1. Participants were asked to recall a negative

personal event, they were then asked what

would have happened if they had behaved

differently

2. Example of a CIT question:

James has missed the train for 5 minutes. Edward

has missed the train for more than an hour.

Who will spend more time thinking about the lost

train?

• James

• Edward

• Both / do not know

Counterfactual thinking in Tourette’s patients

1 DELLI PONTI, A., 2 ZAGO, S., 1 MASTROIANNI, S., 3 SOLCA, F., 3 POLETTI, B., 1 PORTA, M. , 1 RAUGNA, M., 1 COLOMBO, V., 1D’ADDA, F., 1 SERVELLO, D., 1 ZANABONI, C.

1Centro Tourette e Sindromi Correlate, IRCCS Ospedale Galeazzi, Milano 2U.O.C. Neurologia, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano

3U.O. IRCCS Istituto Auxologico Italiano, Milano

COUNTERFACTUAL THINKING

‘Counterfactual thinking or reasoning' (CT) is the ability to mentally represent possible behaviors or alternative

scenarios. This ability affects the skill to produce behavioral intentions and has important repercussions on the

capacity of choice in many areas of mental and social life. Recent neuroimaging studies show that CT requires

brain activation in a large circuit of structures involved in mnestic, attentional and executive processes, such as

temporal lobes, posterior medial cortex, lateral prefrontal cortex and inferior parietal lobule.

ANATOMICAL CORRELATES

Clinical evidence suggests that patients with frontal lobes damage are able to generate a limited number of

alternatives and are also unable to predict possible negative consequences of their actions. In particular, CT

deficiency have been reported in patients with focal damage to frontal lobes, specifically the orbitofrontal region, and

in some psychiatric and neurological disorders related to frontal lobe, such as schizophrenia, Parkinson's disease and

Huntington's disease. On the contrary, an increase of CT was highlighted in anxious and depressed patients.

CT Tests:

1. A task of spontaneous generation of

alternative scenarios to reality

2. A translated version of the Hooker’s

Counterfactual Interference Test (CIT)

RESULTS AND CONCLUSIONS

No differences emerge between TS patients and control subjects performances in CT tests.

These results may be explained by frequent spontaneous improvement of TS over time that differentiates it from

other considered fronto-striatal diseases.

TS patients may have superior cognitive performances in comparison with other patients with basal ganglia

dysfunctions because brain circuits implicated in TS may bypass cortical pathway, only secondarily involved.

A PILOT STUDY

In this work, we evaluated a group of 30 adults

with Tourette syndrome, a neurological disorder

closely related to changes in the fronto-striatal

circuit, compared with a group of healthy subjects

matched for sex, age and education. Results are

shown in the graph.

2013 Annual Meeting of the European Society for the Study of Tourette Syndrome COST International Conference for Tourette Syndrome

Athens, Greece - April 26-27 2013

REFERENCES

Hooker, C., Roese, N.J., Park, S. (2000). Impoverished counterfactual thinking is associated with schizophrenia. Psychiatry, 63(4), 326–35.

Mcnamara, P., Durso, R., Brown, A., Lynch, A. (2003). Counterfactual cognitive deficit in persons with Parkinson’s disease. Journal of Neurology, Neurosurgery, and Psychiatry, 74, 1065–70.