Kansal Kalyani, Yang Zhen, Fishman Ann M, Sair Haris I, Ying Sarah H, Jedynak Bruno M, Prince Jerry L, Onyike Chiadi U
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland, USA.
Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, Maryland, USA.
Brain. 2017 Mar 1;140(3):707-720. doi: 10.1093/brain/aww327.
See King et al. (doi:10.1093/aww348) for a scientific commentary on this article.Detailed mapping of clinical dysfunctions to the cerebellar lobules in disease populations is necessary to establish the functional significance of lobules implicated in cognitive and motor functions in normal subjects. This study constitutes the first quantitative examination of the lobular correlates of a broad range of cognitive and motor phenomena in cerebellar disease. We analysed cross-sectional data from 72 cases with cerebellar disease and 36 controls without cerebellar disease. Cerebellar lobule volumes were derived from a graph-cut based segmentation algorithm. Sparse partial least squares, a variable selection approach, was used to identify lobules associated with motor function, language, executive function, memory, verbal learning, perceptual organization and visuomotor coordination. Motor dysfunctions were chiefly associated with the anterior lobe and posterior lobule HVI. Confrontation naming, noun fluency, recognition, and perceptual organization did not have cerebellar associations. Verb and phonemic fluency, working memory, cognitive flexibility, immediate and delayed recall, verbal learning, and visuomotor coordination were variably associated with HVI, Crus I, Crus II, HVII B and/or HIX. Immediate and delayed recall also showed associations with the anterior lobe. These findings provide preliminary anatomical evidence for a functional topography of the cerebellum first defined in task-based functional magnetic resonance imaging studies of normal subjects and support the hypotheses that (i) cerebellar efferents target frontal lobe neurons involved in forming action representations and new search strategies; (ii) there is greater involvement of the cerebellum when immediate recall tasks involve more complex verbal stimuli (e.g. longer words versus digits); and (iii) it is involved in spontaneous retrieval of long-term memory. More generally, they provide an anatomical background for studies that seek the mechanisms by which cognitive and motor dysfunctions arise from cerebellar degeneration. Beyond replicating these findings, future research should employ experimental tasks to probe the integrity of specific functions in cerebellar disease, and new imaging methods to quantitatively map atrophy across the cerebellum.
有关本文的科学评论，请参阅金等人的文章（doi:10.1093/aww348）。为了确定正常受试者中与认知和运动功能相关的小脑小叶的功能意义，有必要对疾病人群中的临床功能障碍与小脑小叶进行详细映射。本研究首次对小脑疾病中广泛的认知和运动现象的小叶相关性进行了定量检查。我们分析了72例小脑疾病患者和36例无小脑疾病对照的横断面数据。小脑小叶体积来自基于图割的分割算法。稀疏偏最小二乘法是一种变量选择方法，用于识别与运动功能、语言、执行功能、记忆、言语学习、知觉组织和视运动协调相关的小叶。运动功能障碍主要与前叶和后叶HVI相关。对答命名、名词流畅性、识别和知觉组织与小脑无关联。动词和音素流畅性、工作记忆、认知灵活性、即时和延迟回忆、言语学习以及视运动协调与HVI、小脑脚I、小脑脚II、H VII B和/或HIX有不同程度的关联。即时和延迟回忆也与前叶有关联。这些发现为小脑功能地形图提供了初步的解剖学证据，该地形图最初是在正常受试者基于任务的功能磁共振成像研究中定义的，并支持以下假设：（i）小脑传出神经靶向参与形成动作表征和新搜索策略的额叶神经元；（ii）当即时回忆任务涉及更复杂的言语刺激（例如较长单词与数字）时，小脑的参与度更高；（iii）它参与长期记忆的自发检索。更广泛地说，它们为研究认知和运动功能障碍由小脑变性引起的机制提供了解剖学背景。除了重复这些发现之外，未来的研究应该采用实验任务来探究小脑疾病中特定功能的完整性，并采用新的成像方法来定量绘制整个小脑的萎缩情况。
