Trends in Cognitive Sciences
Volume 2, Issue 9, 1 September 1998, Pages 362-371
Journal home page for Trends in Cognitive Sciences

Dysmetria of thought: clinical consequences of cerebellar dysfunction on cognition and affect

https://doi.org/10.1016/S1364-6613(98)01218-2Get rights and content

Abstract

Cognitive and emotional changes might be prominent or even principal manifestations of cerebellar lesions. This realization supports evidence suggesting that the cerebellum is an important part of a set of distributed neural circuits that subserve higher-order processing. Early anecdotal clinical accounts described aberrant mental or intellectual functions in the setting of cerebellar atrophy. Later systematic analyses showed that the cerebellum is able to influence autonomic, vasomotor, and emotional behaviors, and further studies revealed neuropsychological deficits in patients with degenerative diseases. Current descriptions of behavioral changes in adults and children with acquired cerebellar lesions bring the debate about the cerebellar role in neural function within the realm of clinically relevant cognitive neuroscience. The activation of focal cerebellar regions by cognitive tasks on functional neuroimaging studies, and morphologic abnormalities of cerebellum in psychiatric diseases such as autism and schizophrenia further support this view. Anatomical substrates have been elucidated that could support a cerebellar role in cognition and emotion. Our concept of `dysmetria of thought' draws an analogy with the motor system to describe and explain the impairments of higher-order behavior that result when the distributed neural circuits subserving cognitive operations are deprived of cerebellar modulation.

Section snippets

Psychiatric disorders and studies of the cerebellum

The earliest reports of abnormal behaviors in association with cerebellar atrophy or agenesis described both emotional and intellectual dysfunction1, 2. In more recent times, Heath et al.[5]observed increased neuronal discharges in the fastigial nucleus of an emotionally disturbed patient that correlated with the patient's experience of fear and anger. Heath later produced amelioration of aggression in patients with severe emotional dyscontrol by chronically stimulating the cerebellar vermis

Neuropsychological studies

In the past two decades neuropsychological tests have been performed in patients with degenerative cerebellar disorders. Patients with olivopontocerebellar atrophy (OPCA) were found by Landis et al.[24]to have impairments in verbal and nonverbal intelligence, memory and frontal system functions. Difficulties with concept formation, learning of paired associates, visual–spatial abilities (see Appendix A), and general intellectual slowing were noted in the patients studied by Kish et al.[25],

Clinical investigations

A persistent concern shared by investigators and clinicians is that there are very few descriptions of clinically relevant cases that address the possibility of a cerebellar contribution to nonmotor behaviors. It has been argued that detection of subtle behavioral deficits only by neuropsychological tests in patients with cerebellar lesions might be insufficient grounds to warrant a revision of the understanding of the role of the cerebellum in nervous system function. New evidence regarding

Implications of clinical findings

The demonstration of a characteristic behavioral syndrome resulting from acquired lesions of the cerebellum, the cerebellar cognitive affective syndrome, provides documentation of clinically relevant cognitive deficits in patients with pathology restricted to the cerebellum. Furthermore, the defining features of this syndrome are similar to the functional affiliations of the cerebral cortical regions with which the cerebellum has reciprocal interconnections[62]. Specifically, the prefrontal,

Conclusions

The descriptions of clinically relevant cognitive and affective changes resulting from cerebellar lesions indicate that the discussion concerning the role of the cerebellum in higher-order function has direct relevance for patient care (see Appendix C). They also provide an opportunity to study these questions in the patient population. With the new awareness of the cognitive and affective deficits that lesions of the cerebellum can produce, it will be valuable to investigate further the role

Outstanding questions

  • What is the topographic organization of the function within the human cerebellum? Are motor, sensory, intellectual, emotional and autonomic functions all discretely arranged, or do they overlap? Are particular cerebellar lobules and folia dedicated to uniquely different functions? Is the cerebellum just like the cerebral cortex in having regions that are mostly motor, mostly sensory, mostly dedicated to expressive language, visuospatial analysis, working memory, and so on?

  • How do different

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