Liu Qi, Liu Chang, Zhang Yumei
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Front Aging Neurosci. 2022 Oct 4;14:965022. doi: 10.3389/fnagi.2022.965022. eCollection 2022.
This study aimed to explore the characteristics of cognitive function in patients with cerebellar infarction and its association with lesion location. Forty-five patients with isolated cerebellar infarction were collected in the Department of Neurology, Beijing Tiantan Hospital. Thirty healthy controls were recruited matched by age and education. Global cognitive function was evaluated by using Addenbrooke's Cognitive Examination version III (ACE-III). An extensive neuropsychological assessment battery was also tested to evaluate the characteristics of each cognitive domain. 3D slicer software was used to draw the lesion, and evaluate the lesions' volume, side, and location. Group analysis was used to compare the differences in cognitive performance between patients and healthy controls, and patients with left and right cerebellar hemisphere infarction. Spearman analysis was used to explore the correlation between cognitive function and lesion volume. We also subdivided each patient's lesions according to the cerebellar atlas to identify the specific cerebellar location related to cognitive decline. Patients with cerebellar infarction had a lower ACE-III score compared with the healthy group (87.9 ± 6.2 vs. 93.7 ± 2.9, < 0.001), and 22 (48.9%) patients were diagnosed with cognitive impairment. The -transformed score of attention and executive function in the patients' group was -0.9 ± 1.4 and -0.8 ± 1.0 respectively, with 19 (43.2%) and 23 (56.4%) patients impaired. Compared with healthy controls, the relative risk ratio with 95% confidence interval (CI) for impairment in attention and executive function were 3.24 (1.22-8.57) and 3.39 (1.45-7.89). However, only 10 (22.1%) patients showed impairment in more than two cognitive domains. Compared with the left lesion group, patients with right cerebellar infarction showed significantly impaired executive function (-1.1 ± 0.3 vs. -0.5 ± 0.2, = 0.01). And the cerebellar posterior lobe regions, especially lobules VI, VIII, and IX, were explored to have lower cognitive performance. Furthermore, lesion volume was identified to be associated with the ACE-III score ( = -0.37, = 0.04). We identified that cerebellar involvement in cognition, especially in attention processing and executive function. Cerebellar right-sided lateralization of cognition and functional topography were also revealed in the current study.
本研究旨在探讨小脑梗死患者认知功能的特点及其与病变部位的关系。在北京天坛医院神经内科收集了45例孤立性小脑梗死患者。招募了30名年龄和教育程度相匹配的健康对照者。使用Addenbrooke认知检查量表第三版（ACE-III）评估整体认知功能。还进行了广泛的神经心理学评估电池测试，以评估每个认知领域的特点。使用3D Slicer软件绘制病变，并评估病变的体积、侧别和位置。采用组间分析比较患者与健康对照者以及左侧和右侧小脑半球梗死患者之间认知表现的差异。采用Spearman分析探讨认知功能与病变体积之间的相关性。我们还根据小脑图谱对每位患者的病变进行细分，以确定与认知衰退相关的特定小脑位置。与健康组相比，小脑梗死患者的ACE-III评分较低（87.9±6.2 vs. 93.7±2.9，P<0.001），22例（48.9%）患者被诊断为认知障碍。患者组注意力和执行功能的Z转换评分分别为-0.9±1.4和-0.8±1.0，19例（43.2%）和23例（56.4%）患者受损。与健康对照者相比，注意力和执行功能受损的相对风险比及95%置信区间（CI）分别为3.24（1.22-8.57）和3.39（1.45-7.89）。然而，只有1例（22.1%）患者在两个以上认知领域表现出受损。与左侧病变组相比，右侧小脑梗死患者的执行功能明显受损（-1.1±0.3 vs. -0.5±0.2，P=0.01）。并且发现小脑后叶区域，尤其是小叶VI、VIII和IX，认知表现较低。此外，确定病变体积与ACE-III评分相关（r=-0.37，P=0.04）。我们发现小脑参与认知，尤其是在注意力处理和执行功能方面。本研究还揭示了认知的小脑右侧化和功能地形图。
