His medical history included Asperger syndrome, restless legs syndrome, irritable bowel syndrome, type 2 diabetes mellitus, obesity, depression/anxiety, migraines, hypertension, and hypothyroidism, all associated with the premutation.2 He experienced handwriting problems, balance problems with frequent tripping and 2 falls in the previous year, and a slight postural tremor and an intention tremor in the head and right hand beginning in his late 20s. His deep tendon reflexes were 1+ in all extremities but he jerked his whole body when each reflex was tested. His snout, jaw jerk, and palmomental and glabellar reflexes were positive, but his Babinski reflex was negative. His cognitive testing (Wechsler Adult Intelligence Scale III) included a score of 112 for verbal IQ, 98 for performance IQ, and 106 for full-scale IQ. However, his visual attention vigilance (Integrated-Visual and Auditory-Continuous Performance Test) score was 70 and his sustained visual attention score was 35. He used crack cocaine, methamphetamines, and alcohol (6 drinks per sitting once a week). He had 2 psychiatric hospitalizations, one for depression related to bipolar disorder in his late 20s and a second after a manic episode due to crack cocaine use, which led to 6 mild strokes in rapid succession in his late 20s. We propose that the early onset of FXTAS in this patient may have been related to substance abuse as has been previously reported.3- 5 He died in an accident.