Sex Differences in Youth with Chronic Tic Disorder and Tourette Syndrome: Evaluation of Tic Severity, Psychological Profiles, and Quality of Life.

Background: Tourette syndrome (TS) and Chronic Tic Disorder (CT) are neurodevelopmental conditions involving motor and/or phonic tics. Youth with tics may encounter feelings of isolation, diminished self-esteem and quality of life, and academic difficulties. A growing body of scientific literature suggests sex differences in youth with tics, but findings have been mixed so far. Because symptom severity peaks around puberty, understanding sex differences in tic manifestations and associated symptoms during this critical period is essential. Therefore, we aimed to assess sex differences related to tic symptoms, action planning styles, quality of life, and externalizing/internalizing symptoms in youth with tics. Methods: Our sample consisted of 66 youths with tics (19 girls) aged 7-14 (mean = 10 years). Youths were assessed with clinical interviews, as well as self- and parent-reported inventories evaluating tic symptoms, psychological profiles, and quality of life. Results: While no differences in tic symptoms were found, girls exhibited lower functional inflexibility, reduced overall functional planning effectiveness, and higher impairment in the psychological well-being subscale than boys. Additionally, girls had reduced general life satisfaction and social self-esteem. Boys reported more explosive outbursts, higher levels of hyperactivity, and more difficulties with self-concept. Conclusions: Our analyses suggested differences in several manifestations associated with tics. This introduces new perspectives that refine our understanding of sex differences. A better understanding of sex differences in tic disorders may eventually improve outcomes for all individuals living with these conditions.

Comparing the 'When' and the 'Where' of Electrocortical Activity in Patients with Tourette Syndrome, Body-Focused Repetitive Behaviors, and Obsessive Compulsive Disorder.

Background/Objectives: Tourette Syndrome (TS), Obsessive Compulsive Disorder (OCD), and Body-Focused Repetitive Behaviors (BFRB) are three disorders that share many similarities in terms of phenomenology, neuroanatomy, and functionality. However, despite the literature pointing toward a plausible spectrum of these disorders, only a few studies have compared them. Studying the neurocognitive processes using Event-Related Potentials (ERPs) offers the advantage of assessing brain activity with excellent temporal resolution. The ERP components can then reflect specific processes known to be potentially affected by these disorders. Our first goal is to characterize 'when' in the processing stream group differences are the most prominent. The second goal is to identify 'where' in the brain the group discrepancies could be. Methods: Participants with TS (n = 24), OCD (n = 18), and BFRB (n = 16) were matched to a control group (n = 59) and were recorded with 58 EEG electrodes during a visual counting oddball task. Three ERP components were extracted (i.e., P200, N200, and P300), and generating sources were modelized with Standardized Low-Resolution Electromagnetic Tomography. Results: We showed no group differences for the P200 and N200 when controlling for anxiety and depressive symptoms, suggesting that the early cognitive processes reflected by these components are relatively intact in these populations. Our results also showed a decrease in the later anterior P300 oddball effect for the TS and OCD groups, whereas an intact oddball effect was observed for the BFRB group. Source localization analyses with sLORETA revealed activations in the lingual and middle occipital gyrus for the OCD group, distinguishing it from the other two clinical groups and the controls. Conclusions: It seems that both TS and OCD groups share deficits in anterior P300 activation but reflect distinct brain-generating source activations.

Impacts of ADHD Symptomatology on the Response to Cognitive-Behavioural Therapy with Gilles de la Tourette Syndrome Patients.

(1) Background: Gilles de la Tourette Syndrome (TS) is a neurodevelopmental disorder characterized by motor and vocal tics. Attention deficit and hyperactivity disorder (ADHD) is a common comorbidity of TS that adds further impairment. Cognitive-behavioural therapy (CBT) has shown efficacy in treating tics, yet its effectiveness in individuals with TS and comorbid ADHD remains unclear. Also, it is suggested that ADHD characteristics like executive dysfunction and inattention could hinder the response to CBT. This study aims to compare the response to CBT for tics and its maintenance six months post-therapy among TS individuals with and without ADHD symptoms. (2) Methods: In this study, 55 TS participants who completed 14-week CBT for tics were split into high (TS+) or low (TS-) ADHD symptomatology groups. Outcomes were evaluated using the Yale Global Tic Severity Scale (YGTSS) regarding global tic severity and motor and vocal tic frequency post-CBT and at a 6-month follow-up. (3) Results: No significant group difference was found regarding improvements post-CBT (n = 55), nor the maintenance six months later (n = 45). (4) Conclusions: ADHD symptoms may not hinder the response to CBT or its maintenance, suggesting that TS individuals with ADHD symptoms may not require specialized CBT interventions.

Development of a novel sandwich-structured composite from biopolymers and cellulose microfibers for building envelope applications.

A novel sandwich-structured composite was developed from the surface layers of polyhydroxyalkanoate (PHA) and the interlayer of polylactic acid (PLA)/cellulose microfibers (CMF) composite. Moreover, CMF was chemically modified via a sol-gel process to improve the compatibility between the natural reinforcement and the polymer matrix. According to the obtained results, the modified CMF exhibited a highly hydrophobic characteristic (contact angel value of approximately 118°), and they were homogeneously dispersed in the PLA matrix. The results of the thermogravimetric analysis indicated that the sandwich composites reinforced with the modified CMF showed improvement in thermal stability. Regarding the mechanical properties, the incorporation of the natural reinforcement into sandwich composites increased the values of tensile modulus and strength of materials. The water vapor permeability of sandwich composites increased with the addition of untreated fibers; however, the composites reinforced with the modified CMF showed superior barrier performance than that of untreated CMF. In addition, a durability test was performed to determine the effect of accelerated aging on the properties of sandwich composites. The results demonstrated that the mechanical and barrier properties of composites incorporated with untreated CMF decreased after the accelerated aging, whereas the composites reinforced with the modified CMF experienced the least change.

Preparation of Breathable Cellulose Based Polymeric Membranes with Enhanced Water Resistance for the Building Industry.

This study focuses on the development of advanced water-resistant bio-based membranes with enhanced vapour permeability for use within building envelopes. Building walls are vulnerable to moisture damage and mold growth due to water penetration, built-in moisture, and interstitial condensation. In this work, breathable composite membranes were prepared using micro-fibrillated cellulose fiber (CF) and polylactic acid (PLA). The chemical composition and physical structure of CF is responsible for its hydrophilic nature, which affects its compatibility with polymers and consequently its performance in the presence of excessive moisture conditions. To enhance the dispersibility of CF in the PLA polymer, the fibers were treated with an organic phosphoric acid ester-based surfactant. The hygroscopic properties of the PLA-CF composites were improved after surfactant treatment and the membranes were resistant to water yet permeable to vapor. Morphological examination of the surface showed better interfacial adhesion and enhanced dispersion of CF in the PLA matrix. Thermal analysis revealed that the surfactant treatment of CF enhanced the glass transition temperature and thermal stability of the composite samples. These bio-based membranes have immense potential as durable, eco-friendly, weather resistant barriers for the building industry as they can adapt to varying humidity conditions, thus allowing entrapped water vapor to pass through and escape the building, eventually prolonging the building life.

A State of the Art of the Overall Energy Efficiency of Wood Buildings-An Overview and Future Possibilities.

The main goal of this study was to review current studies on the state of the art of wood constructions with a particular focus on energy efficiency, which could serve as a valuable source of information for both industry and scholars. This review begins with an overview of the role of materials in wood buildings to improve energy performance, covering structural and insulation materials that have already been successfully used in the market for general applications over the years. Subsequently, studies of different wood building systems (i.e., wood-frame, post-and-beam, mass timber and hybrid constructions) and energy efficiency are discussed. This is followed by a brief introduction to strategies to increase the energy efficiency of constructions. Finally, remarks and future research opportunities for wood buildings are highlighted. Some general recommendations for developing more energy-efficient wood buildings are identified in the literature and discussed. There is a lack of emerging construction concepts for wood-frame and post-and-beam buildings and a lack of design codes and specifications for mass timber and hybrid buildings. From the perspective of the potential environmental benefits of these systems as a whole, and their effects on energy efficiency and embodied energy in constructions, there are barriers that need to be considered in the future.

Steatite Powder Additives in Wood-Cement Drywall Particleboards.

The objective of this study was to develop a new drywall wood-based particleboard as an alternative to gypsum board. Various development iterations have led to the use of wood particles, steatite powder and Portland cement. The resulting outcome shows that screw withdrawal resistance was improved by 37% and bending properties by 69% compared to gypsum board of a similar density (0.68-0.70). The raw surface of the boards is of good quality and comparable to the paper-faced surface of gypsum board. Furthermore, the reaction to fire was evaluated through bench-scale test with a cone calorimeter. The investigated particleboard did not reveal visual signs of combustion after 20 min when exposed to a radiant heat of 50 kW/m2, while burning of the overlay paper of gypsum board occurred at about 57 s, suggesting that wood-cement-steatite powder particleboard could be classified as a quasi non-combustible material.

Parkinsonian Symptoms, Not Dyskinesia, Negatively Affect Active Life Participation of Dyskinetic Patients with Parkinson's Disease.

Background: The impact of slight-to-moderate levodopa-induced dyskinesia (LID) on the level of participation in active life in patients with Parkinson's disease (PD) has never been objectively determined. Methods: Levels of LID, tremor and bradykinesia were measured during best-ON state in 121 patients diagnosed with PD and having peak-dose LID using inertial sensors positioned on each body limb. Rigidity and postural instability were assessed using clinical evaluations. Cognition and depression were assessed using the MMSE and the GDS-15. Participation in active life was assessed in patients and in 69 healthy controls using the Activity Card Sort (ACS), which measures levels of activity engagement and activities affected by the symptomatology. Outcome measures were compared between patients and controls using ANCOVA, controlling for age or Wilcoxon-Mann-Whitney tests. Spearman correlations and multivariate analyses were then performed between symptomatology and ACS scores. Results: Patients had significantly lower activity engagement than controls and had significantly affected activities. LID was neither associated with activity engagement nor affected activities. Higher levels of tremor, postural instability, cognitive decline and depression were associated with lower activity engagement and higher affected activities. Multivariate analyses revealed that only tremor, postural instability and depression accounted significantly in the variances of these variables. Discussion: Slight-to-moderate LID had little impact compared to other symptoms on the level of participation in active life, suggesting that other symptoms should remain the treatment priority to maintain the level of participation of patients in an active lifestyle.

A Focused Update on Tardive Dyskinesia.

Tardive dyskinesia (TD) is a delayed and potentially irreversible motor complication following chronic exposure to centrally acting dopamine receptor antagonists, mainly of the class of antipsychotics drugs. New generations of antipsychotic drugs reduced its mean prevalence to 20%, but it continues to mar the drug experience and social integration in a significant fraction of patients. The underlying molecular cascade remains elusive, explaining in part why TD management is so often difficult. Protocol variations between experimental laboratories and inter-species differences in the biological response to antipsychotic drugs have added layers of complexity. The traditional dopamine D2 receptor supersensitivity hypothesis was revisited in an experimental nonhuman primate model. Findings in the striatum revealed a strong upregulation of D3, not D2, receptors specific to dyskinetic animals, and indirect evidence suggestive of a link between overactivation of glycogen synthase kinase-3ß signaling and TD. New effective vesicular monoamine transporter type 2 inhibitors alleviating TD have been approved in the USA. They were integrated to an emerging stepwise treatment algorithm for troublesome TD, which also includes consideration for changes in the current antipsychotic drug regimen and recognition of potentially aggravating factors such as anticholinergic co-medications. These advances may benefit TD.

Chronic Neuroleptic-Induced Parkinsonism Examined With Positron Emission Tomography.

BACKGROUND: Neuroleptic drug-induced parkinsonism (NIP) is a leading cause of parkinsonism, particularly in aging. Based on abnormal dopamine transporter scan results, individuals displaying chronic NIP are often diagnosed with Lewy-body Parkinson's disease (PD), but this assumption needs further substantiation. OBJECTIVE: To quantitate the profile of striatal dopaminergic nerve terminal density in NIP relative to PD. METHODS: We used the positron emission tomography ligand [11 C](+)-dihydrotetrabenazine targeting vesicular monoamine transporter type 2 (VMAT2) binding sites and collected various clinical parameters (motor ratings, olfaction, polysomnography to document rapid eye movement sleep muscle activity, quantitative sensory testing for pain thresholds) possibly predicting binding results in patients older than age 50 living with schizophrenia spectrum disorders under long-term stable antipsychotic drug treatment, with (N = 11) or without (N = 11) chart documention of chronic NIP, and compared them to healthy volunteers (N = 11) and others medicated for PD (N = 12). RESULTS: Striatal VMAT2 binding was dichotomous in the NIP group between those with spared (N = 5) or low (N = 6) PD-like values. Striatal binding reduction in the low VMAT2-NIP group was asymmetric without the gradient of maximal involvement in the posterior putamen typical of PD. Anosmia was the only nonmotor parameter measured matching the abnormal striatal VMAT2 binding status. CONCLUSION: These preliminary observations suggest that striatal VMAT2 binding is abnormal in a fraction of chronic NIP cases and differs in spatial distribution from PD. The possibility of a drug-induced axonopathy and resultant synaptopathy, as well as the evolution of the binding deficit, warrant further longitudinal studies in a large cohort. © 2020 International Parkinson and Movement Disorder Society.

Can We Predict the Motor Performance of Patients With Parkinson's Disease Based on Their Symptomatology?

Introduction: Parkinson's disease hinders the ability of a person to perform daily activities. However, the varying impact of specific symptoms and their interactions on a person's motor repertoire is not understood. The current study investigates the possibility to predict global motor disabilities based on the patient symptomatology and medication. Methods: A cohort of 115 patients diagnosed with Parkinson's disease (mean age = 67.0 ± 8.7 years old) participated in the study. Participants performed different tasks, including the Timed-Up & Go, eating soup and the Purdue Pegboard test. Performance on these tasks was judged using timing, number of errors committed, and count achieved. K-means method was used to cluster the overall performance and create different motor performance groups. Symptomatology was objectively assessed for each participant from a combination of wearable inertial sensors (bradykinesia, tremor, dyskinesia) and clinical assessment (rigidity, postural instability). A multinomial regression model was derived to predict the performance cluster membership based on the patients' symptomatology, socio-demographics information and medication. Results: Clustering exposed four distinct performance groups: normal behavior, slightly affected in fine motor tasks, affected only in TUG, and affected in all areas. The statistical model revealed that low to moderate level of dyskinesia increased the likelihood of being in the normal group. A rise in postural instability and rest tremor increase the chance to be affected in TUG. Finally, LEDD did not help distinguishing between groups, but the presence of Amantadine as part of the medication regimen appears to decrease the likelihood of being part of the groups affected in TUG. Conclusion: The approach allowed to demonstrate the potential of using clinical symptoms to predict the impact of Parkinson's disease on a person's mobility performance.

Improvement of White Spruce Wood Dimensional Stability by Organosilanes Sol-Gel Impregnation and Heat Treatment.

Wood is a living material with a dimensional stability problem. White spruce wood is a Canadian non-permeable wood that is used for siding applications. To improve this property, white spruce wood was treated with organosilanes sol-gel treatment with different moisture content (oven dried, air dried, and green wood). No major morphological changes were observed after treatment. However, organosilanes were impregnated into the cell wall without densifying the wood and without modifying the wood structure. Si-O-C chemical bonds between organosilanes and wood and Si-O-Si bonds were confirmed by FTIR and NMR, showing the condensation of organosilanes. The green wood (41% moisture content) showed only 26% dimensional stability due to the presence of too much water for organosilanes treatment. With a moisture content of 14%-18% (oven dried or air dried wood), the treatment was adapted to obtain the best improvement in dimensional stability of 35% and a 25% reduction of water vapor sorption. Finally, impregnation with organosilanes combined with the appropriate heat treatment improved the dimensional stability of white spruce wood by up to 35%. This treated Canadian wood could be an interesting option to validate for siding application in Canada.

Regionalised Life Cycle Assessment of Bio-Based Materials in Construction; the Case of Hemp Shiv Treated with Sol-Gel Coatings.

Interest in intrinsically low-energy construction materials is becoming mainstream, and bio-based materials form a key part of that group of materials. The goal of this study was to analyse the environmental impact of applying a sol-gel coating on hemp shiv, in order to improve the durability of this innovative bio-based material, using a regionalised LCA model, taking into account regional specific peculiarities. This study analysed the environmental performance of using bio-based materials in the building envelope compared with traditional synthetic construction materials, and compared the impact of a regionalised approach with a global approach. The carbon footprint of treated hemp shiv in a wall with a U-value of 0.15 W/m2.K was compared to untreated hempcrete and a reference cavity wall with the same U-value. Considering the environmental damage caused by the production of hemp shiv, nitrogen fertiliser was the hotspot. The LCA results showed that, using innovative bio-based materials in construction, treated hemp shiv with sol-gel can decrease the carbon footprint of a building envelope through carbon sequestration. Using the more accurate site-specific information in life cycle inventory and impact assessment methods will result in more consistent and site-appropriate environmental results for decision-making.

The Effect of Wood Ash as a Partial Cement Replacement Material for Making Wood-Cement Panels.

The aim of this study was to consider the use of biomass wood ash as a partial replacement for cement material in wood-cement particleboards. Wood-cement-ash particleboards (WCAP) were made with 10%, 20%, 30%, 40%, and 50% of wood ash as a partial replacement for cement with wood particles and tested for bending strength, stiffness, water absorption, and thermal properties. Test results indicate that water demand increases as the ash content increases, and the mechanical properties decrease slightly with an increase of the ash content until 30% of replacement. On the other hand, the heat capacity increases with the wood ash content. The WCAP can contribute to reducing the heat loss rate of building walls given their relatively low thermal conductivity compared to gypsum boards. The replacement of cement to the extent of approximately 30% by weight was found to give the optimum results.

Remnants of Cardinal Symptoms of Parkinson's Disease, Not Dyskinesia, Are Problematic for Dyskinetic Patients Performing Activities of Daily Living.

Introduction: The impact of levodopa-induced dyskinesia (LID) on the daily lives of patients with Parkinson's disease (PD) remains to be determined. Furthermore, evidence suggests that cardinal motor symptoms of PD may coexist with LID, but their impact on activities of daily living (ADL) relative to LID is not known. This cross-sectional study aimed at determining the effect of LID and cardinal motor symptoms of PD on ADL in patients who were experiencing peak-dose choreic-type LID. Method: One hundred and twenty-one patients diagnosed with PD known to experience choreic-type LID were recruited for the study. Patients were asked to perform a set of ADL. Levels of LID, tremor, bradykinesia, and freezing of gait (FoG) were measured using 17 inertial sensors design to capture full body movements, while rigidity, and postural instability were assessed using clinical evaluations. Cognition was also assessed using the mini-mental state examination. Success criteria were set for each ADL using the time needed to perform the task and errors measured in 69 age-gender-matched healthy controls. Binary logistic regressions were used to identify symptoms influencing success or failure for each activity. Receiver operating characteristic curves were computed on each significant symptom, and Youden indexes were calculated to determine the critical level of symptomatology at which the performance significantly changed. Results: Results show that 97.7% of patients who presented with LID during the experiment also presented with at least one cardinal motor symptom. On average, patients took more time and did more errors during ADL. Multivariate analyses revealed that for the great majority of ADL, LID were not associated with worsening of performance; however, postural instability, tremor, rigidity, and cognitive decline significantly decreased the odds of success. Conclusions: Residual symptoms of PD, such as tremor, rigidity, and postural instability still present at peak-dose were more problematic than LID in the performance of ADL for patients experiencing slight-to-moderate LID. We also found that cognitive decline was associated with decreased performance in certain tasks. Therefore, a strategy using lower doses of medication to manage LID may be counterproductive since it would not address most of these symptoms already present in patients.

Parkinson's disease patients experiencing peak-dose dyskinesia redistribute involuntary movements throughout their body to improve motor control.

INTRODUCTION: In Parkinson's disease (PD), dyskinesia is considered a major side effect of dopamine replacement therapy. Nevertheless, many patients with dyskinesia function adequately. OBJECTIVE: To study objectively dyskinesia phenomenology in order to understand why or how patients with dyskinesia are still able to perform motor tasks. METHODS: Patients with and without dyskinesia, as well as healthy older adults, performed a geostationary task during which they attempted to stabilize a glass of water at eye level. Dyskinesia amplitude displayed by each body segment was extracted from accelerometers, and its distribution among the segments, analyzed. RESULTS: Patients experiencing dyskinesia initially distributed most of their dyskinesia away from the segments directly involved in the task. With time, this distribution shifts back towards the hand. CONCLUSION: Our results suggest that patients developed a strategy of involuntary movement's redistribution to attenuate their functional impact on voluntary movements. However, this strategy can only be maintained for a certain period before "re-emerging" dyskinesia occurs.

Tardive dyskinesia is associated with altered putamen Akt/GSK-3ß signaling in nonhuman primates.

BACKGROUND: Tardive dyskinesia is a delayed and potentially irreversible motor complication arising from chronic exposure to antipsychotic drugs. Interaction of antipsychotic drugs with G protein-coupled receptors triggers multiple intracellular events. Nevertheless, signaling pathways that might be associated with chronic unwanted effects of antipsychotic drugs remain elusive. In this study, we aimed to better understand kinase signaling associated with the expression of tardive dyskinesia in nonhuman primates. METHODS: We exposed capuchin monkeys to prolonged haloperidol (n = 10) or clozapine (n = 6) treatments. Untreated animals were used as controls (n = 6). Half of haloperidol-treated animals (5) developed mild tardive dyskinesia similar to that found in humans. Using Western blots and immunochemistry, we measured putamen total and phosphorylated protein kinase levels associated with canonical and noncanonical signaling cascades of G protein-coupled receptors. RESULTS: Antipsychotic drugs enhanced pDARPP-32 and pERK1/2, but no difference ws observed in phosphoprotein kinase levels between dyskinetic and nondyskinetic monkeys. On the other hand, comparison of kinase levels between haloperidol-treated dyskinetic and nondyskinetic monkeys indicated that dyskinetic animals had lower GRK6 and ß-arrestin2 levels. Levels of pAkt and pGSK-3ß were also reduced, but only haloperidol-treated monkeys that developed tardive dyskinesia had reduced pGSK-3ß levels, whereas pAkt levels in dyskinetic animals positively correlated with dyskinetic scores. Interestingly, double immunofluorescence labeling showed that putamen dopamine D3 receptor levels were upregulated and that D3/pAkt colocalization was enriched in haloperidol-treated animals displaying tardive dyskinesia. CONCLUSIONS: Our results suggest that upregulation of putamen dopamine D3 receptor and alterations along the noncanonical GRK6/ß-arrestin2/Akt/GSK-3ß molecular cascade are associated with the development of tardive dyskinesia in nonhuman primates. © 2019 International Parkinson and Movement Disorder Society.

Electrophysiological predictors of cognitive-behavioral therapy outcome in tic disorders.

Cognitive-behavioral therapy (CBT) constitutes an empirically based treatment for tic disorders (TD), but much remains to be learned about its impact at the neural level. Therefore, we examined the electrophysiological correlates of CBT in TD patients, and we evaluated the utility of event-related potentials (ERP) as predictors of CBT outcome. ERPs were recorded during a stimulus-response compatibility (SRC) task in 26 TD patients and 26 healthy controls. Recordings were performed twice, before and after CBT in TD patients, and with a similar time interval in healthy controls. The stimulus- and response-locked lateralized readiness potentials (sLRP & rLRP) were assessed, as well as the N200 and the P300. The results revealed that before CBT, TD patients showed a delayed sLRP onset and larger amplitude of both the sLRP and rLRP peaks, in comparison with healthy controls. The CBT induced an acceleration of the sLRP onset and a reduction of the rLRP peak amplitude. Compared to healthy controls, TD patients showed a more frontal distribution of the No-Go P300, which was however not affected by CBT. Finally, a multiple linear regression analysis including the N200 and the incompatible sLRP onset corroborated a predictive model of therapeutic outcome, which explained 43% of the variance in tic reduction following CBT. The current study provided evidence that CBT can selectively normalize motor processes relative to stimulus-response compatibility in TD patients. Also, ERPs can predict the amount of tic symptoms improvement induced by the CBT and might therefore improve treatment modality allocation among TD patients.