Skip to main content
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2004 Nov;75(11):1524–1531. doi: 10.1136/jnnp.2003.018093

Evidence for distinct cognitive deficits after focal cerebellar lesions

B Gottwald 1, B Wilde 1, Z Mihajlovic 1, H Mehdorn 1
PMCID: PMC1738803  PMID: 15489381

Abstract

Objectives: Anatomical evidence and lesion studies, as well as functional magnetic resonance imaging (fMRI) studies, indicate that the cerebellum contributes to higher cognitive functions. Cerebellar posterior lateral regions seem to be relevant for cognition, while vermal lesions seem to be associated with changes in affect. However, the results remain controversial. Deficits of patients are sometimes still attributed to motor impairment.

Methods: We present data from a detailed neuropsychological examination of 21 patients with cerebellar lesions due to tumour or haematoma, and 21 controls matched for age, sex, and years of education.

Results: Patients showed deficits in executive function, and in attentional processes such as working memory and divided attention. Further analysis revealed that patients with right-sided lesions were in general more impaired than those with left-sided lesions.

Conclusions: Those hypotheses that suggest that lesions of the right cerebellar hemisphere lead to verbal deficits, while those of the left lead to non-verbal deficits, have in part been confirmed. The generally greater impairment of those patients with a right-sided lesion has been interpreted as resulting from the connection of the right cerebellum to the left cerebral hemisphere, which is dominant for language functions and crucial for right hand movements. Motor impairment was correlated with less than half of the cognitive measures, with no stronger tendency for correlation with cognitive tests that require motor responses discernible. The results are discussed on the basis of an assumption that the cerebellum has a predicting and preparing function, indicating that cerebellar lesions lead to a "dysmetria of thought."

Full Text

The Full Text of this article is available as a PDF (89.6 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Allen G., Buxton R. B., Wong E. C., Courchesne E. Attentional activation of the cerebellum independent of motor involvement. Science. 1997 Mar 28;275(5308):1940–1943. doi: 10.1126/science.275.5308.1940. [DOI] [PubMed] [Google Scholar]
  2. Appollonio I. M., Grafman J., Schwartz V., Massaquoi S., Hallett M. Memory in patients with cerebellar degeneration. Neurology. 1993 Aug;43(8):1536–1544. doi: 10.1212/wnl.43.8.1536. [DOI] [PubMed] [Google Scholar]
  3. Berquin P. C., Giedd J. N., Jacobsen L. K., Hamburger S. D., Krain A. L., Rapoport J. L., Castellanos F. X. Cerebellum in attention-deficit hyperactivity disorder: a morphometric MRI study. Neurology. 1998 Apr;50(4):1087–1093. doi: 10.1212/wnl.50.4.1087. [DOI] [PubMed] [Google Scholar]
  4. Castellanos F. X., Giedd J. N., Berquin P. C., Walter J. M., Sharp W., Tran T., Vaituzis A. C., Blumenthal J. D., Nelson J., Bastain T. M. Quantitative brain magnetic resonance imaging in girls with attention-deficit/hyperactivity disorder. Arch Gen Psychiatry. 2001 Mar;58(3):289–295. doi: 10.1001/archpsyc.58.3.289. [DOI] [PubMed] [Google Scholar]
  5. Courchesne E., Allen G. Prediction and preparation, fundamental functions of the cerebellum. Learn Mem. 1997 May-Jun;4(1):1–35. doi: 10.1101/lm.4.1.1. [DOI] [PubMed] [Google Scholar]
  6. Courchesne E., Townsend J., Akshoomoff N. A., Saitoh O., Yeung-Courchesne R., Lincoln A. J., James H. E., Haas R. H., Schreibman L., Lau L. Impairment in shifting attention in autistic and cerebellar patients. Behav Neurosci. 1994 Oct;108(5):848–865. doi: 10.1037//0735-7044.108.5.848. [DOI] [PubMed] [Google Scholar]
  7. Daum I., Ackermann H., Schugens M. M., Reimold C., Dichgans J., Birbaumer N. The cerebellum and cognitive functions in humans. Behav Neurosci. 1993 Jun;107(3):411–419. doi: 10.1037//0735-7044.107.3.411. [DOI] [PubMed] [Google Scholar]
  8. Drepper J., Timmann D., Kolb F. P., Diener H. C. Non-motor associative learning in patients with isolated degenerative cerebellar disease. Brain. 1999 Jan;122(Pt 1):87–97. doi: 10.1093/brain/122.1.87. [DOI] [PubMed] [Google Scholar]
  9. Fiez J. A., Petersen S. E., Cheney M. K., Raichle M. E. Impaired non-motor learning and error detection associated with cerebellar damage. A single case study. Brain. 1992 Feb;115(Pt 1):155–178. doi: 10.1093/brain/115.1.155. [DOI] [PubMed] [Google Scholar]
  10. Gottwald Birgit, Mihajlovic Zoran, Wilde Barbara, Mehdorn Hubertus Maximilian. Does the cerebellum contribute to specific aspects of attention? Neuropsychologia. 2003;41(11):1452–1460. doi: 10.1016/s0028-3932(03)00090-3. [DOI] [PubMed] [Google Scholar]
  11. Grafman J., Litvan I., Massaquoi S., Stewart M., Sirigu A., Hallett M. Cognitive planning deficit in patients with cerebellar atrophy. Neurology. 1992 Aug;42(8):1493–1496. doi: 10.1212/wnl.42.8.1493. [DOI] [PubMed] [Google Scholar]
  12. Gómez Beldarrain M., García-Moncó J. C., Quintana J. M., Llorens V., Rodeño E. Diaschisis and neuropsychological performance after cerebellar stroke. Eur Neurol. 1997;37(2):82–89. doi: 10.1159/000117415. [DOI] [PubMed] [Google Scholar]
  13. Helmuth L. L., Ivry R. B., Shimizu N. Preserved performance by cerebellar patients on tests of word generation, discrimination learning, and attention. Learn Mem. 1997 Mar-Apr;3(6):456–474. doi: 10.1101/lm.3.6.456. [DOI] [PubMed] [Google Scholar]
  14. Hubrich-Ungureanu Petra, Kaemmerer Nina, Henn Fritz A., Braus Dieter F. Lateralized organization of the cerebellum in a silent verbal fluency task: a functional magnetic resonance imaging study in healthy volunteers. Neurosci Lett. 2002 Feb 15;319(2):91–94. doi: 10.1016/s0304-3940(01)02566-6. [DOI] [PubMed] [Google Scholar]
  15. Le T. H., Pardo J. V., Hu X. 4 T-fMRI study of nonspatial shifting of selective attention: cerebellar and parietal contributions. J Neurophysiol. 1998 Mar;79(3):1535–1548. doi: 10.1152/jn.1998.79.3.1535. [DOI] [PubMed] [Google Scholar]
  16. Leggio M. G., Silveri M. C., Petrosini L., Molinari M. Phonological grouping is specifically affected in cerebellar patients: a verbal fluency study. J Neurol Neurosurg Psychiatry. 2000 Jul;69(1):102–106. doi: 10.1136/jnnp.69.1.102. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Levisohn L., Cronin-Golomb A., Schmahmann J. D. Neuropsychological consequences of cerebellar tumour resection in children: cerebellar cognitive affective syndrome in a paediatric population. Brain. 2000 May;123(Pt 5):1041–1050. doi: 10.1093/brain/123.5.1041. [DOI] [PubMed] [Google Scholar]
  18. Marien P., Engelborghs S., Fabbro F., De Deyn P. P. The lateralized linguistic cerebellum: a review and a new hypothesis. Brain Lang. 2001 Dec;79(3):580–600. doi: 10.1006/brln.2001.2569. [DOI] [PubMed] [Google Scholar]
  19. Molinari M., Leggio M. G., Silveri M. C. Verbal fluency and agrammatism. Int Rev Neurobiol. 1997;41:325–339. doi: 10.1016/s0074-7742(08)60358-x. [DOI] [PubMed] [Google Scholar]
  20. Moschner C., Crawford T. J., Heide W., Trillenberg P., Kömpf D., Kennard C. Deficits of smooth pursuit initiation in patients with degenerative cerebellar lesions. Brain. 1999 Nov;122(Pt 11):2147–2158. doi: 10.1093/brain/122.11.2147. [DOI] [PubMed] [Google Scholar]
  21. Mostofsky S. H., Reiss A. L., Lockhart P., Denckla M. B. Evaluation of cerebellar size in attention-deficit hyperactivity disorder. J Child Neurol. 1998 Sep;13(9):434–439. doi: 10.1177/088307389801300904. [DOI] [PubMed] [Google Scholar]
  22. Nelson H. E. A modified card sorting test sensitive to frontal lobe defects. Cortex. 1976 Dec;12(4):313–324. doi: 10.1016/s0010-9452(76)80035-4. [DOI] [PubMed] [Google Scholar]
  23. Raichle M. E., Fiez J. A., Videen T. O., MacLeod A. M., Pardo J. V., Fox P. T., Petersen S. E. Practice-related changes in human brain functional anatomy during nonmotor learning. Cereb Cortex. 1994 Jan-Feb;4(1):8–26. doi: 10.1093/cercor/4.1.8. [DOI] [PubMed] [Google Scholar]
  24. Rapoport M., van Reekum R., Mayberg H. The role of the cerebellum in cognition and behavior: a selective review. J Neuropsychiatry Clin Neurosci. 2000 Spring;12(2):193–198. doi: 10.1176/jnp.12.2.193. [DOI] [PubMed] [Google Scholar]
  25. Ravizza S. M., Ivry R. B. Comparison of the basal ganglia and cerebellum in shifting attention. J Cogn Neurosci. 2001 Apr 1;13(3):285–297. doi: 10.1162/08989290151137340. [DOI] [PubMed] [Google Scholar]
  26. Riva D., Giorgi C. The cerebellum contributes to higher functions during development: evidence from a series of children surgically treated for posterior fossa tumours. Brain. 2000 May;123(Pt 5):1051–1061. doi: 10.1093/brain/123.5.1051. [DOI] [PubMed] [Google Scholar]
  27. Schmahmann J. D., Pandya D. N. The cerebrocerebellar system. Int Rev Neurobiol. 1997;41:31–60. doi: 10.1016/s0074-7742(08)60346-3. [DOI] [PubMed] [Google Scholar]
  28. Schmahmann J. D., Sherman J. C. The cerebellar cognitive affective syndrome. Brain. 1998 Apr;121(Pt 4):561–579. doi: 10.1093/brain/121.4.561. [DOI] [PubMed] [Google Scholar]
  29. Seger C. A., Desmond J. E., Glover G. H., Gabrieli J. D. Functional magnetic resonance imaging evidence for right-hemisphere involvement in processing unusual semantic relationships. Neuropsychology. 2000 Jul;14(3):361–369. doi: 10.1037//0894-4105.14.3.361. [DOI] [PubMed] [Google Scholar]
  30. Townsend J., Courchesne E., Covington J., Westerfield M., Harris N. S., Lyden P., Lowry T. P., Press G. A. Spatial attention deficits in patients with acquired or developmental cerebellar abnormality. J Neurosci. 1999 Jul 1;19(13):5632–5643. doi: 10.1523/JNEUROSCI.19-13-05632.1999. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Townsend J., Westerfield M., Leaver E., Makeig S., Jung T., Pierce K., Courchesne E. Event-related brain response abnormalities in autism: evidence for impaired cerebello-frontal spatial attention networks. Brain Res Cogn Brain Res. 2001 Mar;11(1):127–145. doi: 10.1016/s0926-6410(00)00072-0. [DOI] [PubMed] [Google Scholar]
  32. de Zubicaray G. I., Zelaya F. O., Andrew C., Williams S. C., Bullmore E. T. Cerebral regions associated with verbal response initiation, suppression and strategy use. Neuropsychologia. 2000;38(9):1292–1304. doi: 10.1016/s0028-3932(00)00026-9. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES