Cerebellum In Cognitive Functions Research Articles

The Cerebellum and Cognitive Function: Anatomical Evidence from a Transdiagnostic Sample

Multiple lines of evidence across human functional, lesion, and animal data point to a cerebellar role, in particular of crus I, crus II, and lobule VIIB, in cognitive function. However, a mapping of distinct facets of cognitive function to cerebellar structure is missing. We analyzed structural neuroimaging data from the Healthy Brain Network (HBN). Cerebellar parcellation was performed with a validated automated segmentation pipeline (CERES) and stringent visual quality check (n = 662 subjects retained from initial n = 1452). Canonical correlation analyses (CCA) examined regional gray matter volumetric (GMV) differences in association to cognitive function (quantified with NIH Toolbox Cognition domain, NIH-TB), accounting for psychopathology severity, age, sex, scan location, and intracranial volume. Multivariate CCA uncovered a significant correlation between two components entailing a latent cognitive canonical (NIH-TB subscales) and a brain canonical variate (cerebellar GMV and intracranial volume, ICV), surviving bootstrapping and permutation procedures. The components correspond to partly shared cerebellar-cognitive function relationship with a first map encompassing cognitive flexibility (r = 0.89), speed of processing (r = 0.65), and working memory (r = 0.52) associated with regional GMV in crus II (r = 0.57) and lobule X (r = 0.59) and a second map including the crus I (r = 0.49) and lobule VI (r = 0.49) associated with working memory (r = 0.51). We show evidence for a structural subspecialization of the cerebellum topography for cognitive function in a transdiagnostic sample.

The cerebellum and cognitive neural networks.

Cognitive function represents a complex neurophysiological capacity of the human brain, encompassing a higher level of neural processing and integration. It is widely acknowledged that the cerebrum plays a commanding role in the regulation of cognitive functions. However, the specific role of the cerebellum in cognitive processes has become a subject of considerable scholarly intrigue. In 1998, Schmahmann first proposed the concept of "cognitive affective syndrome (CCAS)," linking cerebellar damage to cognitive and emotional impairments. Since then, a substantial body of literature has emerged, exploring the role of the cerebellum in cognitive neurological function. The cerebellum's adjacency to the cerebral cortex, brainstem, and spinal cord suggests that the cerebral-cerebellar network loops play a crucial role in the cerebellum's participation in cognitive neurological functions. In this review, we comprehensively examine the recent literature on the involvement of the cerebellum in cognitive functions from three perspectives: the cytological basis of the cerebellum and its anatomical functions, the cerebellum and cognitive functions, and Crossed cerebellar diaschisis. Our aim is to shed light on the role and mechanisms of the cerebellum in cognitive neurobrain networks.

Cerebellar control of thalamocortical circuits for cognitive function: A review of pathways and a proposed mechanism.

There is general agreement that cerebrocerebellar interactions via cerebellothalamocortical pathways are essential for a cerebellar cognitive and motor functions. Cerebellothalamic projections were long believed target mainly the ventral lateral (VL) and part of the ventral anterior (VA) nuclei, which project to cortical motor and premotor areas. Here we review new insights from detailed tracing studies, which show that projections from the cerebellum to the thalamus are widespread and reach almost every thalamic subnucleus, including nuclei involved in cognitive functions. These new insights into cerebellothalamic pathways beyond the motor thalamus are consistent with the increasing evidence of cerebellar cognitive function. However, the function of cerebellothalamic pathways and how they are involved in the various motor and cognitive functions of the cerebellum is still unknown. We briefly review literature on the role of the thalamus in coordinating the coherence of neuronal oscillations in the neocortex. The coherence of oscillations, which measures the stability of the phase relationship between two oscillations of the same frequency, is considered an indicator of increased functional connectivity between two structures showing coherent oscillations. Through thalamocortical interactions coherence patterns dynamically create and dissolve functional cerebral cortical networks in a task dependent manner. Finally, we review evidence for an involvement of the cerebellum in coordinating coherence of oscillations between cerebral cortical structures. We conclude that cerebellothalamic pathways provide the necessary anatomical substrate for a proposed role of the cerebellum in coordinating neuronal communication between cerebral cortical areas by coordinating the coherence of oscillations.

A Method for the Study of Cerebellar Cognitive Function-Re-Cognition and Validation of Error-Related Potentials.

The cerebellar region has four times as many brain cells as the brain, but whether the cerebellum functions in cognition, and how it does so, remain unexplored. In order to verify whether the cerebellum is involved in cognition, we chose to investigate whether the cerebellum is involved in the process of error judgment. We designed an experiment in which we could activate the subject’s error-related potentials (ErrP). We recruited 26 subjects and asked them to wear EEG caps with cerebellar regions designed by us to participate in the experiment so that we could record their EEG activity throughout the experiment. We successfully mitigated the majority of noise interference after a series of pre-processing of the data collected from each subject. Our analysis of the preprocessed data revealed that our experiment successfully activated ErrP, and that the EEG signals, including the cerebellum, were significantly different when subjects made errors compared to when they made correct judgments. We designed a feature extraction method that requires selecting channels with large differences under different classifications, firstly by extracting the time-frequency features of these channels, and then screening these features with sequence backward feature (SBS) selection. We use the extracted features as the input and different event types in EEG data as the labels for multiple classifiers to classify the data in the executive and feedback segments, where the average accuracy for two-class classification of executive segments can reach 80.5%. The major contribution of our study is the discovery of the presence of ErrP in cerebellar regions and the extraction of an effective feature extraction method for EEG data.

IMG-03. Impact of childhood cerebellar tumor surgery on cognition: Can fMRI serve as a surrogate marker?

BACKGROUND: Childhood cerebellar pilocytic astrocytomas harbour excellent overall survival rates after surgical resection, but the patients may exhibit specific cognitive and behavioural problems emphasising our current understanding of the cerebellar role in cognition. Functional MRI has catalysed the mechanistic insights into brain functional systems and has already been linked with the neuropsychological performance. We aimed to exploit the question whether functional MRI can be used as a surrogate measure for the cognitive outcome assessment of these patients. METHODS: We investigated 13 patients (median age 22.0 years, range 15.2 – 31.7) after a median interval between surgery and examination of 15.0 years (range 4.2 – 20.8) and 16 matched controls. All subjects underwent a functional 3T MRI scans in a resting state condition and a battery neuropsychological tests. RESULTS: Patients showed a significantly increased functional connectivity in the precuneus compared to controls (p<0.05) and at the same time impairments in various domains of neuropsychological functioning such as a lower mean WIE IQ percentile (M = 48.62, SD = 29.14), lower scores in the TMT letter sequencing (M = 49.54, SD = 30.66), worse performance on the WIE subtest Digit Symbol Coding (M = 38.92, SD = 35.29), subtest Symbol Search (M = 40.75, SD = 35,28), and TAP divided attention task (M = 783.92, SD = 73.20). CONCLUSION: Functional MRI has the potential to serve as a surrogate measure for the cognitive outcome assessment. The precuneus brain region is heavily involved in the cerebral associative oversight of cerebellar cognitive function.

Portable Neuroimaging-Guided Noninvasive Brain Stimulation of the Cortico-Cerebello-Thalamo-Cortical Loop-Hypothesis and Theory in Cannabis Use Disorder.

Background: Maladaptive neuroplasticity-related learned response in substance use disorder (SUD) can be ameliorated using noninvasive brain stimulation (NIBS); however, inter-individual variability needs to be addressed for clinical translation. Objective: Our first objective was to develop a hypothesis for NIBS for learned response in SUD based on a competing neurobehavioral decision systems model. The next objective was to develop the theory by conducting a computational simulation of NIBS of the cortico-cerebello-thalamo-cortical (CCTC) loop in cannabis use disorder (CUD)-related dysfunctional “cue-reactivity”—a construct closely related to “craving”—that is a core symptom. Our third objective was to test the feasibility of a neuroimaging-guided rational NIBS approach in healthy humans. Methods: “Cue-reactivity” can be measured using behavioral paradigms and portable neuroimaging, including functional near-infrared spectroscopy (fNIRS) and electroencephalogram (EEG) metrics of sensorimotor gating. Therefore, we conducted a computational simulation of NIBS, including transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS) of the cerebellar cortex and deep cerebellar nuclei (DCN) of the CCTC loop for its postulated effects on fNIRS and EEG metrics. We also developed a rational neuroimaging-guided NIBS approach for the cerebellar lobule (VII) and prefrontal cortex based on a healthy human study. Results: Simulation of cerebellar tDCS induced gamma oscillations in the cerebral cortex, while transcranial temporal interference stimulation induced a gamma-to-beta frequency shift. A preliminary healthy human study (N = 10) found that 2 mA cerebellar tDCS evoked similar oxyhemoglobin (HbO) response in the range of 5 × 10−6 M across the cerebellum and PFC brain regions (α = 0.01); however, infra-slow (0.01–0.10 Hz) prefrontal cortex HbO-driven phase–amplitude-coupled (PAC; 4 Hz, ±2 mA (max)) cerebellar tACS evoked HbO levels in the range of 10−7 M that were statistically different (α = 0.01) across these brain regions. Conclusion: Our healthy human study showed the feasibility of fNIRS of cerebellum and PFC and closed-loop fNIRS-driven ctACS at 4 Hz, which may facilitate cerebellar cognitive function via the frontoparietal network. Future work needs to combine fNIRS with EEG for multi-modal imaging for closed-loop NIBS during operant conditioning.

Cerebellar Coordination of Neuronal Communication in Cerebral Cortex.

Cognitive processes involve precisely coordinated neuronal communications between multiple cerebral cortical structures in a task specific manner. Rich new evidence now implicates the cerebellum in cognitive functions. There is general agreement that cerebellar cognitive function involves interactions between the cerebellum and cerebral cortical association areas. Traditional views assume reciprocal interactions between one cerebellar and one cerebral cortical site, via closed-loop connections. We offer evidence supporting a new perspective that assigns the cerebellum the role of a coordinator of communication. We propose that the cerebellum participates in cognitive function by modulating the coherence of neuronal oscillations to optimize communications between multiple cortical structures in a task specific manner.

Cerebellar atrophy in non‐fluent variant primary progressive aphasia correlates with disease severity and cognitive decline

AbstractBackgroundThe role of the cerebellum in cognitive function has been extensively investigated in the last decades. The aim of our work was to characterize cerebellar atrophy in non‐fluent variant primary progressive atrophy (nfvPPA) and to determine whether its atrophy is associated with cognitive impairment.MethodSixteen patients with nfvPPA (mean age 59.6±9.2 years, 7 males) and 10 healthy controls (65.6±11.3 years, 4 males) were included in the study. Disease duration ranged from 12 to 84 months. Notably, the patients had no clinical signs of cerebellar involvement. All participants underwent brain MRI and cognitive assessment. A whole brain VBM analysis between patients and controls was carried out using SPM12. The relationship between clinical data and grey matter atrophy of cerebellum and its distinct areas (anterior lobe, posterior lobe, vermis, left and right hemispheres) was assessed by correlation analysis using the Spearman's rank correlation coefficient.ResultVBM revealed a significant decline in grey matter (GM) volume in the anterior (specifically, 4, 5 and 6 lobules) and posterior (specifically, Crus I and II, 7b and 8 lobules) cerebellar lobes bilaterally compared to controls (Figure 1). Correlation analysis revealed a significant correlation between the posterior lobe GM volume and disease severity and total Addenbrooke Cognitive Examination score (r = ‒0.62, p = 0.01 and r = 0.69, p = 0.028, respectively). No correlations with other clinical manifestations and neuropsychological findings (disease duration, total MoCA and FAB scores, semantic and literal verbal fluency, Trail Making Test part B) were detected.ConclusionThe findings demonstrate that, even in the absence of clinical signs of cerebellar involvement, prominent cerebellar atrophy is characteristic of nfvPPA. This atrophy is associated with disease severity and contributes to cognitive dysfunction.The study was supported by RFBR 19‐015‐00533.

Patterns of Cerebellar Gray Matter Atrophy Across Alzheimer's Disease Progression.

The role of the cerebellum in cognitive function has been broadly investigated in the last decades from an anatomical, clinical, and functional point of view and new evidence points toward a significant contribution of the posterior lobes of the cerebellum in cognition in Alzheimer’s disease (AD). In the present work we used SUIT-VBM (spatially unbiased infratentorial template, voxel-based morphometry) to perform an analysis of the pattern of cerebellar gray matter (GM) atrophy in amnestic mild cognitive impairment (a-MCI) and AD dementia patients compared to healthy subjects (HS), in order to follow the changes of non-motor features of cerebellar degeneration throughout disease progression. This template has been validated to guarantee a significant improvement in voxel-to-voxel alignment of the individual fissures and the deep cerebellar nuclei compared to Montreal Neurological Institute (MNI) whole-brain template. Our analysis shows a progression of cerebellar GM volume changes throughout a continuous spectrum from early to late clinical stages of AD. In particular vermis and paravermian areas of the anterior (I-V) and posterior (VI) lobes are involved since the a-MCI stage, with a later involvement of the hemispheric part of the posterior lobes (VI lobule) and Crus I in AD dementia patients only. These findings support the role of the cerebellum in higher-level functions, and whilst confirming previous data on the involvement of Crus I in AD dementia, provide new evidence of an involvement of the vermis in the early stages of the disease.

The cerebellum: from development to structural complexity and motor learning.

The cerebellum: from development to structural complexity and motor learning.

Cognitive disorders in pediatric medulloblastoma: what neuroimaging has to offer.

Medulloblastomas are the most common malignant childhood brain tumors arising in the posterior fossa. Treatment improvements for these tumors have meant that there are a greater number of survivors, but this long-term patient survival has increased the awareness of resulting neurocognitive deficits. Impairments in attention, memory, executive functions, and intelligence quotient demonstrate that the cerebellum likely plays a significant role in numerous higher cognitive functions such as language, cognitive, and emotional functions. In addition, children with medulloblastoma not only have cerebellar lesions but also brain white matter damages due to radiation and chemotherapy. Functional neuroimaging, a noninvasive method with many advantages, has become the standard tool in clinical and cognitive neuroscience research. By reviewing functional neuroimaging studies, this review aims to clarify the role of the cerebellum in cognitive function and explain more clearly cognitive sequelae due to polytherapy in children with medulloblastoma. This review suggests that the posterior cerebellar lobes are crucial to maintaining cognitive performance. Clinical investigations could help to better assess the involvement of these lobes in cognitive functions.

Cerebellar damage impairs executive control and monitoring of movement generation.

Executive control of motor responses is a psychological construct of the executive system. Several studies have demonstrated the involvement of the cerebral cortex, basal ganglia, and thalamus in the inhibition of actions and monitoring of performance. The involvement of the cerebellum in cognitive function and its functional interaction with basal ganglia have recently been reported. Based on these findings, we examined the hypothesis of cerebellar involvement in executive control by administering a countermanding task in patients with focal cerebellar damage. The countermanding task requires one to make a movement in response to a ‘go’ signal and to halt it when a ‘stop’ signal is presented. The duration of the go process (reaction time; RT), the duration of the stop process (stop signal reaction time; SSRT), and their relationship, expressed by a psychometric function, are recorded as measures of executive control. All patients had longer go process duration in general and in particular, as a proactive control, as demonstrated by the increase in RT after erroneously performed stop trials. Further, they were defective in the slope of the psychometric function indicating a difficulty on triggering the stop process, although the SSRT did not differ from controls. Notably, their performance was worse when lesions affected deep cerebellar nuclei. Our results support the hypothesis that the cerebellum regulates the executive control of voluntary actions. We speculate that its activity is attributed to specific cerebellar influence over the cortico-striatal loop.

Age-Dependent Impairment of Eyeblink Conditioning in Prion Protein-Deficient Mice

Mice lacking the prion protein (PrPC) gene (Prnp), Ngsk Prnp 0/0 mice, show late-onset cerebellar Purkinje cell (PC) degeneration because of ectopic overexpression of PrPC-like protein (PrPLP/Dpl). Because PrPC is highly expressed in cerebellar neurons (including PCs and granule cells), it may be involved in cerebellar synaptic function and cerebellar cognitive function. However, no studies have been conducted to investigate the possible involvement of PrPC and/or PrPLP/Dpl in cerebellum-dependent discrete motor learning. Therefore, the present cross-sectional study was designed to examine cerebellum-dependent delay eyeblink conditioning in Ngsk Prnp 0/0 mice in adulthood (16, 40, and 60 weeks of age). The aims of the present study were two-fold: (1) to examine the role of PrPC and/or PrPLP/Dpl in cerebellum-dependent motor learning and (2) to confirm the age-related deterioration of eyeblink conditioning in Ngsk Prnp 0/0 mice as an animal model of progressive cerebellar degeneration. Ngsk Prnp 0/0 mice aged 16 weeks exhibited intact acquisition of conditioned eyeblink responses (CRs), although the CR timing was altered. The same result was observed in another line of PrPc-deficient mice, ZrchI PrnP 0/0 mice. However, at 40 weeks of age, CR incidence impairment was observed in Ngsk Prnp 0/0 mice. Furthermore, Ngsk Prnp 0/0 mice aged 60 weeks showed more significantly impaired CR acquisition than Ngsk Prnp 0/0 mice aged 40 weeks, indicating the temporal correlation between cerebellar PC degeneration and motor learning deficits. Our findings indicate the importance of the cerebellar cortex in delay eyeblink conditioning and suggest an important physiological role of prion protein in cerebellar motor learning.

Congenital hypoplasia of the cerebellum: developmental causes and behavioral consequences

Over the last 60 years, the spotlight of research has periodically returned to the cerebellum as new techniques and insights have emerged. Because of its simple homogeneous structure, limited diversity of cell types and characteristic behavioral pathologies, the cerebellum is a natural home for studies of cell specification, patterning, and neuronal migration. However, recent evidence has extended the traditional range of perceived cerebellar function to include modulation of cognitive processes and implicated cerebellar hypoplasia and Purkinje neuron hypo-cellularity with autistic spectrum disorder. In the light of this emerging frontier, we review the key stages and genetic mechanisms behind cerebellum development. In particular, we discuss the role of the midbrain hindbrain isthmic organizer in the development of the cerebellar vermis and the specification and differentiation of Purkinje cells and granule neurons. These developmental processes are then considered in relation to recent insights into selected human developmental cerebellar defects: Joubert syndrome, Dandy–Walker malformation, and pontocerebellar hypoplasia. Finally, we review current research that opens up the possibility of using the mouse as a genetic model to study the role of the cerebellum in cognitive function.

Role of the Cerebellum in Cognitive Function

Researchers in the Department of Psychology, University of Rome, Italy, retrospectively analyzed charts from patients in the Ataxia Lab of Santa Lucia Foundation between 1997 and 2007, focusing on the role of the cerebellum in cognition.

小脳と眼球運動―視標追跡眼球運動をモデルとした基礎研究と臨床応用―

Recent studies implicate the cerebellum in cognitive functions in addition to its well-established roles in motor control and learning. Using a memory-based smooth-pursuit task that separates visual working memory from motor preparation and execution, monkeys were trained to pursue (i.e., go) or not pursue (i.e., no-go), a cued direction, based on the working memory of visual motion-direction and a go/no-go instruction. Task-related neuronal activity was examined in cerebral and cerebellar major smooth-pursuit pathways. Different cerebral and cerebellar areas carried distinctly different signals during memory-based smooth-pursuit. In the cerebellum, prediction-related signals (visual working memory, pursuit selection and movement preparation) were represented in the vermal lobules VI-VII and caudal fastigial nucleus, whereas the floccular region (flocculus and ventral paraflocculus) contained predominantly execution-related signals. This task was applied to patients with cerebellar degeneration and idiopathic Parkinson's disease (PD). None of the PD patients tested exhibited impaired working memory of motion-direction and/or go/no-go selection, but they did show task-specific difficulty in generating an initial smooth-pursuit component, suggesting difficulty in smooth-pursuit preparation. In contrast, most cerebellar patients exhibited impaired visual working memory in addition to difficulty in preparing for and executing smooth-pursuit. These results suggest different roles for the basal ganglia and cerebellum in smooth-pursuit planning.

Síndrome de Joubert: a propósito de cuatro hermanos adultos afectados

Joubert syndrome is a rare, autosomal recessive genetic transmission illness, with ten associated genes discovered at the time. They code for primary ciliary proteins; that is why Joubert syndrome is considered a 'ciliopathie'. The primary cilia are involved in cell proliferation and neuronal migration in cerebellum and axonal brain, being essential for their proper development. The first description was made in 1969 by Marie Joubert and colleagues. They reported four cases with partial or total agenesis of the cerebellar vermis, apnea-hyperpnea neonatal episodic, abnormal eye movements, ataxia and mental retardation. One of them also showed occipital meningoencephalocele. Four adult individuals affected by the disease are described. All of them biological siblings, within 24-35 years old, and presenting the 'sign of the molar' midbrain in their clinical and neuroimaging. It is an entity characteristic, with the image formed by agenesis or hypoplasia of the cerebellar vermis, superior cerebellar peduncle narrow, flatten, thickened and elongated with a lack of decussation and deep interpeduncular fossa at the level of the isthmus and upper bridges. This study shows the need for early disease diagnosis to ensure proper monitoring, therapeutic approach and family genetic counseling, as well as the role of the cerebellum in cognitive functions and intelligence development.

Influence of cerebellar malformations on cerebral volume: does it matter?

The cerebellum is not only important for motor functions, but also affects a wide range of cognitive tasks including executive functions, spatial perception, language and speech, and affective functions. This was highlighted by Schmahmann and Sherman1 in their description and conceptualization of the cerebellar cognitive affective syndrome (CCAS). Since then, the impact of the cerebellum on cognitive functions has been increasingly shown in cerebellar malformations.2 Even though the pattern of cognitive impairment in cerebellar malformations is less specific than in acquired focal cerebellar lesions, it is still reminiscent of the CCAS. The anatomical basis of the cerebellar role in higher cognitive functions is the existence of cerebro-cerebellar connections (cortico-ponto-cerebellar and cerebello-thalamo-cortical loops) that link the cerebellum with associative regions in the prefrontal, posterior parietal, superior temporal polymodal regions, and dorsal parastriate cortices as well as with the limbic/paralimbic regions. The interaction between cerebellum and cerebrum may affect the anatomical structures involved in terms of volume. In preterm infants, unilateral cerebral parenchymal brain injuries have been shown to result in subsequent impairment in the contralateral cerebellar volume and, conversely, primary unilateral cerebellar injuries were reported to be associated with impaired contralateral cerebral brain volume at term.3 Bolduc et al.4 demonstrate that cerebellar volumetric impairment is associated with altered growth in specific cerebral regions and attribute this to cerebellar malformations.5 Although the small number of children included and the heterogeneous cohort of patients may be limitations of the study (in terms of different cerebellar malformations), the authors demonstrated significantly reduced volume in the deep grey matter nuclei, inferior occipital grey matter, and subgenual and midtemporal white matter. The developing cerebrum, therefore, appears to require an intact cerebellum to achieve its normal structure and volume as the result of a trophic transynaptic effect. The authors hypothesize that the associated regional reductions in cerebral volumes may represent a possible mechanism underlying developmental disabilities and cognitive impairment in children with cerebellar malformations. The interaction between cerebellum and cerebrum, however, is not limited only to a trophic transsynaptic effect, but may also lead to a cerebral cortical functional impairment. The posterior fossa syndrome is a particularly acute form of the CCAS characterized by cerebellar dysfunction, oromotor apraxia, emotional lability, and mutism in patients after infratentorial injury. This syndrome is a good example of functionally disrupted cerebro-cerebellar connections.6 In children with the posterior fossa syndrome, low fractional anisotropy values in the bilateral superior cerebellar peduncles, bilateral fornices, white matter region proximate to the right angular gyrus, and white matter region proximate to the left superior frontal gyrus have been found.6 These results show that proximal lesions of the dentato-thalamo-cortical pathway may lead to a functional disconnection between the cerebellum and the associate cortical regions and, subsequently, cause the characteristic neurocognitive impairment in the posterior fossa syndrome. I am not aware of any study in the literature showing cerebro-cerebellar functional disconnection in cerebellar malformations. It is plausible that in cerebellar malformations, both regional reductions in cerebral volumes due to a transynaptic trophic effect as well as functional disconnection in the cerebro-cerebellar white matter pathway may play a pathogenetic role causing cognitive problems. The combination of volumetric and connectivity studies may further increase our understanding of the role of the cerebellum in cognitive functions.

The Role of Cerebellar Rehabilitation in Improvement of ADHD Imbalance

Back to table of contents Previous article Next article LettersFull AccessThe Role of Cerebellar Rehabilitation in Improvement of ADHD ImbalanceMona Delavarian, M.D., and Shahriar Gharibzadeh, M.D.Mona DelavarianSearch for more papers by this author, M.D., and Shahriar GharibzadehSearch for more papers by this author, M.D.Published Online:1 Oct 2011https://doi.org/10.1176/jnp.23.4.jnpe34AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Attention deficit hyperactivity disorder (ADHD) is a relatively common neurobehavioral disorder.1 Children with ADHD have continuous symptoms of inattention, hyperactivity, and/or impulsivity in more than one setting, such as at home, school, and work.2,3 Several studies have focused on ADHD balance dysfunction, which affects many gross and fine motor activities, and most of these studies attribute it to inattentiveness4,5 and even have suggested attention exercises to improve the problem.5 On the other hand, SPECT studies in ADHD have identified some decreased activities in different parts of the CNS, including the cerebellum.7 Also, many MRI morphologic studies have identified some differences between the cerebellum of normal-control children and those with ADHD.1On the basis of the above-mentioned points, we hypothesize that cerebellar disturbances are probably involved in ADHD balance dysfunction. It is worth noting that the cerebellum has a dual effect in this area: not only is it involved directly in equilibrium, but there is also strong evidence for the role of the cerebellum in cognitive functions including attention.8 We have observed in a preliminary small clinical trial that “cerebellar rehabilitation exercises,” which are typically used in ataxia rehabilitation, improve ADHD balance dysfunction. These exercises involve proprioceptive, vestibular, and visual systems, all of which are in close relationship with the cerebellum.9 We suggest that cerebellar rehabilitation will improve both balance and attention in these children. Of course, for confirming this hypothesis, larger clinical trials are needed.Biomedical Engineering Faculty, Amirkabir University of Technology, Tehran, IranCorrespondence: [email protected]ac.ir1. Voeuer Kytja KS : Attention-deficit hyperactivity disorder (ADHD). J Child Neurol 2004; 19:798–814Crossref, Medline, Google Scholar2. Sadock BJ , Sadock VA : Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 10th Edition. Lippincott Williams & Wilkins, 2007Google Scholar3. Delavarian M , Towhidkhah F , Dibajnia P , et al.: Designing a decision-support system for distinguishing ADHD from similar child behavioral disorders. J Med Systems 2010; Sept.; E-pub ahead of printMedline, Google Scholar4. Aranha KM : A Comparison of Postural Control: Typical Developing Children vs. Children With ADHD. A Thesis in Exercise and Sport Science, 2006Google Scholar5. Leitner Y , Barak R , Giladi N , et al.: Gait in attention-deficit hyperactivity disorder: effects of methylphenidate and dual-tasking. J Neurol 2007; 254:1330–1338Crossref, Medline, Google Scholar6. Ghanizadeh A : Predictors of postural stability in children with ADHD. J Attention Disord 2011; 15:604–610Crossref, Medline, Google Scholar7. Dunn S , Sharman J : Understanding ADHD. MIND 1998; 1:16Google Scholar8. Baldaçara L , Borgio JGF , de Lacerda ALT , et al.: Cerebellum and psychiatric disorders. Rev Bras Psiquiatr 2008; 30:281–289Crossref, Medline, Google Scholar9. Armutlu K : Ataxia: physical therapy and rehabilitation applications for ataxic patients. Int Encyclopedia of Rehabilitation, State University of New York at Buffalo, Center for International Rehabilitation Research and Exchange (CIRRIE), 2010; 1:19Google Scholar FiguresReferencesCited byDetailsCited byJournal of adapted physical activity and exercise, Vol. 23, No. 3Increasing Performance in Children With ADHD By Trapping Lead With a Nano-ZeoliteMona Delavarian, Ph.D. student, Ali Hassanvand, M.Sc., and Shahriar Gharibzadeh, M.D., Ph.D.1 January 2013 | The Journal of Neuropsychiatry and Clinical Neurosciences, Vol. 25, No. 1The Effect of Visual and Cerebellar Exercises on DyslexiaMona Delavarian, M.D., G. Ali Afrooz, M.D., and Shahriar Gharibzadeh, M.D., Ph.D.1 January 2013 | The Journal of Neuropsychiatry and Clinical Neurosciences, Vol. 25, No. 1 Volume 23Issue 4 Fall 2011Pages E34-E34 Metrics PDF download History Published online 1 October 2011 Published in print 1 October 2011

The Role of Cerebellar Rehabilitation in Improvement of ADHD Imbalance

Back to table of contents Previous article Next article LettersFull AccessThe Role of Cerebellar Rehabilitation in Improvement of ADHD ImbalanceMona Delavarian, M.D., and Shahriar Gharibzadeh, M.D.Mona DelavarianSearch for more papers by this author, M.D., and Shahriar GharibzadehSearch for more papers by this author, M.D.Published Online:1 Oct 2011https://doi.org/10.1176/jnp.23.4.jnpe34AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Attention deficit hyperactivity disorder (ADHD) is a relatively common neurobehavioral disorder.1 Children with ADHD have continuous symptoms of inattention, hyperactivity, and/or impulsivity in more than one setting, such as at home, school, and work.2,3 Several studies have focused on ADHD balance dysfunction, which affects many gross and fine motor activities, and most of these studies attribute it to inattentiveness4,5 and even have suggested attention exercises to improve the problem.5 On the other hand, SPECT studies in ADHD have identified some decreased activities in different parts of the CNS, including the cerebellum.7 Also, many MRI morphologic studies have identified some differences between the cerebellum of normal-control children and those with ADHD.1On the basis of the above-mentioned points, we hypothesize that cerebellar disturbances are probably involved in ADHD balance dysfunction. It is worth noting that the cerebellum has a dual effect in this area: not only is it involved directly in equilibrium, but there is also strong evidence for the role of the cerebellum in cognitive functions including attention.8 We have observed in a preliminary small clinical trial that “cerebellar rehabilitation exercises,” which are typically used in ataxia rehabilitation, improve ADHD balance dysfunction. These exercises involve proprioceptive, vestibular, and visual systems, all of which are in close relationship with the cerebellum.9 We suggest that cerebellar rehabilitation will improve both balance and attention in these children. Of course, for confirming this hypothesis, larger clinical trials are needed.Biomedical Engineering Faculty, Amirkabir University of Technology, Tehran, IranCorrespondence: [email protected]ac.ir1. Voeuer Kytja KS : Attention-deficit hyperactivity disorder (ADHD). J Child Neurol 2004; 19:798–814Crossref, Medline, Google Scholar2. Sadock BJ , Sadock VA : Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 10th Edition. Lippincott Williams & Wilkins, 2007Google Scholar3. Delavarian M , Towhidkhah F , Dibajnia P , et al.: Designing a decision-support system for distinguishing ADHD from similar child behavioral disorders. J Med Systems 2010; Sept.; E-pub ahead of printMedline, Google Scholar4. Aranha KM : A Comparison of Postural Control: Typical Developing Children vs. Children With ADHD. A Thesis in Exercise and Sport Science, 2006Google Scholar5. Leitner Y , Barak R , Giladi N , et al.: Gait in attention-deficit hyperactivity disorder: effects of methylphenidate and dual-tasking. J Neurol 2007; 254:1330–1338Crossref, Medline, Google Scholar6. Ghanizadeh A : Predictors of postural stability in children with ADHD. J Attention Disord 2011; 15:604–610Crossref, Medline, Google Scholar7. Dunn S , Sharman J : Understanding ADHD. MIND 1998; 1:16Google Scholar8. Baldaçara L , Borgio JGF , de Lacerda ALT , et al.: Cerebellum and psychiatric disorders. Rev Bras Psiquiatr 2008; 30:281–289Crossref, Medline, Google Scholar9. Armutlu K : Ataxia: physical therapy and rehabilitation applications for ataxic patients. Int Encyclopedia of Rehabilitation, State University of New York at Buffalo, Center for International Rehabilitation Research and Exchange (CIRRIE), 2010; 1:19Google Scholar FiguresReferencesCited byDetailsCited ByJournal of adapted physical activity and exercise, Vol. 23, No. 3Increasing Performance in Children With ADHD By Trapping Lead With a Nano-ZeoliteMona Delavarian, Ph.D. student, Ali Hassanvand, M.Sc., and Shahriar Gharibzadeh, M.D., Ph.D.1 January 2013 | The Journal of Neuropsychiatry and Clinical Neurosciences, Vol. 25, No. 1The Effect of Visual and Cerebellar Exercises on DyslexiaMona Delavarian, M.D., G. Ali Afrooz, M.D., and Shahriar Gharibzadeh, M.D., Ph.D.1 January 2013 | The Journal of Neuropsychiatry and Clinical Neurosciences, Vol. 25, No. 1 Volume 23Issue 4 Fall 2011Pages E34-E34 Metrics PDF download History Published online 1 October 2011 Published in print 1 October 2011