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Behavioural Neurology
Volume 2014, Article ID 256089, 7 pages
Research Article

Counterfactual Thinking in Tourette’s Syndrome: A Study Using Three Measures

1U.O.C. Neurologia, IRCCS, Fondazione Ospedale Maggiore Policlinico, Milan, Italy
2Tourette Centre and Department of Functional Neurosurgery, IRCCS Galeazzi, Milan, Italy
3Department of Neurology and Laboratory of Neuroscience, “Dino Ferrari Center”, University of Milan Medical School, IRCCS Istituto Auxologico Italiano, Milan, Italy
4Dipartimento di Psicologia Generale, Università degli Studi di Padova, Italy

Received 22 July 2014; Revised 6 October 2014; Accepted 18 October 2014; Published 30 November 2014

Academic Editor: Mario Zappia

Copyright © 2014 Stefano Zago et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Pathophysiological evidence suggests an involvement of frontostriatal circuits in Tourette syndrome (TS) and cognitive abnormalities have been detected in tasks sensitive to cognitive deficits associated with prefrontal damage (verbal fluency, planning, attention shifting, working memory, cognitive flexibility, and social reasoning). A disorder in counterfactual thinking (CFT), a behavioural executive process linked to the prefrontal cortex functioning, has not been investigated in TS. CFT refers to the generation of a mental simulation of alternatives to past factual events, actions, and outcomes. It is a pervasive cognitive feature in everyday life and it is closely related to decision-making, planning, problem-solving, and experience-driven learning—cognitive processes that involve wide neuronal networks in which prefrontal lobes play a fundamental role. Clinical observations in patients with focal prefrontal lobe damage or with neurological and psychiatric diseases related to frontal lobe dysfunction (e.g., Parkinson’s disease, Huntington’s disease, and schizophrenia) show counterfactual thinking impairments. In this work, we evaluate the performance of CFT in a group of patients with Tourette’s syndrome compared with a group of healthy participants. Overall results showed no statistical differences in counterfactual thinking between TS patients and controls in the three counterfactual measures proposed. The possible explanations of this unexpected result are discussed below.