Cognitive Deficit And Contralateral Frontal Hypoperfusion In Patients With Cerebellar Lesions

Česká verzia

Authors: E. Bolcekováihash2 ^{1,2 1,2}
Authors place of work: Katedra psychologie, Filozofická fakulta UK v Praze ¹; Neurologická klinika, IPVZ a Thomayerova nemocnice, Praha ²; Fakulta jaderná a fyzikálně inženýrská ČVUT v Praze ³; Radioizotopové pracoviště IKEM, Praha ⁴; Neurochirurgická klinika 1. LF UK, IPVZ a ÚVN Praha ⁵
Published in the journal: Cesk Slov Neurol N 2012; 75/108(5): 595-601
Category: Original Paper

Summary

Introduction:
The cerebellum is considered to be mainly involved in motor circuits, particularly movement coordination and muscle tone regulation. However, recent findings show that its functions also include cognition and emotions. The aim of our study was to contribute to this discussion by investigating neuropsychological deficits in patients with cerebellar lesions.

Methods:
We included 16 subjects with a structural lesion limited to the cerebellum, five women and eight men, with mean age of 51.4 years (range 22–79 years). Etiology involved ischemia in eight patients and tumour surgery in the other eight. The control group was composed of 16 subjects, five women and eight men, mean age 57.7 (range 29–79 years). All subjects underwent a semistructured interview, neurological assessment of ataxia, comprehensive neuropsychological assessment of cognitive, executive and affective functions and single-photon emission computed tomography (SPECT).

Results:
Patients with cerebellar damage scored significantly lower on neuropsychological measurement of executive functions (planning, strategy, abstraction, flexibility, inhibition) and also on memory, visuospatial and attention measures. Affective changes, although clearly present in the clinical picture of the research sample, were not confirmed. SPECT revealed hypoperfusion in the affected cerebellar hemisphere associated with hypoperfusion in the contralateral frontal lobe, suggesting mutual functional relationship between these regions.

Conclusion:
Our quantitative study of neuropsychological deficits in patients with cerebellar lesions provides a comprehensive account of deficits associated with this type of insult: executive alteration is the most pronounced followed by visuospatial and construction impairment, whereas attention, learning and memory are less impaired.

Key words:
cerebellum – cognition – emotions – executive functions – SPECT

Zdroje

1. Hamilton NG, Frick RB, Takahashi T, Hopping MW. Psychiatric symptoms and cerebellar pathology. Am J Psychiatry 1983; 140(10): 1322–1326.

2. Leiner HC, Leiner AL, Dow RS. Does the cerebellum contribute to mental skills? Behav Neurosci 1986; 100(4): 443–454.

3. Daum I, Ackermann H, Schugens MM, Reimold C, Dichgans J, Birbaumer N. The cerebellum and cognitive functions in humans. Behav Neurosci 1993; 107(3): 411–419.

4. Grafman J, Litvan I, Massaquoi S, Stewart M, Sirigu A, Hallett M. Cognitive planning deficit in patients with cerebellar atrophy. Neurology 1992; 42(8): 1493–1496.

5. Gómez Beldarrain M, García-Monco JC, Quintana JM, Llorens V, Rodeño E. Diaschisis and neuropsychological performance after cerebellar stroke. Eur Neurol 1997; 37(2): 82–89.

6. Silveri MC, Leggio MG, Molinari M. The cerebellum contributes to linguistic production : a case of agrammatic speech following a right cerebellar lesion. Neurology 1994; 44(11): 2047–2050.

7. Schmahmann JD, Sherman JC. The cerebellar cognitive affective syndrome. Brain 1998; 121(Pt 4): 561–579.

8. Haarmeier T, Thier P. The attentive cerebellum – myth or reality? Cerebellum 2007; 6(3): 177–183.

9. Steinlin M. The cerebellum in cognitive processes: Supporting studies in children. Cerebellum 2007; 6(3): 237–241.

10. Bellebaum C, Daum I. Cerebellar involvement in executive control. Cerebellum 2007; 6(3): 184–192.

11. Ben-Yehudah G, Guediche S, Fiez JA. Cerebellar contributions to verbal working memory: beyond cognitive theory. Cerebellum 2007; 6(3): 193–210.

12. Ackermann H, Mathiak K, Riecker A. The contribution of the cerebellum to speech production and speech perception: clinical and functional imaging data. Cerebellum 2007; 6(3): 202–213.

13. Molinari M, Leggio MG. Cerebellar information processing and visuospatial functions. Cerebellum 2007; 6(3): 214–220.

14. Timmann D, Daum I. Cerebellar contributions to cognitive functions: a progress report after two decades of research. Cerebellum 2007; 6(3): 15–18.

15. Schmahmann JD. Disorders of the cerebellum: Ataxia, dysmetria of thought and the cerebellar cognitive affective syndrome. J Neuropsychiatry Clin Neurosci 2004; 16(3): 367–378.

16. Schmahmann JD. The cerebellar cognitive affective syndrome: clinical correlations of the dysmetria of thought hypothesis. Int Rev Psychiatry 2001; 13(4): 313–322.

17. Ito M. Control of mental activities by internal models in the cerebellum. Nat Rev Neurosci 2008; 9(4): 304–131.

18. Husárová I, Bareš M. Účasť cerebella na kognitívnych a nemotorických funkciách v obraze funkčnej magnetickej rezonancie. Neurol Prax 2008; 9(4): 236–239.

19. Bareš M. Mozeček a kognitivní funkce. In: Rektorová I (ed). Kognitivní poruchy a demence. 1st ed. Praha: Triton 2007: 52–159.

20. Bareš M, Lungu O, Liu T, Waechter T, Gomez CM, Ashe J. Impaired predictive motor timing in patients with cerebellar disorders. Exp Brain Res 2007; 180(2): 355–365.

21. Bares M, Lungu OV, Husárová I, Gescheidt T. Predictive motor timing performance dissociates between early diseases of the cerebellum and Parkinson‘s disease. Cerebellum 2010; 9(1): 124–135.

22. Bares M, Lungu OV, Liu T, Waechter T, Gomez CM, Ashe J. Neural substrate of predictive motor timing. Cerebellum 2011; 10(2): 233–244.

23. Zumrová A, Kopečková M, Mušová Z, Křepelová A, Apltová L, Paděrová A. Autozomálně dominantní spinocerebellární ataxie. Neurol Prax 2007; 8(5): 277–282.

24. Zumrová A, Mušová Z, Košťálová E, Apltová L, Křepelová A Paděrová A. Autozomálně recesivní a X-vázané ataxie. Neurol Prax 2007; 8(5): 272–276.

25. Trouillas P, Takayanagi T, Hallett M, Currier RD, Subramony SH, Wessel K et al. International Cooperative Ataxia Rating Scale for pharmacological assessment of the cerebellar syndrome. J Neurol Sci 1997; 145(2): 205–211.

26. Preiss M, Rodriguez M, Kawaciuková R, Laing H. Neuropsychologická baterie Psychiatrického centra Praha. 2nd ed. Praha: Psychiatrické centrum Praha 2007.

27. Gaál L. Príručka k programom Neurop-2. 1. vyd. Bernried: Samco 2003.

28. Delis DC, Kramer JH, Freeland J, Kaplan E. Integrating clinical assessment with cognitive neuroscience: construct validation of the California Verbal Learning Test. J Consult Clin Psychol 1988; 56(1): 123–130.

29. Dubois B, Slachevsky A, Litvan I, Pillon B. The FAB: a frontal assessment battery at bedside. Neurology 2000; 55(11): 1621–1626.

30. Jones-Gotman M, Milner B. Design ﬂuency: the invention of nonsense drawings after focal cortical lesions. Neuropsychologia 1977; 15(4–5): 653–674.

31. Regard M. Cognitive rigidity and flexibility: a neuropsychological study. In: Spreen O, Strauss E (eds). A compendium of neuropsychological tests. Administration, norms, and commentary. 1st ed. New York: Oxford University Press 1991: 52–56.

32. Ferjenčík J. Farebné progresívne matice. 1st ed. Bratislava: Psychodiagnostické a didaktické testy 1985.

33. Stančák A. Skrátená verzia MMPI/100. 1st ed. Bratislava: Psychodiagnostické a didaktické testy 1989.

34. Terry PC, Lane AM. User guide for the Brunel Mood Scale (BRUMS). Unpublished 2003.

35. Mehrabian A, Epstein N. A measure of emotional empathy. J Pers 1972; 40(4): 525–543.

36. Karatekin C, Lazareff JA, Asarnow RF. Relevance of the cerebellar hemispheres for executive functions. Pediatr Neurol 2000; 22(2): 106–112.

37. Feeney DM, Baron JC. Diaschisis. Stroke 1986; 17(5): 817–830.

38. Komaba Y, Osono E, Kitamura S, Katayama Y. Crossed cerebellocerebral diaschisis in patients with cerebellar stroke. Acta Neurol Scand 2000; 101(1): 8–12.

39. Gottwald B, Wilde B, Mihajlovic Z, Mehdorn HM. Evidence for distinct cognitive deficits after focal cerebellar lesions. J Neurol Neurosurg Psychiatry 2004; 75(11): 1524–1531.

40. Mathiak K, Hertrich I, Grodd W, Ackermann H: Cerebellum and speech perception: a functional magnetic resonance imaging study. J Cogn Neurosci 2002; 14(6): 902–912.

41. Tedesco AM, Chiricozzi FR, Clausi S, Lupo M, Molinari M, Leggio MG. The cerebellar cognitive profile. Brain 2011; 134(12): 3669–3683.

42. Turner BM, Paradiso S, Marvel CL, Pierson R, Boles Ponto LL, Hochwa R et al. The cerebellum and emotional experience. Neuropsychologia 2007; 45(6): 1331–1341.

43. Schutter DJ, Van Honk J. The cerebellum on the rise in human emotion. Cerebellum 2005; 4(4): 290–294.

44. Passani B. The emotional cerebellum. Neuroreport 2002; 13(11): 1376.