Stoodley Catherine J, Schmahmann Jeremy D
Department of Psychology and Center for Behavioral Neuroscience, American University, Washington, DC, United States.
Ataxia Unit, Cognitive Behavioral Neurology Unit and Laboratory for Neuroanatomy and Cerebellar Neurobiology, Massachusetts General Hospital, Boston, MA, United States.
Handb Clin Neurol. 2018;154:59-70. doi: 10.1016/B978-0-444-63956-1.00004-7.
Accumulating evidence points to a critical role for the human cerebellum in both motor and nonmotor behaviors. A core tenet of this new understanding of cerebellar function is the existence of functional subregions within the cerebellum that differentially support motor, cognitive, and affective behaviors. This cerebellar functional topography - based on converging evidence from neuroanatomic, neuroimaging, and clinical studies - is evident in both adult and pediatric populations. The sensorimotor homunculi in the anterior lobe and lobule VIII established in early tract tracing and electrophysiologic studies are evident in both task-based and resting-state human functional imaging studies. In patients, damage to the anterior cerebellum, extending into medial lobule VI, is associated with the cerebellar motor syndrome. The cerebellar posterior lobe, including vermal and hemispheric regions of lobules VI and VII, is reciprocally interconnected with cerebral association and paralimbic cortices. Resting-state and task-based neuroimaging studies show functional activation patterns in these regions during higher-level cognitive tasks, and lesions of the posterior cerebellum lead to the cerebellar cognitive affective/Schmahmann syndrome with its characteristic intellectual and emotional impairments. The existence of cerebellar connectional and functional topography provides the critical anatomic substrate for a cerebellar role in both motor and nonmotor functions. It also establishes a framework for interpreting cerebellar activation patterns, cognitive and behavioral outcomes following cerebellar damage, and the cerebellar structural and functional differences reported in a range of neurodevelopmental and neuropsychiatric disorders.
越来越多的证据表明，人类小脑在运动和非运动行为中都起着关键作用。对小脑功能这一新认识的一个核心原则是，小脑内存在功能亚区，它们分别支持运动、认知和情感行为。这种基于小脑功能拓扑结构的认识——来自神经解剖学、神经影像学和临床研究的汇聚证据——在成人和儿童群体中都很明显。早期束路追踪和电生理研究中确定的前叶和小叶VIII中的感觉运动小人在基于任务和静息状态的人类功能成像研究中都很明显。在患者中，小脑前叶损伤延伸至内侧小叶VI，与小脑运动综合征有关。小脑后叶，包括小叶VI和VII的蚓部和半球区域，与大脑联合皮质和边缘旁皮质相互连接。静息状态和基于任务的神经影像学研究表明，在高级认知任务期间，这些区域存在功能激活模式，小脑后叶损伤会导致小脑认知情感/施马曼综合征及其特征性的智力和情感障碍。小脑连接和功能拓扑结构的存在为小脑在运动和非运动功能中的作用提供了关键的解剖学基础。它还为解释小脑激活模式、小脑损伤后的认知和行为结果，以及一系列神经发育和神经精神疾病中报道的小脑结构和功能差异建立了一个框架。
