Evidence for topographic organization in the cerebellum of motor control versus cognitive and affective processing

Patients with cerebellar damage often present with the cerebellar motor syndrome of dysmetria, dysarthria and ataxia, yet cerebellar lesions can also result in the cerebellar cognitive affective syndrome (CCAS), including executive, visual spatial, and linguistic impairments, and affective dysregulation. We have hypothesized that there is topographic organization in the human cerebellum such that the anterior lobe and lobule VIII contain the representation of the sensorimotor cerebellum; lobules VI and VII of the posterior lobe comprise the cognitive cerebellum; and the posterior vermis is the anatomical substrate of the limbic cerebellum. Here we analyze anatomical, functional neuroimaging, and clinical data to test this hypothesis. We find converging lines of evidence supporting regional organization of motor, cognitive, and limbic behaviors in the cerebellum. The cerebellar motor syndrome results when lesions involve the anterior lobe and parts of lobule VI, interrupting cerebellar communication with cerebral and spinal motor systems. Cognitive impairments occur when posterior lobe lesions affect lobules VI and VII (including Crus I, Crus II, and lobule VIIB), disrupting cerebellar modulation of cognitive loops with cerebral association cortices. Neuropsychiatric disorders manifest when vermis lesions deprive cerebro-cerebellar-limbic loops of cerebellar input. We consider this functional topography to be a consequence of the differential arrangement of connections of the cerebellum with the spinal cord, brainstem, and cerebral hemispheres, reflecting cerebellar incorporation into the distributed neural circuits subserving movement, cognition, and emotion. These observations provide testable hypotheses for future investigations.     

Disorders of the cerebellum: ataxia, dysmetria of thought, and the cerebellar cognitive affective syndrome

Many diseases involve the cerebellum and produce ataxia, which is characterized by incoordination of balance, gait, extremity and eye movements, and dysarthria. Cerebellar lesions do not always manifest with ataxic motor syndromes, however. The cerebellar cognitive affective syndrome (CCAS) includes impairments in executive, visual-spatial, and linguistic abilities, with affective disturbance ranging from emotional blunting and depression, to disinhibition and psychotic features. The cognitive and psychiatric components of the CCAS, together with the ataxic motor disability of cerebellar disorders, are conceptualized within the dysmetria of thought hypothesis. This concept holds that a universal cerebellar transform facilitates automatic modulation of behavior around a homeostatic baseline, and the behavior being modulated is determined by the specificity of anatomic subcircuits, or loops, within the cerebrocerebellar system. Damage to the cerebellar component of the distributed neural circuit subserving sensorimotor, cognitive, and emotional processing disrupts the universal cerebellar transform, leading to the universal cerebellar impairment affecting the lesioned domain. The universal cerebellar impairment manifests as ataxia when the sensorimotor cerebellum is involved and as the CCAS when pathology is in the lateral hemisphere of the posterior cerebellum (involved in cognitive processing) or in the vermis (limbic cerebellum). Cognitive and emotional disorders may accompany cerebellar diseases or be their principal clinical presentation, and this has significance for the diagnosis and management of patients with cerebellar dysfunction.     

Cerebellar Clustering and Functional Connectivity During Pain Processing

The cerebellum has been traditionally considered a sensory-motor structure, but more recently has been related to other cognitive and affective functions. Previous research and meta-analytic studies suggested that it could be involved in pain processing. Our aim was to distinguish the functional networks subserved by the cerebellum during pain processing. We used functional magnetic resonance imaging (fMRI) on 12 subjects undergoing mechanical pain stimulation and resting state acquisition. For the analysis of data, we used fuzzy c-mean to cluster cerebellar activity of each participant during nociception. The mean time courses of the clusters were used as regressors in a general linear model (GLM) analysis to explore brain functional connectivity (FC) of the cerebellar clusters. We compared our results with the resting state FC of the same cluster and explored with meta-analysis the behavior profile of the FC networks. We identified three significant clusters: cluster V, involving the culmen and quadrangular lobules (vermis IV-V, hemispheres IV-V-VI); cluster VI, involving the posterior quadrangular lobule and superior semilunar lobule (hemisphere VI, crus 1, crus 2), and cluster VII, involving the inferior semilunar lobule (VIIb, crus1, crus 2). Cluster V was more connected during pain with sensory-motor areas, cluster VI with cognitive areas, and cluster VII with emotional areas. Our results indicate that during the application of mechanical punctate stimuli, the cerebellum is not only involved in sensory functions but also with areas typically associated with cognitive and affective functions. Cerebellum seems to be involved in various aspects of nociception, reflecting the multidimensionality of pain perception.     

Distinct critical cerebellar subregions for components of verbal working memory

A role for the cerebellum in cognition has been proposed based on studies suggesting a profile of cognitive deficits due to cerebellar stroke. Such studies are limited in the determination of the detailed organisation of cerebellar subregions that are critical for different aspects of cognition. In this study we examined the correlation between cognitive performance and cerebellar integrity in a specific degeneration of the cerebellar cortex: Spinocerebellar Ataxia type 6 (SCA6). The results demonstrate a critical relationship between verbal working memory and grey matter density in superior (bilateral lobules VI and crus I of lobule VII) and inferior (bilateral lobules VIIIa and VIIIb, and right lobule IX) parts of the cerebellum. We demonstrate that distinct cerebellar regions subserve different components of the prevalent psychological model for verbal working memory based on a phonological loop. The work confirms the involvement of the cerebellum in verbal working memory and defines specific subsystems for this within the cerebellum.     

Exploration and Identification of Cortico-Cerebellar-Brainstem Closed Loop During a Motivational-Motor Task: an fMRI Study

The cerebellum is involved not only in motor coordination, training, and memory, but also in cognition and emotion. Lobule VI in particular belongs to sensorimotor, salience, and executive cerebellar networks. This study aims to determine whether lobule VI would constitute an integrative interface between motor and cognitive/emotional circuits during a motor task with verbal encouragement, likely in conjunction with the basal ganglia (reward and motivational system). We used fMRI to identify specific recruitment of cerebellar and striatal systems during physical performance using two motor tasks with and without encouragement. We found that: (i) Force results were higher during verbal encouragement than during basal condition in all participants. (ii) The anterior part of the right lobule VI was activated by motor execution in both tasks, while its posterior part was specifically activated by verbal encouragement. (iii) The closed-connectivity loop maintained motivation induced by verbal encouragement between cerebral and cerebellar through the red nucleus and striatal network. Therefore, right lobule VI is a hub-controlling sensorimotor and motivates aspects of motor performance in relation with the red nucleus and the ventral striatum. These results could have important implications for extrapyramidal and multisystem degenerative diseases.     

Topography of Cerebellar Deficits in Humans

The cerebellum is a key-piece for information processing and is involved in numerous motor and nonmotor activities, thanks to the anatomical characteristics of the circuitry, the enormous computational capabilities and the high connectivity to other brain areas. Despite its uniform cytoarchitecture, cerebellar circuitry is segregated into functional zones. This functional parcellation is driven by the connectivity and the anatomo-functional heterogeneity of the numerous extra-cerebellar structures linked to the cerebellum, principally brain cortices, precerebellar nuclei and spinal cord. Major insights into cerebellar functions have been gained with a detailed analysis of the cerebellar outputs, with the evidence that fundamental aspects of cerebrocerebellar operations are the closed-loop circuit and the predictions of future states. Cerebellar diseases result in disturbances of accuracy of movements and lack of coordination. The cerebellar syndrome includes combinations of oculomotor disturbances, dysarthria and other speech deficits, ataxia of limbs, ataxia of stance and gait, as well as often more subtle cognitive/behavioral impairments. Our understanding of the corresponding anatomo-functional maps for the human cerebellum is continuously improving. We summarize the topography of the clinical deficits observed in cerebellar patients and the growing evidence of a regional subdivision into motor, sensory, sensorimotor, cognitive and affective domains. The recently described topographic dichotomy motor versus nonmotor cerebellum based upon anatomical, functional and neuropsychological studies is also discussed.     

Cerebellar–cortical dysconnectivity in resting‐state associated with sensorimotor tasks in schizophrenia

Abnormalities of cerebellar function have been implicated in the pathophysiology of schizophrenia. Since the cerebellum has afferent and efferent projections to diverse brain regions, abnormalities in cerebellar lobules could affect functional connectivity with multiple functional systems in the brain. Prior studies, however, have not examined the relationship of individual cerebellar lobules with motor and nonmotor resting‐state functional networks. We evaluated these relationships using resting‐state fMRI in 30 patients with a schizophrenia‐spectrum disorder and 37 healthy comparison participants. For connectivity analyses, the cerebellum was parcellated into 18 lobular and vermal regions, and functional connectivity of each lobule to 10 major functional networks in the cerebrum was evaluated. The relationship between functional connectivity measures and behavioral performance on sensorimotor tasks (i.e., finger‐tapping and postural sway) was also examined. We found cerebellar–cortical hyperconnectivity in schizophrenia, which was predominantly associated with Crus I, Crus II, lobule IX, and lobule X. Specifically, abnormal cerebellar connectivity was found to the cerebral ventral attention, motor, and auditory networks. This cerebellar–cortical connectivity in the resting‐state was differentially associated with sensorimotor task‐based behavioral measures in schizophrenia and healthy comparison participants—that is, dissociation with motor network and association with nonmotor network in schizophrenia. These findings suggest that functional association between individual cerebellar lobules and the ventral attentional, motor, and auditory networks is particularly affected in schizophrenia. They are also consistent with dysconnectivity models of schizophrenia suggesting cerebellar contributions to a broad range of sensorimotor and cognitive operations.     

Crus I in the Rodent Cerebellum: Its Homology to Crus I and II in the Primate Cerebellum and Its Anatomical Uniqueness Among Neighboring Lobules

In the human cerebellum, the crus I and crus II lobules (or the ansiform lobule), which are implicated in cognitive and visuomotor functions, are significantly expanded compared to other anterior and posterior lobules, which are involved mainly in somatosensorimotor function. In applying rodent models, it is essential to identify the lobules that are homologous to human crus I and crus II. Observation of the lobular structure in human, macaque, marmoset, rat, and mouse has indicated that human crus I and II are homologous to crus I in rodents (referred to as “ansiform area, AA”). This new lobular definition is supported by lobule-based mapping of the olivocerebellar climbing fiber and Purkinje cell (PC) projection patterns in rodents; crus II and simple lobules are innervated by the mediocaudal part of each inferior olive subnucleus and project to the dorsal part of the cerebellar nuclei, while crus I (or the AA) is innervated by the rostrolateral part of each inferior olive subnucleus and projects to the ventral part of the cerebellar nuclei. Concerning zebrin stripes, the central lobules (lobules VI–VII and AA or crus I in rodents) show a laterally expanded arrangement solely of positive stripes. Our recent analysis has shown that this arrangement of zebrin-positive stripes in the AA originates from their developmental process. Between E14.5 and E17.5, lateral protrusion and shift has been observed in the domains of protocadherin 10-positive PC subsets (which would become zebrin-positive later) in the central area of the immature cerebellum that eventually becomes lobules VI–VII and AA or crus I. These data suggest that the AA (or crus I in rodents) is a unique lobule in the mammalian cerebellum which is characterized by distinct connectivity from neighboring lobules, a massive expansion in skillful primates, and the formation of longitudinal stripes different from that in neighboring anterior and posterior lobules.     

Crossed cerebro-cerebellar language dominance

In addition to its traditional role in motor control, the cerebellum has been implicated in various cognitive and linguistic functions. Lesion, anatomic, and functional imaging studies indicate a link between left frontal language regions and the right cerebellum. To probe the specificity of this circuit, we examined the association between language-related lateralized activation of the frontal cortex with lateralized activation of the cerebellum. Functional magnetic resonance imaging (fMRI) was carried out during letter-cued word generation in 14 healthy subjects: 7 subjects displayed typical left-hemisphere and 7 subjects displayed atypical right-hemisphere language dominance. We found activation of the cerebellar hemisphere contralateral to the language-dominant cerebral hemisphere in each subject. The cerebellar activation was confined to the lateral posterior cerebellar hemisphere (lobule VI, VII B, Cr I, Cr II). This study demonstrates that crossed cerebral and cerebellar language dominance is a typical characteristic of brain organization. The functional significance of the reported activations can now be tested in patients with lesions of the lateral posterior cerebellum.     

Cerebellar fMRI Activation Increases with Increasing Working Memory Demands

The aim of the present study was to explore cerebellar contributions to the central executive in n-back working memory tasks using 7-T functional magnetic imaging (fMRI). We hypothesized that cerebellar activation increased with increasing working memory demands. Activations of the cerebellar cortex and dentate nuclei were compared between 0-back (serving as a motor control task), 1-back, and 2-back working memory tasks for both verbal and abstract modalities. A block design was used. Data of 27 participants (mean age 26.6?±?3.8 years, female/male 12:15) were included in group statistical analysis. We observed that cerebellar cortical activations increased with higher central executive demands in n-back tasks independent of task modality. As confirmed by subtraction analyses, additional bilateral activations following higher executive demands were found primarily in four distinct cerebellar areas: (i) the border region of lobule VI and crus I, (ii) inferior parts of the lateral cerebellum (lobules crus II, VIIb, VIII, IX), (iii) posterior parts of the paravermal cerebellar cortex (lobules VI, crus I, crus II), and (iv) the inferior vermis (lobules VI, VIIb, VIII, IX). Dentate activations were observed for both verbal and abstract modalities. Task-related increases were less robust and detected for the verbal n-back tasks only. These results provide further evidence that the cerebellum participates in an amodal bilateral neuronal network representing the central executive during working memory n-back tasks.     

Functional Imaging and the Cerebellum: Recent Developments and Challenges. Editorial

Recent neuroimaging developments allow a better in vivo characterization of the structural and functional connectivity of the human cerebellum. Ultrahigh fields, which considerably increase spatial resolution, enable to visualize deep cerebellar nuclei and cerebello-cortical sublayers. Tractography reconstructs afferent and efferent pathway of the cerebellum. Resting-state functional connectivity individualizes the prewired, parallel close-looped sensorimotor, cognitive, and affective networks passing through the cerebellum. These results are un agreement with activation maps obtained during stimulation functional neuroimaging or inferred from neurological deficits due to cerebellar lesions. Therefore, neuroimaging supports the hypothesis that cerebellum constitutes a general modulator involved in optimizing mental performance and computing internal models. However, the great challenges will remain to unravel: (1) the functional role of red and bulbar olivary nuclei, (2) the information processing in the cerebellar microcircuitry, and (3) the abstract computation performed by the cerebellum and shared by sensorimotor, cognitive, and affective domains.     

Development of a Psychiatric Disorder Linked to Cerebellar Lesions

Cerebellar dysfunction plays a critical role in neurodevelopmental disorders with long-term behavioral and neuropsychiatric symptoms. A 43-year-old woman with a cerebellum arteriovenous malformation and history of behavioral dysregulation since childhood is described. After the rupture of the cerebellar malformation in adulthood, her behavior morphed into specific psychiatric symptoms and cognitive deficits occurred. The neuropsychological assessment evidenced impaired performance in attention, visuospatial, memory, and language domains. Moreover, psychiatric assessment indicated a borderline personality disorder. Brain MRI examination detected macroscopic abnormalities in the cerebellar posterior lobules VI, VIIa (Crus I), and IX, and in the posterior area of the vermis, regions usually involved in cognitive and emotional processing. The described patient suffered from cognitive and behavioral symptoms that are part of the cerebellar cognitive affective syndrome. This case supports the hypothesis of a cerebellar role in personality disorders emphasizing the importance of also examining the cerebellum in the presence of behavioral disturbances in children and adults.     

The language of the cerebellum

Background: During the past three decades neuroanatomical, neuroimaging, and clinical studies have substantially altered the view on the role of the cerebellum as a sole coordinator of sensorimotor function. Currently, the cerebellum is believed to be also crucially involved in cognitive, affective, and behavioural functioning.

Aims: This paper aims to summarise a number of critical insights from different research areas (anatomy, functional imaging, clinical practice) that provide evidence for a role of the cerebellum in motor speech and nonmotor language processing.

Main contribution: By means of identifying a dense network of crossed reciprocal connections between the cerebellum and the supratentorial association areas, neuroanatomical studies provided a robust basis for the development of new insights in the modulatory role of the cerebellum in neurocognition, including nonmotor language processing. A topological distinction was established between the “motor” cerebellum, projecting to the cortical motor areas, and the “cognitive/affective” cerebellum, connected with the cortical and limbic association areas. Neuroimaging studies demonstrated cerebellar involvement in several different language tasks, even after controlling for motor aspects. In addition, several clinical studies identified a variety of nonmotor linguistic deficits after cerebellar damage, implying a prominent role for the cerebellum in these linguistic processes. Functional neuroimaging confirmed the functional impact of cerebellar lesions on remote, structurally intact cortical regions via crossed cerebello-cerebral diaschisis.

Conclusion: Evidence from neuroanatomical, neuroimaging, and clinical studies suggests a strongly lateralised involvement of the cerebellum in a broad spectrum of nonmotor language functions through crossed cerebello-cerebral connectivity. It is argued that the cerebellum is involved in language in a similar manner as it is involved in motor functions: through monitoring/coordinating cortical functions.     

Cortical and cerebellar activity of the human brain during imagined and executed unimanual and bimanual action sequences: a functional MRI study

The neural (blood oxygenation level dependent) correlates of executed and imagined finger sequences, both unimanual and bimanual, were studied in adult right-handed volunteers using functional magnetic resonance imaging (fMRI) of the entire brain. The finger to thumb opposition tasks each consisted of three conditions, two unimanual and one bimanual. Each experimental condition consisted of overt movement of the fingers in a prescribed sequence and imagery of the same task. An intricate network consisting of sensorimotor cortex, supplementary motor area (SMA), superior parietal lobule and cerebellum was identified when the tasks involved both planning and execution. During imagery alone, however, cerebellar activity was largely absent. This apparent decoupling of sensorimotor cortical and cerebellar areas during imagined movement sequences, suggests that cortico-cerebellar loops are engaged only when action sequences are both intended and realized. In line with recent models of motor control, the cerebellum may monitor cortical output and feed back corrective information to the motor cortex primarily during actual, not imagined, movements. Although parietal cortex activation occurred during both execution and imagery tasks, it was most consistently present during bimanual action sequences. The engagement of the superior parietal lobule appears to be related to the increased attention and memory resources associated, in the present instance, with coordinating difficult bimanual sequences.     

Cognitive, linguistic and affective disturbances following a right superior cerebellar artery infarction: a case study

The cerebellar cognitive affective syndrome (CCAS) is a neurobehavioral syndrome that may develop after congenital and acquired cerebellar lesions. The syndrome consists of deficits in executive functioning, spatial cognition, visual-spatial memory and language and also involves personality and behavioral changes. We describe a 58-year-old right-handed man who in addition to affective disturbances presented with a unique combination of cognitive and linguistic deficits following an ischemic infarction in the vascular territory of the right superior cerebellar artery (SCA). Neurocognitive and neurolinguistic examinations were performed in the acute phase (10 days post-onset) and lesion phase (four weeks post-onset) of the stroke. A Tc-99m-ECD SPECT study was performed five weeks after the stroke. Acute phase data revealed a generalized cognitive decline and mild transcortical sensory aphasia. In the lesion phase, the neurobehavioral tableau was dominated by executive dysfunctions, disrupted divided attention, disturbed visual-spatial organization and behavioral abnormalities. Neurolinguistic investigations disclosed visual dyslexia and surface dysgraphia. Reading of words and visual lexical decision tasks of words and nonwords were severely defective and predominantly characterized by visual errors. In addition, writing irregular and ambiguous words resulted in regularization errors (phonologically plausible errors based on phoneme-grapheme correspondence rules). In the absence of any structural damage in the supratentorial brain regions, a quantified SPECT study showed a relative hypoperfusion in the right cerebellar hemisphere and the left medial frontal lobe. CCAS is for the first time reported in association with visual dyslexia and surface dysgraphia. We hypothesize that the cognitive and linguistic deficits might result from functional disruption of the cerebellar-encephalic pathways, connecting the cerebellum to the frontal supratentorial areas which subserve attentional and planning processes. This phenomenon of crossed cerebellar-cerebral diaschisis is supported by SPECT findings revealing a hypoperfusion in the anatomoclinically suspected brain regions. The constellation of cognitive, linguistic and behavioral symptoms adds new evidence to the multifaceted area of cerebellar neurocognition and demonstrates that the cerebellum might play a crucial role in cognitive, linguistic, and affective processing.     

Sensorimotor,language, and working memory representation within the human cerebellum

The cerebellum is involved in a wide range of behaviours. A key organisational principle from animal studies is that somatotopically corresponding sensory input and motor output reside in the same cerebellar cortical areas. However, compelling evidence for a similar arrangement in humans and whether it extends to cognitive functions is lacking. To address this, we applied cerebellar optimised whole‐brain functional MRI in 20 healthy subjects. To assess spatial overlap within the sensorimotor and cognitive domains, we recorded activity to a sensory stimulus (vibrotactile) and a motor task; the Sternberg verbal working memory (VWM) task; and a verb generation paradigm. Consistent with animal data, sensory and motor activity overlapped with a somatotopic arrangement in ipsilateral areas of the anterior and posterior cerebellum. During the maintenance phase of the Sternberg task, a positive linear relationship between VWM load and activity was observed in right Lobule VI, extending into Crus I bilaterally. Articulatory movement gave rise to bilateral activity in medial Lobule VI. A conjunction of two independent language tasks localised activity during verb generation in right Lobule VI‐Crus I, which overlapped with activity during VWM. These results demonstrate spatial compartmentalisation of sensorimotor and cognitive function in the human cerebellum, with each area involved in more than one aspect of a given behaviour, consistent with an integrative function. Sensorimotor localisation was uniform across individuals, but the representation of cognitive tasks was more variable, highlighting the importance of individual scans for mapping higher order functions within the cerebellum.     

The effect of damage to the cerebellum on sensorimotor and cognitive function in children and adolescents

This review provides a developmental perspective on our current understanding of the role of the cerebellum for sensorimotor and cognitive function. A synopsis on the contribution of the cerebellum on motor control, learning and cognition based on experiments in human adults and animals is presented. This knowledge is contrasted to the relevant literature on children and adolescents. Special attention is given to findings derived from lesion studies and clinical reports that examined the effect of cerebellar damage during development. In general, it is established that children may show the same sensorimotor deficits as adults as a result of cerebellar damage, while the findings of cognitive dysfunction in children are less clear and remain controversial. Younger children do not necessarily recover better than older children or adolescents. The sparing of the deep cerebellar nuclei and the extent of adjuvant chemo- or radiation therapy are better predictors of later motor and cognitive function in children and adolescents.     

The cerebellum: from motor coordination to cognitive function

Clinical data in man, as well as experimental results in animals, classically involve the cerebellum in the coordination of ballistic movements and in their accompanying postural adjustment. The cerebellum intervenes in the coding of the order and duration of contraction of the different protagonist muscular groups contributing to the same movement. In normal life, this is an automatic, non conscious procedure. Recent studies seem to indicate that the human neocerebellum (lateral hemispheres and dentate nuclei) plays a role in the regulation of some neocortical cognitive functions. This new functional aspect of cerebellar activity has been inferred from the results obtained by three quite different domains: neuroanatomical data showing the existence of, sometimes reciprocal, pathways between the neocerebellum and associative and limbic areas in primates, neuropsychological data assessing the presence, in some cerebellar patients, of purely cognitive impairments, and data from functional imagery pointing out cerebellar activation in healthy subjects during non motor tasks. II would ensue that, thanks to new cortical targets. The cerebellum could regulate sensorial, procedural, linguistic and emotional activities, so that a cerebellar lesion could be followed by a cognitive and affective syndrome, depending on the importance and on the location of the lesion.     

The cerebellum and learning processes in animals

In theories of motor learning, the cerebellum is assumed to be the storage site of the engram. Recent evidence is presented that the cerebellum, in addition to its mediation of learning of simple motor responses, has a role in cognitive behaviors. For this type of learning, it is possible that the storage site is not the cerebellum, but cerebellar target areas.The possible role of the cerebellum in spatial learning and discrimination learning is emphasized. Ascending cerebellar afferents to fronto-parietal association cortex, the limbic system and the superior colliculus and feedback loops from these areas may be the anatomical basis underlying cerebellar modulation of spatial learning. In regard to discrimination learning, the possible significance of pathways arising from the visual cortex to pontine nuclei projecting to the cerebellar hemispheres must be evaluated.Although much remains to be resolved, the cerebellum seems to contribute to various emotions such as fear, the neural basis of which being cerebellar contributions to the reticular activating system, the limbic system and two-way hypothalamo-cerebellar connections.