sequence learning task over two days. The children with TS showed sequence learning advantages on both days, despite a regression of sequence knowledge overnight to the level of the TD children. This is the first demonstration of procedural learning advantages in any disorder. The findings may further our understanding of procedural memory and its enhancement. The evidence presented here, together with previous findings suggesting enhanced grammar processing in TS, underscore the dependence of language on a system that also subserves visuomotor sequencing.

A verbal strength in children with Tourette syndrome? Evidence from a non-word repetition task

Tourette syndrome (TS) is characterized by motor and vocal tics, and frontal/basal-ganglia abnormalities. Whereas cognitive strengths have been found in other neurodevelopmental disorders, less attention has been paid to strengths in TS, or to verbal strengths in any neurodevelopmental disorder. We examined whether the finding of speeded TS production of rule-governed morphological forms (e.g., "slipped") that involve composition (Walenski, Mostofsky, & Ullman, 2007) might extend to another language domain, phonology. Thirteen children with TS and 14 typically-developing (TD) children performed a non-word repetition task: they repeated legal phonological strings (e.g.,"naichovabe"), a task that taps rule-governed (de)composition. Parallel to the morphology findings, the children with TS showed speeded production, while the two groups had similar accuracy. The results were not explained by potentially confounding factors, including IQ. Overall, the findings suggest that rule-governed grammatical composition may be speeded in TS, perhaps due to frontal/basal-ganglia abnormalities.

Electrophysiological correlates of reinforcement learning in young people with Tourette syndrome with and without co-occurring ADHD symptoms

Altered reinforcement learning is implicated in the causes of Tourette syndrome (TS) and attention-deficit/hyperactivity disorder (ADHD). TS and ADHD frequently co-occur but how this affects reinforcement learning has not been investigated. We examined the ability of young people with TS (n=18), TS+ADHD (N=17), ADHD (n=13) and typically developing controls (n=20) to learn and reverse stimulus-response (S-R) associations based on positive and negative reinforcement feedback. We used a 2 (TS-yes, TS-no)×2 (ADHD-yes, ADHD-no) factorial design to assess the effects of TS, ADHD, and their interaction on behavioural (accuracy, RT) and event-related potential (stimulus-locked P3, feedback-locked P2, feedback-related negativity, FRN) indices of learning and reversing the S-R associations. TS was associated with intact learning and reversal performance and largely typical ERP amplitudes. ADHD was associated with lower accuracy during S-R learning and impaired reversal learning (significantly reduced accuracy and a trend for smaller P3 amplitude). The results indicate that co-occurring ADHD symptoms impair reversal learning in TS+ADHD. The implications of these findings for behavioural tic therapies are discussed.

WITHDRAWN: Electrophysiological correlates of reinforcement learning in young people with Tourette syndrome with and without co-occurring ADHD symptoms

The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.ijdevneu.2016.04.006. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

Probing Implicit Learning in Obsessive-Compulsive Disorder: Moderating Role of Medication on the Weather Prediction Task

Deficits in implicit learning, a process by which knowledge is acquired accretively through practice independent of conscious awareness, have been implicated in Obsessive-Compulsive Disorder (OCD). The weather-prediction task (WPT) was used to assess implicit learning in 26 unmedicated patients with OCD and 23 healthy controls. An additional analysis compared these two groups with 25 medicated patients with OCD. In the comparison of unmedicated patients with healthy controls there was a subtle but statistically significant group-by-block interaction. Patients with OCD showed slower improvement in performance during the middle phase of learning. In a three-group comparison, there was no main effect of group; in post-hoc tests, medicated patients with OCD differed from unmedicated patients and were not different from healthy controls. Unmedicated patients with OCD have a subtle deficit in implicit learning in the WPT. This may be mitigated by pharmacotherapy, although prospective studies would be required to confirm this conclusion.

Individuals With OCD Lack Unrealistic Optimism Bias in Threat Estimation

Overestimating the occurrence of threatening events has been highlighted as a central cognitive factor in the maintenance of obsessive-compulsive disorder (OCD). The present study examined the different facets of this cognitive bias, its underlying mechanisms, and its specificity to OCD. For this purpose, threat estimation, probabilistic classification learning (PCL) and psychopathological measures were assessed in 23 participants with OCD, 30 participants with social phobia, and 31 healthy controls. Whereas healthy participants showed an optimistic expectation bias regarding positive and negative future events, OCD participants lacked such a bias. This lack of an optimistic expectation bias was not specific to OCD. Compared to healthy controls, OCD participants overestimated their personal risk for experiencing negative events, but did not differ from controls in their risk estimation regarding other people. Finally, OCD participants' biases in the prediction of checking-related events were associated with their impairments in learning probabilistic cue-outcome associations in a disorder-relevant context. In sum, the present results add to a growing body of research demonstrating that cognitive biases in OCD are context-dependent.

Self-insight in probabilistic category learning

The Weather Prediction (WP) task is one of the most extensively used Probabilistic Category Learning tasks. Although it has been usually treated as an implicit task, its implicit nature has been questioned with focus on the structural knowledge of the acquired information. The goal of the current studies is to test if participants acquire explicit knowledge on the WP task. Experiment 1 addresses this question directly with the help of a subjective measure on self-insight in two groups: an experimental group facing the WP task and a control group with a task lacking predictive structure. Participants in the experimental group produced more explicit reports than the control group, and only on trials with explicit knowledge was their performance higher. Experiment 2 provided further evidence against the implicitness of the task by showing that decreasing stimulus presentation times extends the learning process, but does not result in more implicit processes.

Imminent danger? Probabilistic classification learning of threat-related information in obsessive-compulsive disorder

A tendency to overestimate threat has been shown in individuals with OCD. We tested the hypothesis that this bias in judgment is related to difficulties in learning probabilistic associations between events. Thirty participants with OCD and 30 matched healthy controls completed a learning experiment involving 2 variants of a probabilistic classification learning task. In the neutral weather-prediction task, rainy and sunny weather had to be predicted. In the emotional task danger of an epidemic from virus infection had to be predicted (epidemic-prediction task). Participants with OCD were as able as controls to improve their prediction of neutral events across learning trials but scored significantly below healthy controls on the epidemic-prediction task. Lower performance on the emotional task variant was significantly related to a heightened tendency to overestimate threat. Biased information processing in OCD might thus hamper corrective experiences regarding the probability of threatening events.

Battery powered thought: enhancement of attention, learning, and memory in healthy adults using transcranial direct current stimulation

This article reviews studies demonstrating enhancement with transcranial direct current stimulation (tDCS) of attention, learning, and memory processes in healthy adults. Given that these are fundamental cognitive functions, they may also mediate stimulation effects on other higher-order processes such as decision-making and problem solving. Although tDCS research is still young, there have been a variety of methods used and cognitive processes tested. While these different methods have resulted in seemingly contradictory results among studies, many consistent and noteworthy effects of tDCS on attention, learning, and memory have been reported. The literature suggests that although tDCS as typically applied may not be as useful for localization of function in the brain as some other methods of brain stimulation, tDCS may be particularly well-suited for practical applications involving the enhancement of attention, learning, and memory, in both healthy subjects and in clinical populations.

Stimulus dependence in probabilistic category learning

The current study investigates whether probabilistic categorization on the Weather Prediction task involves a single, modality/domain general learning mechanism or there are modality/domain differences. The same probabilistic categorization task was used in three modalities/domains and two modes of presentation. Cues consisted of visual, auditory-verbal or auditory-nonverbal stimuli, and were presented either sequentially or simultaneously. Results show that while there was no general difference in performance across modalities/domains, the mode of presentation affected them differently. In the visual modality, simultaneous performance had a general advantage over sequential presentation, while in the auditory conditions, there was an initial advantage of simultaneous presentation, which disappeared, and in the non-verbal condition, gave over to a sequential advantage in the later stages of learning. Data suggest that there are strong peripheral modality effects; however, there are no signs of modality/domain of stimuli centrally affecting categorization.

Altered neurophysiologic response to intermittent theta burst stimulation in Tourette syndrome

BACKGROUND

The motor system in Tourette syndrome has been found to be abnormal in previous fine-motor and neurophysiologic studies.

OBJECTIVE

This novel pilot study uses repetitive transcranial magnetic stimulation as a method to characterize the neurophysiology of the motor system in Tourette syndrome.

METHOD

We investigated the modulation of cortical excitability in adult Tourette syndrome patients by measuring motor-evoked potential amplitudes before and after applying intermittent theta burst transcranial magnetic stimulation.

RESULTS

Motor-evoked potential amplitude changes over 1 and 10 minutes after intermittent theta burst transcranial magnetic stimulation were greater in 11 healthy controls than 10 adult patients with Tourette syndrome (P = 0.004).

CONCLUSIONS

This altered neurophysiologic response to intermittent theta burst stimulation may contribute to the understanding of motor cortical mechanisms in Tourette syndrome.

Tourette syndrome in children: an updated review

Tourette syndrome (TS) is a common neuropsychiatric disorder in children characterized by multiple motor and vocal tics that fluctuate in severity and lasting for at least 1 year. Boys are more commonly affected than girls. Symptoms usually begin with simple motor or vocal tics which then evolve into more complex motor and vocal tics over time. Premonitory sensory urges are common in children over the age of 8 years, and these urges help distinguish tics from symptoms of other movement disorders. Common comorbidities of TS include attention deficit hyperactivity disorder, obsessive-compulsive disorder and learning difficulties. Several genes have been assessed as candidate genes for TS; environmental factors such as stress and streptococcal infections might also contribute to its etiology. The pathophysiology of TS mainly involves dysfunction of basal ganglia-related circuits and hyperactive dopaminergic innervations. A thorough history assessment and neurological examination are important for the correct diagnosis and differentiation from other movement disorders. Treatment for TS should focus on improving the patient's social functioning, minimizing the impairment from cormobid disorders, and controlling tics, if they are severe. Commonly used medications for TS include a2-adrenergic agonists and atypical neuroleptics. Habit reversal therapy is an effective option for TS, and repetitive transcranial magnetic stimulation may be a promising approach for severe cases.

Intact implicit learning in autism spectrum conditions

Individuals with autism spectrum condition (ASC) have diagnostic impairments in skills that are associated with an implicit acquisition; however, it is not clear whether ASC individuals show specific implicit learning deficits. We compared ASC and typically developing (TD) individuals matched for IQ on five learning tasks: four implicit learning tasks--contextual cueing, serial reaction time, artificial grammar learning, and probabilistic classification learning tasks--that used procedures expressly designed to minimize the use of explicit strategies, and one comparison explicit learning task, paired associates learning. We found implicit learning to be intact in ASC. Beyond no evidence of differences, there was evidence of statistical equivalence between the groups on all the implicit learning tasks. This was not a consequence of compensation by explicit learning ability or IQ. Furthermore, there was no evidence to relate implicit learning to ASC symptomatology. We conclude that implicit mechanisms are preserved in ASC and propose that it is disruption by other atypical processes that impact negatively on the development of skills associated with an implicit acquisition.

Distinguishing the contributions of implicit and explicit processes to performance of the weather prediction task

Examinations of the cognitive neuroscience of category learning frequently rely on probabilistic classification-learning tasks-namely, the weather prediction task (WPT)-to study the neural mechanisms of implicit learning. Accumulating evidence suggests that the task also depends on explicit-learning processes. The present investigation manipulated the WPT to assess the specific contributions of implicit- and explicit-learning processes to performance, with a particular focus on how the contributions of these processes change as the task progresses. In Experiment 1, a manipulation designed to disrupt implicit-learning processes had no effect on classification accuracy or the distribution of individual response strategies. In Experiment 2, by contrast, a manipulation designed to disrupt explicit-learning processes substantially reduced classification accuracy and reduced the number of participants who relied on a correct response strategy. The present findings suggest that WPT learning is not an effective tool for investigating nondeclarative learning processes.

Inhibitory deficits in Tourette's syndrome

A developmental approach to the study of psychopathology can broaden understanding of a wide variety of complex psychological disorders. This article reviews research on Tourette's syndrome (TS), a developmental disorder characterized by unwanted motor and vocal tics. Over the past decade, knowledge of the neurobiology and pathophysiology of TS has progressed rapidly. The application of brain imaging techniques, primarily magnetic resonance imaging, to the study of Tourette's has increased knowledge of structural and functional deficits in brain areas associated with behavioral and psychological disturbances in the disorder. By reviewing some of this work, we will describe one way in which knowledge of brain function in TS has both informed and been informed by a developmental science approach. In particular, we will consider the extent to which the cognitive and emotional development of persons with TS may be affected by specific neurobiological characteristics of the disorder.

Interactive memory systems and category learning in schizophrenia

Schizophrenia is a devastating mental disorder with multiple facets, including the impairment of learning and memory. Recent evidence suggests that information is processed and represented by multiple interacting memory systems in the brain, including prefrontal cortex, basal ganglia, and medial temporal lobe. These structures are critical in the pathophysiology of schizophrenia. Whereas executive and declarative memory dysfunctions are well known in schizophrenia, habit learning deficits related to the basal ganglia are less clear, despite the fact that dopaminergic and other neurochemical processes in the basal ganglia may play a crucial role in the pathophysiology and pharmacology of schizophrenia. In this article, I propose that the investigation of different classification learning functions, including reward- and feedback-guided learning and acquired equivalence learning, may shed light on the neuropsychology, pathophysiology, pharmacology, and behavioral genetics of schizophrenia.

Tourette syndrome and tic disorders: a decade of progress

OBJECTIVE

This is a review of progress made in the understanding of Tourette syndrome (TS) during the past decade including models of pathogenesis, state-of-the-art assessment techniques, and treatment.

METHOD

Computerized literature searches were conducted under the key words "Tourette syndrome," "Tourette disorder," and "tics." Only references from 1996-2006 were included.

RESULTS

Studies have documented the natural history of TS and the finding that tics usually improve by the end of the second decade of life. It has also become clear that TS frequently co-occurs with attention-deficit/hyperactivity disorder), obsessive-compulsive disorder, and a range of other mood and anxiety disorders. These comorbid conditions are often the major source of impairment for the affected child. Advances have also been made in understanding the underlying neurobiology of TS using in vivo neuroimaging and neurophysiology techniques. Progress on the genetic front has been less rapid. Proper diagnosis and education (involving the affected child and his or her parents, teachers, and peers) are essential prerequisites to the successful management of children with TS. When necessary, modestly effective antitic medications are available, although intervening to treat the comorbid attention-deficit/hyperactivity disorder and/or obsessive-compulsive disorder is usually the place to start.

CONCLUSIONS

Prospective longitudinal studies and randomized clinical trials have led to the refinement of several models of pathogenesis and advanced our evidence base regarding treatment options. However, fully explanatory models are needed that would allow for more accurate prognosis and the development of targeted and efficacious treatments.

The role of abnormal neural oscillations in the pathophysiology of co-occurring Tourette syndrome and attention-deficit/hyperactivity disorder

OBJECTIVE

To examine the role of aberrant neural oscillatory activity in the pathophysiology of co-occurring Tourette Syndrome (TS) and Attention-Deficit/Hyperactivity Disorder (ADHD).

METHOD

Neural oscillations refer to periodic variations in the recording of neural activity. The temporal synchronization of oscillations represents a mechanism of neural communication implicated in normal brain functioning as well as psychopathology. We reviewed physiological, imaging, and neuropsychological evidence that tics and symptoms of ADHD may result from abnormal oscillatory activity in the brain.

RESULTS

Structural and functional abnormalities in the cortical-striatal-thalamo-cortical circuits may result in the disruption of oscillatory activity within the basal ganglia of individuals with TS and lead to transient hyperpolarization of selected thalamocortical regions. Extended to TS plus ADHD this or similar mechanisms, in turn, would lead to the dysrhythmia of particular vulnerable cortical regions and give rise to various deficits in motor control (TS + ADHD) as well as impulsivity and attention (ADHD). Compensatory systems within the prefrontal cortex could be activated and trained to modulate the misguided striatal and thalamocortical oscillations.

CONCLUSIONS

Although it is highly likely that abnormal neural oscillations have a prominent role in co-occurrence of TS + ADHD, its final relevance in this case deserves further differentiated research (i.e. oscillatory networks disentangled from other neuropsychiatric disorders).

Neuroimaging of tic disorders with co-existing attention-deficit/hyperactivity disorder

BACKGROUND

Tourette syndrome (TS) and Attention-Deficit/Hyperactivity Disorder (ADHD) are common and debilitating neuropsychiatric illnesses that typically onset in the preschool years. Recently, both conditions have been subject to neuroimaging studies, with the aim of understanding their underlying neurobiological correlates.

OBJECTIVE

The relation of TS and ADHD is discussed against the background of findings from previous Magnetic Resonance Imaging (MRI) studies.

METHODS

We review the designs and major findings of previous studies that have examined TS with comorbid ADHD, and we briefly contrast these findings with those in ADHD without comorbid tic disorders.

RESULTS

The frequent comorbidity of TS and ADHD may reflect a common underlying neurobiological substrate, and studies confirm the hypothesized involvement of fronto-striatal circuits in both TS and ADHD. However, poor inhibitory control and volumetric reductions in fronto-striatal circuits appear to be core features of ADHD, whereas reduced volumes of the caudate nucleus, together with activation and hypertrophy of prefrontal regions that likely help to suppress tics, seem to be core features of TS.

CONCLUSION

The etiological relationship between TS and ADHD must be clarified further with cross-sectional and, if possible, longitudinal imaging studies that examine samples of substantial size, including subgroups with pure TS and ADHD, as well as with comorbid conditions.

Speeded processing of grammar and tool knowledge in Tourette's syndrome

Tourette's syndrome (TS) is a developmental disorder characterized by motor and verbal tics. The tics, which are fast and involuntary, result from frontal/basal-ganglia abnormalities that lead to unsuppressed behaviors. Language has not been carefully examined in TS. We tested the processing of two basic aspects of language: idiosyncratic and rule-governed linguistic knowledge. Evidence suggests that idiosyncratic knowledge (e.g., in irregular past tense formation; bring-brought) is stored in a mental lexicon that depends on the temporal-lobe-based declarative memory system that also underlies conceptual knowledge. In contrast, evidence suggests that rule-governed combination (e.g., in regular past tenses; walk+-ed) takes place in a mental grammar that relies on the frontal/basal-ganglia-based procedural memory system, which also underlies motor skills such as how to use a hammer. We found that TS children were significantly faster than typically developing control children in producing rule-governed past tenses (slip-slipped, plim-plimmed, bring-bringed) but not irregular and other unpredictable past tenses (bring-brought, splim-splam). They were also faster than controls in naming pictures of manipulated (hammer) but not non-manipulated (elephant) items. These data were not explained by a wide range of potentially confounding subject- and item-level factors. The results suggest that the processing of procedurally based knowledge, both of grammar and of manipulated objects, is particularly speeded in TS. The frontal/basal-ganglia abnormalities may thus lead not only to tics, but also to a wider range of rapid behaviors, including the cognitive processing of rule-governed forms in language and other types of procedural knowledge.

Tourette syndrome: the self under siege

Tourette syndrome is a neurodevelopmental disorder characterized by motor and vocal tics--rapid, repetitive, stereotyped movements or vocalizations. Tourette syndrome typically has a prepubertal onset, and boys are more commonly affected than girls. Symptoms usually begin with transient bouts of simple motor tics. By age 10 years, most children are aware of nearly irresistible somatosensory urges that precede the tics. These urges likely reflect a defect in sensorimotor gating because they intrude into the child's conscious awareness and become a source of distraction and distress. A momentary sense of relief typically follows the completion of a tic. Over the course of hours, tics occur in bouts, with a regular intertic interval. Tics increase during periods of emotional excitement and fatigue. Tics can become "complex" in nature and appear to be purposeful. Tics can be willfully suppressed for brief intervals and can be evoked by the mere mention of them. Tics typically diminish during periods of goal-directed behavior, especially those that involve both heightened attention and fine motor or vocal control, as occur in musical and athletic performances. Over the course of months, tics wax and wane. New tics appear, often in response to new sources of somatosensory irritation, such as the appearance of a persistent vocal tic (a cough) following a cold. Over the course of years, tic severity typically peaks between 8 and 12 years of age. By the end of the second decade of life, many individuals are virtually tic free. Less than 20% of cases continue to experience clinically impairing tics as adults. Tics rarely occur in isolation, and other coexisting conditions--such as behavioral disinhibition, hypersensitivity to a broad range of sensory stimuli, problems with visual motor integration, procedural learning difficulties, attention-deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder, depression, anxiety, and emotional instability--are often a greater source of impairment than the tics themselves. Emerging behavioral treatments of Tourette syndrome are based in part on an understanding of the moment-to-moment experience of somatosensory urges and motor response. With identification of specific genes of major effect and advances in our understanding of the neural circuitry of sensorimotor gating, habit formation, and procedural memory--together with insights from postmortem brain studies, in vivo brain imaging, and electrophysiologic recordings--we might be on the threshold of a deeper understanding of the phenomenology and natural history of Tourette syndrome.

Annotation: Tourette syndrome: a relentless drumbeat--driven by misguided brain oscillations

OBJECTIVE

This annotation reviews recent evidence that points to the likely role of aberrant neural oscillations in the pathogenesis of Tourette syndrome (TS).

METHODS

The available anatomic and electrophysiological findings in TS are reviewed in the context of an emerging picture of the crucial role that neural oscillations play in maintaining normal central nervous system (CNS) function.

RESULTS

Neurons form behavior-dependent oscillating networks of various sizes and frequencies that bias input selection and facilitate synaptic plasticity, mechanisms that cooperatively support temporal representation as well as the transfer and long-term consolidation of information. Coherent network activity is likely to modulate sensorimotor gating as well as focused motor actions. When these networks are dysrhythmic, there may be a loss of control of sensory information and motor action. The known electrophysiological effects of medications and surgical interventions used to treat TS likely have an ameliorative effect on these aberrant oscillations. Similarly, a strong case can be made that successful behavioral treatments involve the willful training regions of the prefrontal cortex to engage in tic suppression and the performance of competing motor responses to unwanted sensory urges such that these prefrontal regions become effective modulators of aberrant thalamocortical rhythms.

CONCLUSIONS

A deeper understanding of neural oscillations may illuminate the complex, challenging, enigmatic, internal world that is TS.

When artificial grammar acquisition in Parkinson's disease is impaired: the case of learning via trial-by-trial feedback

Although there is strong evidence that human category learning is mediated by qualitatively distinct systems, the neural substrates of procedural category learning remain largely unclear. The present research sought to investigate the role of the basal ganglia in the acquisition of categorical knowledge via an examination of the ability of people with Parkinson's disease (PD) to learn an artificial grammar (AG) system in a format akin to habit learning tasks such as probabilistic classification learning. Eighteen nondemented patients with PD were compared with 22 matched controls on a task modified so that participants' grammar learning depended on making use of feedback provided on each trial. Results showed that patients with PD exhibited abnormal AG learning, with the deficit more pronounced early in the task. Impaired categorisation performance in patients was not related to declarative knowledge obtained during the test and was independent of frontal functioning. The findings presented here indicate that prior inconsistencies across category learning tasks in PD performance may be explained, at least in part, by whether the task necessitates the formation of associations between stimulus cues and categorical responses, and support the hypothesis that the basal ganglia play a specific role in procedural learning in complex feedback-based categorisation tasks.

Effects of Parkinson Disease on Two Putative Nondeclarative Learning Tasks

OBJECTIVE

To assess performance on two nondeclarative (implicit) memory tasks of Parkinson disease (PD) patients without dementia in the earlier or later stages of the disease (Hoehn and Yahr Scale scores of 1-2.5 or 3-4, respectively).

BACKGROUND

Different subtypes of nondeclarative memory appear to depend on different components of frontostriatal circuitry. Performance on a probabilistic classification learning (PCL) task was impaired by striatal damage (eg, in PD or Huntington disease) but not by circumscribed frontal lobe damage. On the other hand, performance on the Iowa Gambling Task (IGT) was impaired by damage to the prefrontal cortex.

METHOD AND RESULTS

On the PCL, the learning of the control (age- and education-matched) group (n = 19) and the early PD group (n = 16) was comparable with each other, and both groups showed better performance than the later PD group (n = 16). On the IGT, the control group learned better than both of the PD groups. The control and early PD groups were similar on measures from the Wisconsin Card Sorting Test, Stroop Test, Mini-Mental State Examination, and Beck Depression Inventory II.

CONCLUSIONS

The PCL and IGT tasks appear to rely on different parts of the frontostriatal circuitry in patients with early PD. The current finding that IGT performance was impaired in early PD implies ventromedial prefrontal cortical dysfunction early in the disease.

Long-term test-retest reliability of functional MRI in a classification learning task

Functional MRI is widely used for imaging the neural correlates of psychological processes and how these brain processes change with learning, development and neuropsychiatric disorder. In order to interpret changes in imaging signals over time, for example, in patient studies, the long-term reliability of fMRI must first be established. Here, eight healthy adult subjects were scanned on two sessions, 1 year apart, while performing a classification learning task known to activate frontostriatal circuitry. We show that behavioral performance and frontostriatal activation were highly concordant at a group level at both time-points. Furthermore, intra-class correlation coefficients (ICCs), which index the degree of correlation between subjects at different time-points, were high for behavior and for functional activation. ICC was significantly higher within the network recruited by learning than outside that network. We conclude that fMRI can have high long-term test-retest reliability, making it suitable as a biomarker for brain development and neurodegeneration.

Habit Learning and the Genetics of the Dopamine D₃ Receptor: Evidence From Patients With Schizophrenia and Healthy Controls

In this study, the authors investigated the relationship between the Ser9Gly (SG) polymorphism of the dopamine D3 receptor (DRD3) and striatal habit learning in healthy controls and patients with schizophrenia. Participants were given the weather prediction task, during which probabilistic cue-response associations were learned for tarot cards and weather outcomes (rain or sunshine). In both healthy controls and patients with schizophrenia, participants with Ser9Ser (SS) genotype did not learn during the early phase of the task (1-50 trials), whereas participants with SG genotype did so. During the late phase of the task (51-100 trials), both participants with SS and SG genotype exhibited significant learning. Learning rate was normal in patients with schizophrenia. These results suggest that the DRD3 variant containing glycine is associated with more efficient striatal habit learning in healthy controls and patients with schizophrenia.

The cognitive neuroscience of category learning

Recently, a multidisciplinary approach has provided new insights into the mechanisms of category learning. In this article, results from theoretical modeling, experimental psychology, clinical neuropsychology, functional neuroimaging, and single-cell studies are reviewed. Although the results are not conclusive, some general principles have emerged. Areas localized in the sensory neocortex are responsible for the perceptual representation of category exemplars, whereas lateral and anterior prefrontal structures are necessary for the encoding of category boundaries and abstract rules. The prefrontal cortex may influence categorical representation in the sensory neocortex via top-down control. The neostriatum is important in stimulus-response mapping, and the orbitofrontal cortex/ventral striatum are related to stimulus-reward associations accompanying category learning. Many category learning tasks can be performed implicitly. In conclusion, category learning paradigms provide a unique opportunity to investigate cognitive processes such as perception, memory, and attention in a systematic and interactive manner. Category learning tasks are suitable for mapping damaged brain systems in clinical populations.

Facilitation of probabilistic classification learning by transcranial direct current stimulation of the prefrontal cortex in the human

The aim of our study was to test if the electrical stimulation of the prefrontal cortex (PFC) could modify probabilistic classification learning (PCL). Transcranial direct current stimulation (tDCS) was administered to the left prefrontal and to the primary visual cortex of 22 healthy subjects while they performed a PCL task. In this task subjects learned which of two outcomes would occur on each trial after presentation of a particular combination of cues. Ten minutes of anodal, but not cathodal, stimulation improved implicit learning only when the left PFC was stimulated. Our results show that implicit PLC can be modified by weak anodal tDCS, which probably increases neural excitability, as has been shown in the motor and visual cortices previously. Our results suggest that further studies on the facilitation of learning and memory processes by tDCS are warranted.