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  1. CHA Man,
  2. JS Stern,
  3. A Gharatya,
  4. D Williams,
  5. HS Simmons,
  6. MM Robertson
  1. Department of Neurology, Atkinson Morley's Wing, St George's Hospital, Blackshaw Road, London SW17 0QQ


Objective As Tourette syndrome (TS) is a childhood-onset disease with symptoms which are expected to decrease beyond adolescence, older adults who attend specialist clinics are less common. TS is associated with impaired social functioning and a lowered quality of life. The aim of this study is to investigate the psychosocial health of these patients.

Method Older adults, defined as aged 40 and over, who have attended the specialist clinic at St. George's Hospital in London and diagnosed with TS were included in this study. These patients were divided into three age sub-groups: 40–49 years old, 50–59 years old, and 60+ years old. Comparisons were made with younger adult patients (aged 25–39). Using patient's clinical letters, the mean Yale Global Tic Severity Score (YGTSS) and percentage of patients categorised into each clinician-rated severity impression were calculated. Rates of co-existing psychopathology, coprophenomena, forensic history, alcohol abuse, employment and marital status, and highest level of education achieved were recorded.

Results 524 patients in total have attended the clinic, of which 46 were younger adults. 48 older adults were identified in total: 35 aged 40–49, 8 aged 50–59 and 5 aged 60+. Older adults present with greater tic severity compared to younger adults (mean YGTSS of 28.05 vs. 24.95 and a “severe” clinician-rated severity in 22.0% vs. 12.2%). Greater rates of social impairment were noted in 50–59 year olds than younger adults with respects to: unemployment (50% vs. 23.4%) and lack of a formal educational qualification (37.5% vs. 9.1%). A high proportion of patients 40–49 and 50–59 are either single or divorced- 50% and 25% respectively. Rates of an eventful forensic history (26.5% vs. 14.4%) and past alcohol abuse (32.4% vs. 9.1%) were greater in 40–49 year olds than younger adults. Rates of anxiety (10.4% vs. 4.5%) and depression (29.2% vs. 16.4%) were greater in older adults than younger adults. Rates of coprophenoma are 31.4% in ages 40–49, 37.5% in ages 50–59, and 20.0% in ages 60+.

Conclusion In this clinical cohort, older adults attending a specialist TS clinic have more severe tics and are often in poor psychological health, with a history of past and current social impairment. There is an element of referral bias but the findings indicate the significant psychosocial burden in cases with an atypical evolution with ageing.

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