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This chapter presents an overview and practical approach to conceptualize manifestations of cerebellar lesions and outlines the principles that govern the cerebellar contribution to cognition and emotion as well as to sensorimotor function. Lesions of the cerebellum have been regarded as producing motor impairments. The cerebellar motor syndrome is characterized by wide-based and unsteady, or ataxic, gait; incoordination, or dysmetria, of the arms and legs; articulation impairment, or dysarthria; and eye movement abnormalities that disturb vision. The cerebellar cognitive affective syndrome (CCAS) results from lesions of the posterior lobe, characterized by clinically relevant deficits in executive function, visual spatial performance, linguistic processing, and dysregulation of affect. The connections of the cerebellum with brain circuits are implicated in psychiatric illness. Applying repetitive transcranial magnetic stimulation (TMS) to the limbic cerebellum in the vermis improves psychiatric disorders such as schizophrenia by upregulating cerebellar modulation of cerebrocerebellar circuits engaged in cognition and emotion.
This chapter presents a brief background on the rationale for how the cerebellum is engaged in non-motor functions. It discusses the relationship of the cerebellar motor syndrome to the higher order aspects of cerebellar dysfunction. The chapter analyzes the nature of the neuro-behavioral deficits and their relationship to cerebellar structure and vascular anatomy. It examines the clinical relevance of the cognitive and behavioral manifestations of cerebellar stroke in the diagnosis and management of patients with posterior circulation ischemia. In stroke neurology, the natural and appropriate tendency is to consider stroke syndromes as manifestations of occlusions of specific blood vessels. Bedside and office-based tests that the neurologist can administer to detect the cerebellar cognitive affective syndrome (CCAS) should focus on the domains known to be affected, namely, disorders of executive function, visuospatial cognition, language-based tests, and assessment of affect and other neuropsychiatric domains.
This commentary concerns the cerebellar contribution to cognition. It addresses the relevant historical background, elaborates upon the associative and paralimbic incorporation into both feedforward and feedback limbs of the cerebrocerebellar system, and relates this to the newly described cerebellar cognitive-affective syndrome. It then addresses the degree to which available anatomic data support current theories regarding nonmotor learning in the cerebellum, [HOUK et al.; THACH]
Contemporary investigations provide substantial clinical and experimental support for the hypothesis generated in the early part of the twentieth century that the cerebellum participates in a multitude of nervous system functions beyond that of motor control. Executive functions such as strategy formation, self-monitoring, reasoning, and working memory; visual–spatial learning and analysis; and linguistic processing, among other cognitive paradigms, have all been shown to require a cerebellar contribution both in normal subjects and in patients with acquired cerebellar lesions. The role of the cerebellum in the modulation of emotion also appears to be critically important in both health and disease states. The focus of this chapter, therefore, is directed toward the cerebellar contribution to behaviors associated with the experience and expression of emotion. It summarizes anatomic investigations demonstrating substrates that could sustain a cerebellar contribution to nonmotor as well as motor behaviors, and describes contemporary clinical studies that report changes in behavior, personality, and affect following lesions of the cerebellum. It includes data from morphologic and functional neuroimaging experiments that support a wider role of the cerebellum in nervous system function, and specifically that suggest an important contribution of the cerebellum to the regulation of affect and to psychosis. The chapter concludes with an examination of the dysmetria of thought hypothesis, and discusses how this theory harmonizes with models of cerebellar function proposed by other contemporary theorists.
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