Objective To investigate alterations in associative learning and visual perception in children with Tourette syndrome (TS), in order to provide foundational insights into the mechanisms underlying working memory and visual processing impairments in this population. Methods A total of 75 TS children in the pediatrics department of Dazu Hospital Affiliated to Chongqing Medical University from January 2021 to January 2024 were selected as the study subjects.The participants were stratified into three subgroups based on comorbidity profiles: Sample TS (n=37), TS with comorbid attention-deficit/hyperactivity disorder (TS+ADHD, n=17), and TS with comorbid obsessive-compulsive disorder/obsessive-compulsive behavior (TS+OCD/OCB, n=21).Seventy-five healthy children served as controls.The participants′ associative learning ability was assessed by the Rutgers Acquired Equivalence Test (RAET), and the number of acquisition trials (NAT), acquisition learning error ratio (ALER), retrieval error rate (RER), and generalization error rate (GER) were recorded.Other cognitive assessments included Cambridge Neuropsychological Test Automated Battery (CANTAB) evaluating spatial working memory (SWM),Beery Visual-Motor Integration (Beery VMI) assessing visual-motor integration, visual perception, and motor coordination. Results Compared with controls, TS children showed significantly increased NAT, ALER, and CANTAB total errors (Z=3.744, 4.011, 7.073, P<0.001), reduced visual motor integration score, visual perception score and motion coordination score (Z=6.272, 4.613, 3.608, P<0.001).No significant differences were observed in RER or GER (P>0.05).Compared with the control group, the total number of NAT, ALER and CANTAB errors in TS subgroups was significantly increased (P<0.05), while visual motor integration, visual perception and motion coordination score were significantly decreased (P<0.05).Negative correlations existed between CANTAB errors and VMI visual perception/motor coordination scores in TS children.(r=-0.330, -0.293, P<0.05). Conclusion TS children exhibit impaired associative learning during acquisition (basal ganglia-dependent phase) alongside visual perception and SWM deficits, while hippocampal-dependent retrieval/generalization phases remain intact.
Key words
Tourette syndrome /
associative learning /
spatial working memory /
visual perception /
children
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