Ataxia Center, Cognitive Behavioral Neurology Unit, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, Suite 2000, Boston, MA, 02114, USA.
Cerebellum. 2023 Oct;22(5):947-953. doi: 10.1007/s12311-022-01456-7. Epub 2022 Aug 10.
The notion that the cerebellum is devoted exclusively to motor control has been replaced by a more sophisticated understanding of its role in neurological function, one that includes cognition and emotion. Early clinical reports, as well as physiological and behavioral studies in animal models, raised the possibility of a nonmotor role for the cerebellum. Anatomical studies demonstrate cerebellar connectivity with the distributed neural circuits linked with autonomic, sensorimotor, vestibular, associative and limbic/paralimbic brain areas. Identification of the cerebellar cognitive affective syndrome in adults and children underscored the clinical relevance of the role of the cerebellum in cognition and emotion. It opened new avenues of investigation into higher order deficits that accompany the ataxias and other cerebellar diseases, as well as the contribution of cerebellar dysfunction to neuropsychiatric and neurocognitive disorders. Brain imaging studies demonstrate the complexity of cerebellar functional topography, revealing a double representation of the sensorimotor cerebellum in the anterior lobe and lobule VIII and a triple cognitive representation in the cerebellar posterior lobe, as well as representation in the cerebellum of the intrinsic connectivity networks identified in the cerebral hemispheres. This paradigm shift in thinking about the cerebellum has been advanced by the theories of dysmetria of thought and the universal cerebellar transform, harmonizing the dual anatomic realities of homogeneously repeating cerebellar cortical microcircuitry set against the heterogeneous and topographically arranged cerebellar connections with extracerebellar structures. This new appreciation of the cerebellar incorporation into circuits that subserve cognition and emotion enables deeper understanding and improved care of our patients with cerebellar ataxias and novel cerebellar-based approaches to therapy in neuropsychiatry.
小脑专门负责运动控制的观念已经被一种更复杂的理解所取代，这种理解包括小脑在神经功能中的作用，包括认知和情绪。早期的临床报告，以及动物模型的生理学和行为研究，提出了小脑在非运动功能中的作用的可能性。解剖学研究表明小脑与自主、感觉运动、前庭、联想和边缘/边缘脑区的分布式神经回路相连。在成人和儿童中发现小脑认知情感综合征，强调了小脑在认知和情绪中的作用的临床相关性。它为研究伴随共济失调和其他小脑疾病的高级认知缺陷以及小脑功能障碍对神经精神和神经认知障碍的贡献开辟了新的途径。脑成像研究表明小脑功能拓扑的复杂性，揭示了前叶和VIII 叶感觉运动小脑的双重表现，以及小脑后叶的三重认知表现，以及大脑半球内在连通性网络在小脑中的表现。这种对小脑思考的范式转变是由思维失调和普遍的小脑变换理论推动的，这两种理论协调了小脑皮质微回路均质重复的双重解剖现实，以及与小脑外结构的异质和地形排列的小脑连接。这种对小脑整合到认知和情绪功能回路的新认识，使我们能够更深入地理解和更好地照顾我们的小脑共济失调患者，并为神经精神药理学提供新的基于小脑的治疗方法。
