Abstract
Objective: The cerebellar functional laterality, with its right hemisphere predominantly involved in verbal performance and the left one engaged in visuospatial processes, has strong empirical support. However, the clinical observation and single research results show that the damage to the right cerebellar hemisphere may cause extralinguistic and more global cognitive decline. The aim of our research was to assess the pattern of cognitive functioning, depending on the cerebellar lesion side, with particular emphasis on the damage to the right cerebellar hemisphere.Method: The study sample consisted of 31 patients with focal cerebellar lesions and 31 controls, free of organic brain damage. The Addenbrooke’s Cognitive Examination ACE III and the Trail Making Test TMT were used to assess patients’ cognitive functioning.Results: Left-sided cerebellar lesion patients scored lower than controls in attention and visuospatial domain, but not in language, fluency, and memory functions. Participants with right-sided cerebellar lesion demonstrated a general deficit of cognitive functioning, with impairments not only in language and verbal fluency subscales but also in all ACE III domains, including memory, attention, and visuospatial functions. The TMT results proved that cerebellar damage is associated with executive function impairment, regardless of the lesion side.Conclusion: The cognitive profiles of patients with cerebellum lesions differ with regard to the lesion side. Left-sided cerebellar lesions are associated with selective visuospatial and attention impairments, whereas the right-sided ones may result in a more global cognitive decline, which is likely secondary to language deficiencies, associated with this lateral cerebellar injury.
Highlights
Cerebellar cognitive affective syndrome was proposed to reflect a constellation of deficits in: (a) executive function; (b) visuospatial cognition; (c) language; and (d) emotion (Schmahmann and Sherman, 1998)
A further research confirmed that damage limited to the cerebellum may cause deficits in several cognitive processes, such as working memory (Ziemus et al, 2007; Hautzel et al, 2009; Marvel and Desmond, 2010; Misciagna et al, 2010; Marvel et al, 2012; Baier et al, 2014), phonological short-term memory (Ph-STM) (Timmann and Daum, 2007), episodic memory (Andreasen et al, 1999; Exner et al, 2004; Fliessbach et al, 2007), attention and processing speed (Steinlin et al, 2003; Beebe et al, 2005), executive functions including planning and sequencing (Levisohn et al, 2000), visuospatial functions (Starowicz-Filip et al, 2017), and word fluency (Arasanz et al, 2012)
The cerebellar involvement in the regulation of cognitive processes is strongly supported by the neuroanatomy and neuroimage date, which provide evidence of the existence of pathways between the cerebellum and associative cortex areas, especially prefrontal and posterior parietal cortex, involved in higher cognitive functions (Schmahmann, 1996)
Summary
Cerebellar cognitive affective syndrome was proposed to reflect a constellation of deficits in: (a) executive function (deficient set-shifting, verbal fluency, multitasking, planning, sequencing, and organizing activities); (b) visuospatial cognition (visuospatial disintegration, deficit in copying, and conceptualizing drawn figures); (c) language (agrammatism, dysnomia, and dysprosodia); and (d) emotion (flattening of affect or disinhibition, impulsive actions, overfamiliarity, regressive, and childlike behavior in some patients) (Schmahmann and Sherman, 1998). The cerebellar involvement in the regulation of cognitive processes is strongly supported by the neuroanatomy and neuroimage date, which provide evidence of the existence of pathways between the cerebellum and associative cortex areas, especially prefrontal and posterior parietal cortex, involved in higher cognitive functions (Schmahmann, 1996). Hypo- and hypermetria in the motor activation, observed in the cerebellar damage, can be extended to the non-motor domain and manifests as the cerebellar cognitive affective syndrome Cerebellar cognitive affective syndrome with visuospatial impairments, linguistic deficits, executive dysfunction, and affective disturbances (Schmahmann and Sherman, 1998)
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