Objective: To explore the presence of apathy in teenagers with TS.

Background: TS is a complex neuropsychiatric disorder generally classified as a hyperkinetic disorder. Apathy has not been studied in TS as it is usually associated with hypokinetic movement disorders. In our clinic, adolescents with TS at times seem disengaged from health care. We explored whether this is characteristic of adolescents with health conditions, or is specific to TS.

Methods: 12 to 16-year-old TS subjects were recruited during routine clinic visits. Age, age at onset, sex, co-morbid diagnoses, medications, and Yale Global Tic Severity Scale severity score (YGTSS) were collected. TS subjects and their parents filled the Gilles de la Tourette syndrome quality of life scale (GTS-QOL) and the center for epidemiological studies depression scale for children (CES-DC). The parents completed the children’s motivation scale (CMS), higher scores indicate lower apathy. To explore whether any findings were attributable to a state of disease affliction in general, or to TS specifically, age-matched type 1 diabetics (DM) were recruited as controls.

Results: 14 TS subjects and 5 DM controls have been recruited (recruitment ongoing). The mean YGTSS is 25.2. The TS group included more males (86% vs. 60%). Independent samples t-test was used to compare the means. The mean ages were not statistically different (µ_DM = 14.2, µ_TS = 13.4, Δµ=0.8 with 95% confidence interval -1.1 to 2.6). There was no difference in the CES-DC score (µ_DM = 14.6, µ_TS = 17.1, Δµ=-2.5 with 95% confidence interval -9.2 to 4.1). There was a statistically significant difference in CMS (µ_DM = 44.6, µ_TS = 34, Δµ=10.6 with 95% confidence interval 3.2 to 18). A significant linear regression equation was found (F(1,12)=5.123, p=0.043), R-squared = 0.299. TS subjects predicted CMS is equal to 19.548 + 0.206 (GTS-QOL visual scale). TS subjects mean CMS scores increased by 2 for every 10 points increase in the GTS-QOL visual scale. Similar analyses on other variables did not identify significant regression equations.

Conclusions: In this small study, adolescent TS subjects are more apathetic than controls, independent of depression. The predictive value of the GTS-QOL visual scale on CMS highlights the need for a larger study to confirm and elaborate these findings.

References: [1] Cath DC, Hedderly T, Ludolph AG, Stern JS, Murphy T, Hartmann A, et al. European clinical guidelines for Tourette syndrome and other tic disorders. Part I: assessment. Eur Child Adolesc Psychiatry. 2011;20(4):155-71

[2] Kulisevsky J, Litvan I, Berthier ML, Pascual-Sedano B, Paulsen JS, Cummings JL. Neuropsychiatric assessment of Gilles de la Tourette patients: comparative study with other hyperkinetic and hypokinetic movement disorders. Mov Disord. 2001;16(6):1098-104.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/apathy-in-adolescents-with-tourette-syndrome-ts-more-than-a-teenager-attitude/