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Pardina‐Torner H, De Paepe AE, Garcia‐Gorro C, Rodriguez‐Dechicha N, Vaquer I, Calopa M, Ruiz‐Idiago J, Mareca C, de Diego‐Balaguer R, Camara E. Disentangling the neurobiological bases of temporal impulsivity in Huntington's disease. Brain Behav 2024; 14:e3335. [PMID: 38450912 PMCID: PMC10918610 DOI: 10.1002/brb3.3335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 10/10/2023] [Accepted: 11/08/2023] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Despite its impact on daily life, impulsivity in Huntington's disease (HD) is understudied as a neuropsychiatric symptom. Our aim is to characterize temporal impulsivity in HD and to disentangle the white matter correlate associated with impulsivity. METHODS Forty-seven HD individuals and 36 healthy controls were scanned and evaluated for temporal impulsivity using a delay-discounting (DD) task and complementary Sensitivity to Punishment and Sensitivity to Reward Questionnaire. Diffusion tensor imaging was employed to characterize the structural connectivity of three limbic tracts: the uncinate fasciculus (UF), the accumbofrontal tract (NAcc-OFC), and the dorsolateral prefrontal cortex connectig the caudate nucleus (DLPFC-cn). Multiple linear regression analyses were applied to analyze the relationship between impulsive behavior and white matter microstructural integrity. RESULTS Our results revealed altered structural connectivity in the DLPC-cn, the NAcc-OFC and the UF in HD individuals. At the same time, the variability in structural connectivity of these tracts was associated with the individual differences in temporal impulsivity. Specifically, increased structural connectivity in the right NAcc-OFC and reduced connectivity in the left UF were associated with higher temporal impulsivity scores. CONCLUSIONS The present findings highlight the importance of investigating the spectrum of temporal impulsivity in HD. As, while less prevalent than other psychiatric features, this symptom is still reported to significantly impact the quality of life of patients and caregivers. This study provides evidence that individual differences observed in temporal impulsivity may be explained by variability in limbic frontostriatal tracts, while shedding light on the role of sensitivity to reward in modulating impulsive behavior through the selection of immediate rewards.
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Affiliation(s)
- Helena Pardina‐Torner
- Cognition and Brain Plasticity UnitBellvitge Biomedical Research Institute (IDIBELL)BarcelonaSpain
| | - Audrey E. De Paepe
- Cognition and Brain Plasticity UnitBellvitge Biomedical Research Institute (IDIBELL)BarcelonaSpain
| | - Clara Garcia‐Gorro
- Cognition and Brain Plasticity UnitBellvitge Biomedical Research Institute (IDIBELL)BarcelonaSpain
| | - Nadia Rodriguez‐Dechicha
- Hestia Duran i ReynalsHospital Duran i Reynals, Hospitalet de LlobregatBarcelonaSpain
- Departament de Psicologia Clínica i de la SalutUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Irene Vaquer
- Hestia Duran i ReynalsHospital Duran i Reynals, Hospitalet de LlobregatBarcelonaSpain
- Departament de Psicologia Clínica i de la SalutUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Matilde Calopa
- Movement Disorders Unit, Neurology ServiceHospital Universitari de BellvitgeBarcelonaSpain
- ICREA (Catalan Institute for Research and Advanced Studies)BarcelonaSpain
| | - Jesus Ruiz‐Idiago
- Department of Psychiatry and Forensic MedicineUniversitat Autònoma de BarcelonaBarcelonaSpain
- Hospital Mare de Deu de la MercèBarcelonaSpain
| | - Celia Mareca
- Department of Psychiatry and Forensic MedicineUniversitat Autònoma de BarcelonaBarcelonaSpain
- Hospital Mare de Deu de la MercèBarcelonaSpain
| | - Ruth de Diego‐Balaguer
- Cognition and Brain Plasticity UnitBellvitge Biomedical Research Institute (IDIBELL)BarcelonaSpain
- Department of Cognition, Development and Education PsychologyUniversitat de BarcelonaBarcelonaSpain
- Institute of NeurosciencesUniversitat de BarcelonaBarcelonaSpain
- ICREA (Catalan Institute for Research and Advanced Studies)BarcelonaSpain
| | - Estela Camara
- Cognition and Brain Plasticity UnitBellvitge Biomedical Research Institute (IDIBELL)BarcelonaSpain
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Shiino S, van Wouwe NC, Wylie SA, Claassen DO, McDonell KE. Huntington disease exacerbates action impulses. Front Psychol 2023; 14:1186465. [PMID: 37397312 PMCID: PMC10312388 DOI: 10.3389/fpsyg.2023.1186465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/16/2023] [Indexed: 07/04/2023] Open
Abstract
Background Impulsivity is a common clinical feature of Huntington disease (HD), but the underlying cognitive dynamics of impulse control in this population have not been well-studied. Objective To investigate the temporal dynamics of action impulse control in HD patients using an inhibitory action control task. Methods Sixteen motor manifest HD patients and seventeen age-matched healthy controls (HC) completed the action control task. We applied the activation-suppression theoretical model and distributional analytic techniques to differentiate the strength of fast impulses from their top-down suppression. Results Overall, HD patients produced slower and less accurate reactions than HCs. HD patients also exhibited an exacerbated interference effect, as evidenced by a greater slowing of RT on non-corresponding compared to corresponding trials. HD patients made more fast, impulsive errors than HC, evidenced by significantly lower accuracy on their fastest reaction time trials. The slope reduction of interference effects as reactions slowed was similar between HD and controls, indicating preserved impulse suppression. Conclusion Our results indicate that patients with HD show a greater susceptibility to act rapidly on incorrect motor impulses but preserved proficiency of top-down suppression. Further research is needed to determine how these findings relate to clinical behavioral symptoms.
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Affiliation(s)
- Shuhei Shiino
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
| | | | - Scott A. Wylie
- Department of Neurological Surgery, University of Louisville, Louisville, KY, United States
| | - Daniel O. Claassen
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Katherine E. McDonell
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
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Morris L, O'Callaghan C, Le Heron C. Disordered Decision Making: A Cognitive Framework for Apathy and Impulsivity in Huntington's Disease. Mov Disord 2022; 37:1149-1163. [PMID: 35491758 PMCID: PMC9322688 DOI: 10.1002/mds.29013] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/17/2022] [Accepted: 03/15/2022] [Indexed: 01/12/2023] Open
Abstract
A caregiver's all‐too‐familiar narrative ‐ “He doesn't think through what he does, but mostly he does nothing.” Apathy and impulsivity, debilitating and poorly understood, commonly co‐occur in Huntington's disease (HD). HD is a neurodegenerative disease with manifestations bridging clinical neurology and psychiatry. In addition to movement and cognitive symptoms, neurobehavioral disturbances, particularly apathy and impulsivity, are prevalent features of HD, occurring early in the disease course, often worsening with disease progression, and substantially reducing quality of life. Treatments remain limited, in part because of limited mechanistic understanding of these behavioral disturbances. However, emerging work within the field of decision‐making neuroscience and beyond points to common neurobiological mechanisms underpinning these seemingly disparate problems. These insights bridge the gap between underlying disease pathology and clinical phenotype, offering new treatment strategies, novel behavioral and physiological biomarkers of HD, and deeper understanding of human behavior. In this review, we apply the neurobiological framework of cost‐benefit decision making to the problems of apathy and impulsivity in HD. Through this decision‐making lens, we develop a mechanistic model that elucidates the occurrence of these behavioral disturbances and points to potential treatment strategies and crucial research priorities. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson Movement Disorder Society.
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Affiliation(s)
- Lee‐Anne Morris
- Department of Medicine University of Otago Christchurch New Zealand
- New Zealand Brain Research Institute Christchurch New Zealand
| | - Claire O'Callaghan
- Brain and Mind Centre and School of Medical Sciences, Faculty of Medicine and Health University of Sydney Sydney New South Wales Australia
| | - Campbell Le Heron
- Department of Medicine University of Otago Christchurch New Zealand
- New Zealand Brain Research Institute Christchurch New Zealand
- Department of Neurology Canterbury District Health Board Christchurch New Zealand
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Nair A, Johnson EB, Gregory S, Osborne-Crowley K, Zeun P, Scahill RI, Lowe J, Papoutsi M, Palminteri S, Rutledge RB, Rees G, Tabrizi SJ. Aberrant Striatal Value Representation in Huntington's Disease Gene Carriers 25 Years Before Onset. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2021; 6:910-918. [PMID: 33795209 PMCID: PMC8423628 DOI: 10.1016/j.bpsc.2020.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/14/2020] [Accepted: 12/14/2020] [Indexed: 12/02/2022]
Abstract
BACKGROUND In this study, we asked whether differences in striatal activity during a reinforcement learning (RL) task with gain and loss domains could be one of the earliest functional imaging features associated with carrying the Huntington's disease (HD) gene. Based on previous work, we hypothesized that HD gene carriers would show either neural or behavioral asymmetry between gain and loss learning. METHODS We recruited 35 HD gene carriers, expected to demonstrate onset of motor symptoms in an average of 26 years, and 35 well-matched gene-negative control subjects. Participants were placed in a functional magnetic resonance imaging scanner, where they completed an RL task in which they were required to learn to choose between abstract stimuli with the aim of gaining rewards and avoiding losses. Task behavior was modeled using an RL model, and variables from this model were used to probe functional magnetic resonance imaging data. RESULTS In comparison with well-matched control subjects, gene carriers more than 25 years from motor onset showed exaggerated striatal responses to gain-predicting stimuli compared with loss-predicting stimuli (p = .002) in our RL task. Using computational analysis, we also found group differences in striatal representation of stimulus value (p = .0004). We found no group differences in behavior, cognitive scores, or caudate volumes. CONCLUSIONS Behaviorally, gene carriers 9 years from predicted onset have been shown to learn better from gains than from losses. Our data suggest that a window exists in which HD-related functional neural changes are detectable long before associated behavioral change and 25 years before predicted motor onset. These represent the earliest functional imaging differences between HD gene carriers and control subjects.
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Affiliation(s)
- Akshay Nair
- Huntington's Disease Centre, University College London Queen Square Institute of Neurology, University College London, London, United Kingdom; Max Planck University College London Centre for Computational Psychiatry and Ageing Research, University College London Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Eileanoir B Johnson
- Huntington's Disease Centre, University College London Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Sarah Gregory
- Huntington's Disease Centre, University College London Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Katherine Osborne-Crowley
- Huntington's Disease Centre, University College London Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Paul Zeun
- Huntington's Disease Centre, University College London Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Rachael I Scahill
- Huntington's Disease Centre, University College London Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Jessica Lowe
- Huntington's Disease Centre, University College London Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Marina Papoutsi
- Huntington's Disease Centre, University College London Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Stefano Palminteri
- Laboratoire de Neurosciences Cognitives et Computationnelles, Institut National de la Santé et de la Recherche Médicale, Paris, France; Département d'Etudes Cognitives, Ecole Normale Supérieure, Paris, France; Université de Paris Sciences et Lettres, Paris, France
| | - Robb B Rutledge
- Max Planck University College London Centre for Computational Psychiatry and Ageing Research, University College London Queen Square Institute of Neurology, University College London, London, United Kingdom; University College London Institute of Cognitive Neuroscience, University College London Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Geraint Rees
- University College London Institute of Cognitive Neuroscience, University College London Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Sarah J Tabrizi
- Huntington's Disease Centre, University College London Queen Square Institute of Neurology, University College London, London, United Kingdom; Wellcome Centre for Human Neuroimaging, University College London Queen Square Institute of Neurology, University College London, London, United Kingdom.
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McDonell KE, Ciriegio AE, Pfalzer AC, Hale L, Shiino S, Riordan H, Moroz S, Darby RR, Compas BE, Claassen DO. Risk-Taking Behaviors in Huntington's Disease. J Huntingtons Dis 2020; 9:359-369. [PMID: 33164940 DOI: 10.3233/jhd-200431] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Risky behaviors are common in Huntington's disease (HD) and can lead to significant adverse consequences. However, the prevalence and scope of these symptoms have not been studied systematically, and no empirically validated measures are available to screen for them. OBJECTIVE To test a novel screening tool designed to assess risk-taking behaviors in HD. METHODS We administered the Risk Behavior Questionnaire (RBQ-HD) to HD patients and caregivers at Vanderbilt University Medical Center between 2018-2019. Patients completed the questionnaire based on self-report; caregivers provided collateral reports. Clinical and demographic information were obtained from the electronic medical record. RESULTS 60 patients and 60 caregivers completed the RBQ-HD. 80% of patients (n = 48) and 91.7% of caregivers (n = 60) reported at least one risky behavior. Adverse social behaviors, impulsive/compulsive behaviors, and reckless driving were the most common behavioral domains reported. Male patients were more likely to report risky behaviors than females (92.3% vs. 70.6%, p = 0.04). The number of risky behaviors reported by patients and caregivers was negatively correlated with patient age (r = -0.32, p = 0.01; r = -0.47, p = 0.0001, respectively). Patient and caregiver reports were highly correlated in matched pairs (n = 30; r = 0.63, p = 0.0002). CONCLUSION These findings emphasize that risky behaviors are highly prevalent in HD and can be effectively identified through the use of a novel screening measure. We hypothesize that early pathological involvement of frontostriatal and mesolimbic networks may be important factors in the development of these behaviors.
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Affiliation(s)
- Katherine E McDonell
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Abagail E Ciriegio
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Anna C Pfalzer
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lisa Hale
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shuhei Shiino
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Heather Riordan
- Department of Pediatrics, Division of Child Neurology, Vanderbilt Children's Hospital, United States
| | - Sarah Moroz
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - R Ryan Darby
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bruce E Compas
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Daniel O Claassen
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
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McLauchlan DJ, Lancaster T, Craufurd D, Linden DEJ, Rosser AE. Insensitivity to loss predicts apathy in huntington's disease. Mov Disord 2019; 34:1381-1391. [PMID: 31361357 DOI: 10.1002/mds.27787] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/03/2019] [Accepted: 06/10/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Apathy is a deficit in goal-directed behavior that significantly affects quality of life and function. It is common in Huntington's disease and other disorders affecting corticostriatal pathways. Deficits in processing of reward, altered effort, and executive dysfunction are associated with apathy in other disorders, but the cognitive processes leading to apathy in Huntington's disease remain largely unknown. A previously reported deficit in learning from losses in Huntington's disease raises the possibility of a hitherto unrecognized mechanism leading to apathy. This study's objective was to delineate the cognitive processes associated with apathy in HD. METHODS We tested 51 Huntington's disease participants and 26 controls on a battery of novel and established measures to assess the contribution to apathy in Huntington's disease of executive function, reward value, reward-effort calculations, instrumental learning, and response to reward and loss. RESULTS Huntington's disase participants had deficits in instrumental learning with impaired response to loss, but no evidence to suggest altered reward-related behavior or effort. We also saw an executive dysfunction contribution to apathy in Huntington's disease. DISCUSSION We report the novel finding that apathy in Huntington's disease is associated with blunted responses to losses and impaired instrumental learning. This association is consistent with the known early degeneration of the indirect pathway and amygdala involvement in apathy in Huntington's disease, but is previously unreported in any disorder. In keeping with the comparative preservation of the ventral striatum and orbitofrontal cortex in Huntington's disease, reward valuation and reward-effort calculations did not contribute to apathy. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Duncan J McLauchlan
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK.,MRC Center for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK.,Cardiff University Brain Research Imaging Center, Cardiff University, Cardiff, UK
| | - Thomas Lancaster
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK.,MRC Center for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK.,Cardiff University Brain Research Imaging Center, Cardiff University, Cardiff, UK
| | - David Craufurd
- Manchester Center for Genomic Medicine, Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Center, Manchester, UK.,St. Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center, Manchester, UK
| | - David E J Linden
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK.,MRC Center for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK.,Cardiff University Brain Research Imaging Center, Cardiff University, Cardiff, UK.,School for Mental Health and Neuroscience, Fac. Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Anne E Rosser
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK.,MRC Center for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK.,Brain Repair Group, School of Biosciences, Cardiff University, Cardiff, UK
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Adjeroud N, Besnard J, Verny C, Prundean A, Scherer C, Gohier B, Bonneau D, Massioui NE, Allain P. Dissociation between decision-making under risk and decision-making under ambiguity in premanifest and manifest Huntington's disease. Neuropsychologia 2017; 103:87-95. [PMID: 28712946 DOI: 10.1016/j.neuropsychologia.2017.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 07/10/2017] [Accepted: 07/13/2017] [Indexed: 11/28/2022]
Abstract
We investigated decision-making under ambiguity (DM-UA) and decision making under risk (DM-UR) in individuals with premanifest and manifest Huntington's disease (HD). Twenty individuals with premanifest HD and 23 individuals with manifest HD, on one hand, and 39 healthy individuals divided into two control groups, on the other, undertook a modified version of the Iowa Gambling Task (IGT), an adaptation of a DM-UA task, and a modified version of the Game of Dice Task (GDT), an adaptation of a DM-UR task. Participants also filled in a questionnaire of impulsivity and responded to cognitive tests specifically designed to assess executive functions. Compared to controls, individuals with premanifest HD were unimpaired in performing executive tests as well as in decision-making tasks, except for the Stroop task. In contrast, individuals with manifest HD were impaired in both the IGT and executive tasks, but not in the GDT. No sign of impulsivity was observed in individuals with premanifest or manifest HD. Our results suggest that the progression of HD impairs DM-UA without affecting DM-UR, and indicate that decision-making abilities are preserved during the premanifest stage of HD.
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Affiliation(s)
- Najia Adjeroud
- Institut des Neurosciences Paris-Saclay (Neuro-PSI), UMR 9197, Université Paris Sud, CNRS, Université Paris Saclay, Orsay, France; Centre National de Référence pour les Maladies Neurogénétiques de l'Adulte, Département de Neurologie, Centre Hospitalier Universitaire, Angers, France
| | - Jeremy Besnard
- Laboratoire de Psychologie des Pays de la Loire(EA4638), Université d'Angers, Angers, France
| | - Christophe Verny
- Centre National de Référence pour les Maladies Neurogénétiques de l'Adulte, Département de Neurologie, Centre Hospitalier Universitaire, Angers, France
| | - Adriana Prundean
- Centre National de Référence pour les Maladies Neurogénétiques de l'Adulte, Département de Neurologie, Centre Hospitalier Universitaire, Angers, France
| | - Clarisse Scherer
- Centre National de Référence pour les Maladies Neurogénétiques de l'Adulte, Département de Neurologie, Centre Hospitalier Universitaire, Angers, France
| | - Bénédicte Gohier
- Centre National de Référence pour les Maladies Neurogénétiques de l'Adulte, Département de Neurologie, Centre Hospitalier Universitaire, Angers, France
| | - Dominique Bonneau
- Département de Biochimie et Génétique et UMR CNRS 6015, INSERM 1083n, Centre Hospitalier Universitaire, Angers,France
| | - Nicole El Massioui
- Institut des Neurosciences Paris-Saclay (Neuro-PSI), UMR 9197, Université Paris Sud, CNRS, Université Paris Saclay, Orsay, France
| | - Philippe Allain
- Centre National de Référence pour les Maladies Neurogénétiques de l'Adulte, Département de Neurologie, Centre Hospitalier Universitaire, Angers, France; Laboratoire de Psychologie des Pays de la Loire(EA4638), Université d'Angers, Angers, France.
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