Comorbidities and Disease Duration in Tourette Syndrome: Impact on Cognition and Quality of Life of Children

Conte, Giulia; Costanza, Carola; Novelli, Maria; Scarselli, Veronica; Arigliani, Elena; Valente, Francesca; Baglioni, Valentina; Terrinoni, Arianna; Chiarotti, Flavia; Cardona, Francesco · 2024 · DOAJ

DOI: 10.3390/children11020226

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Summary

This study investigates how psychiatric comorbidities and the duration of Tourette syndrome (TS) influence cognitive functioning and quality of life (QoL) in children. While TS is frequently associated with comorbidities such as ADHD, OCD, anxiety, and depression, prior research has often relied on categorical groupings that fail to capture the nuanced variability of these conditions. Furthermore, the specific impact of disease duration on cognition and QoL had not been previously explored. The authors aimed to address these gaps by employing a dimensional approach to determine the independent contributions of comorbidity severity and tic persistence to cognitive outcomes and well-being. The researchers evaluated 80 children aged 6–16 years diagnosed with TS, recruited from a specialty clinic in Rome. Cognitive abilities were assessed using the Wechsler Intelligence Scale for Children (WISC-IV), which measures Full-Scale IQ and specific domains including verbal comprehension, perceptual reasoning, working memory, and processing speed. Comorbidity severity was quantified using standardized instruments: the Conners Parent Rating Scale for ADHD, the Children’s Yale–Brown Obsessive-Compulsive Scale for OCD, the Children’s Depression Inventory for depression, and the Multidimensional Anxiety Scale for Children for anxiety. QoL was measured via the PEDsQoL 4.0. Statistical analyses included linear regression to assess the independent effects of comorbidities and disease duration on cognitive scores, and mediation analysis to determine if cognition mediated the relationship between clinical factors and QoL. The results indicated that depression and ADHD symptoms were significant predictors of poorer cognitive performance. Conversely, anxiety symptoms were associated with better cognitive outcomes, while OCD severity showed no significant independent effect on cognition. Disease duration was negatively associated with total IQ, verbal reasoning, and working memory abilities. Additionally, depression, anxiety, and longer disease duration significantly influenced QoL measures. The study found that cognitive functioning mediated the impact of these clinical factors on QoL, suggesting that the burden of comorbidities and prolonged tic duration affects well-being partly through their detrimental effects on cognitive abilities. These findings highlight that common TS comorbidities have differential impacts on the cognitive profiles of children, which in turn shape their perceived quality of life. The association between longer disease duration and worse cognitive outcomes suggests that the persistence of tics is a critical factor in clinical prognosis. The authors conclude that disease duration should be considered more rigorously in both clinical practice and research settings. By demonstrating that cognitive deficits serve as a pathway through which comorbidities and disease chronicity affect QoL, the study supports the potential utility of cognitive remediation strategies to improve functional outcomes in pediatric TS populations.

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• cognitive impairment