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Reumers SFI, Schellekens MMI, Lugtmeijer S, Maas RPPWM, Verhoeven JI, Boot EM, Ekker MS, Tuladhar AM, van de Warrenburg BPC, Schutter DJLG, Kessels RPC, de Leeuw FE. Cognitive impairment in young adults following cerebellar stroke: Prevalence and longitudinal course. Cortex 2024; 178:104-115. [PMID: 38986276 DOI: 10.1016/j.cortex.2024.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 05/03/2024] [Accepted: 05/28/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION Cognitive impairment is a well-known result of a stroke, but for cerebellar stroke in young patients detailed knowledge on the nature and extent of cognitive deficits is limited. This study examined the prevalence and course of cognitive impairment in a large cohort of patients with cerebellar stroke. METHODS Sixty young (18-49 years) cerebellar stroke patients completed extensive neuropsychological assessments in the subacute (<9 months post-stroke) and/or chronic phase (≥9 months post-stroke). Performance and course were assessed using standardized scores and Reliable Change Index analyses. Associations between cognitive deficits and lesion locations were explored using subtraction analyses, and associations with subjective cognitive complaints and fatigue were examined. RESULTS Sixty patients (52% male) were included with a mean age at event of 43.1 years. Cognitive impairment was observed in 60.3% of patients in the subacute phase and 51.2% during the chronic phase. Deficits were most frequent for visuo-spatial skills and executive functioning (42.5-54.6%). Both improvement and decline were observed over time, in 17.9% and 41.0% of participants, respectively. Cognitive deficits seem to be associated with lesions in certain cerebellar regions, however, no distinct correlation was found for a specific subregion. Subjective cognitive complaints were present in the majority of participants (61-80.5%) and positively correlated with fatigue in both phases (ρ = -.661 and ρ = -.757, p < .001, respectively). DISCUSSION Cognitive impairment in cerebellar stroke patients is common, with deficits most pronounced for visuo-spatial skills and executive functioning, as in line with the Cerebellar Cognitive Affective Syndrome. The course of cognitive performance was heterogenous, with cognitive decline despite the fact that no recurrent strokes occurred. No clear association between lesion location and cognitive deficits was observed. Subjective cognitive complaints and fatigue were prevalent and positively correlated. Clinicians could use this information to actively screen for and better inform patients about possible cognitive sequalae.
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Affiliation(s)
- Stacha F I Reumers
- Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Department of Neurology, 6525 GA, Nijmegen, the Netherlands
| | - Mijntje M I Schellekens
- Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Department of Neurology, 6525 GA, Nijmegen, the Netherlands
| | - Selma Lugtmeijer
- University of Birmingham, School of Psychology, Birmingham, B15 2TT, UK
| | - Roderick P P W M Maas
- Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Department of Neurology, 6525 GA, Nijmegen, the Netherlands
| | - Jamie I Verhoeven
- Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Department of Neurology, 6525 GA, Nijmegen, the Netherlands
| | - Esther M Boot
- Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Department of Neurology, 6525 GA, Nijmegen, the Netherlands
| | - Merel S Ekker
- Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Department of Neurology, 6525 GA, Nijmegen, the Netherlands
| | - Anil M Tuladhar
- Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Department of Neurology, 6525 GA, Nijmegen, the Netherlands
| | - Bart P C van de Warrenburg
- Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Department of Neurology, 6525 GA, Nijmegen, the Netherlands
| | - Dennis J L G Schutter
- Utrecht University, Department of Experimental Psychology, Helmholtz Institute, 3584 CS, Utrecht, the Netherlands
| | - Roy P C Kessels
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, 6525 GD, Nijmegen, the Netherlands; Radboud University Medical Center, Department of Medical Psychology and Radboudumc Alzheimer Center, 6525 GA, Nijmegen, the Netherlands; Vincent van Gogh Institute for Psychiatry, 5803 AC, Venray, the Netherlands
| | - Frank-Erik de Leeuw
- Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Department of Neurology, 6525 GA, Nijmegen, the Netherlands.
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Bolton C, Lacy M. Comparison of cognitive profiles in spinocerebellar ataxia subtypes: a case series. CEREBELLUM & ATAXIAS 2019; 6:13. [PMID: 31548897 PMCID: PMC6749672 DOI: 10.1186/s40673-019-0107-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 09/11/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND The spinocerebellar ataxias (SCA) are a heterogeneous group of progressive neurodegenerative disorders that are associated with diffuse cerebellar atrophy. While the physical symptoms of this condition have long been studied, more attention has been given to cognitive changes in recent years. We describe a case series of four adults with various genetically-confirmed subtypes of SCA. CASE PRESENTATION Patients with SCA types 2, 3, and 6 presented with impaired cognitive profiles consistent with the existing literature while the reported patient with SCA-14 showed notable impairment inconsistent with the only published case controlled study. CONCLUSIONS Comparisons were made between the four patients with a common pattern of slowed processing speed, poor memory retrieval, and reduced mental flexibility. Confrontation naming and consolidation-based memory were intact across all patients. These findings are discussed in light of the relevant literature on cerebellar cognitive affective syndrome.
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Affiliation(s)
- Corey Bolton
- Department of Psychiatry and Behavioral Neurosciences, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL 60637 USA
| | - Maureen Lacy
- Department of Psychiatry and Behavioral Neurosciences, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL 60637 USA
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Abstract
During the past decades neuroanatomic, neuroimaging, and clinical studies have substantially changed the long-standing view of the role of the cerebellum as a sole coordinator of sensorimotor function. Currently, the cerebellum is considered to be crucially implicated in a variety of cognitive, affective, social, and behavioral processes as well. In this chapter we aim to summarize a number of critical insights from different research areas (neuroanatomy, functional neuroimaging, clinical practice) that provide evidence for a role of the cerebellum in motor speech and nonmotor language processing in both adults and children. Neuroanatomic studies have provided a robust basis for the development of new insights in the modulatory role of the cerebellum in neurocognition, including nonmotor language processing by means of identifying a dense network of crossed reciprocal connections between the cerebellum and the supratentorial association areas. A topologic distinction has been established between the "motor" cerebellum, projecting to the cortical motor areas, and the "cognitive/affective" cerebellum, connected with the cortical and limbic association areas. Neuroimaging studies have demonstrated cerebellar involvement in several different language tasks, even after controlling for motor aspects. In addition, several clinical studies have identified a variety of nonmotor linguistic deficits after cerebellar disease in both children and adults, implying a prominent role for the cerebellum in linguistic processes. Functional neuroimaging has confirmed the functional impact of cerebellar lesions on remote, structurally intact cortical regions via crossed cerebellocerebral diaschisis. Overall, evidence from neuroanatomic, neuroimaging, and clinical studies shows a (strongly lateralized) involvement of the cerebellum in a broad spectrum of nonmotor language functions through a dense network of crossed and reciprocal cerebellocerebral connections. It is argued that the cerebellum is involved in language in a similar manner as it is involved in motor functions: through monitoring/coordinating cortical functions via timing and sequencing mechanisms.
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Affiliation(s)
- Peter Mariën
- Clinical and Experimental Neurolinguistics, Free University of Brussels, Brussels, Belgium.
| | - Renato Borgatti
- Department of Neuropsychiatry and Neurorehabilitation Unit, Eugenio Medea Scientific Institute, Bosisio Parini, Lecco, Italy
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Moberget T, Hilland E, Andersson S, Lundar T, Due-Tønnessen BJ, Heldal A, Ivry RB, Endestad T. Patients with focal cerebellar lesions show reduced auditory cortex activation during silent reading. BRAIN AND LANGUAGE 2016; 161:18-27. [PMID: 26341544 PMCID: PMC4775464 DOI: 10.1016/j.bandl.2015.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 07/28/2015] [Accepted: 08/06/2015] [Indexed: 06/05/2023]
Abstract
Functional neuroimaging studies consistently report language-related cerebellar activations, but evidence from the clinical literature is less conclusive. Here, we attempt to bridge this gap by testing the effect of focal cerebellar lesions on cerebral activations in a reading task previously shown to involve distinct cerebellar regions. Patients (N=10) had lesions primarily affecting medial cerebellum, overlapping cerebellar regions activated during the presentation of random word sequences, but distinct from activations related to semantic prediction generation and prediction error processing. In line with this pattern of activation-lesion overlap, patients did not differ from matched healthy controls (N=10) in predictability-related activations. However, whereas controls showed increased activation in bilateral auditory cortex and parietal operculum when silently reading familiar words relative to viewing letter strings, this effect was absent in the patients. Our results highlight the need for careful lesion mapping and suggest possible roles for the cerebellum in visual-to-auditory mapping and/or inner speech.
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Affiliation(s)
| | - Eva Hilland
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Stein Andersson
- Department of Psychology, University of Oslo, Oslo, Norway; Department of Psychosomatic Medicine, Oslo University Hospital, Oslo, Norway
| | - Tryggve Lundar
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | | | - Aasta Heldal
- Department of Psychosomatic Medicine, Oslo University Hospital, Oslo, Norway
| | - Richard B Ivry
- Psychology Department, University of California, Berkeley, Berkeley, CA, USA
| | - Tor Endestad
- Department of Psychology, University of Oslo, Oslo, Norway; Department of Psychosomatic Medicine, Oslo University Hospital, Oslo, Norway
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Robertson EE, Hall DA, McAsey AR, O'Keefe JA. Fragile X-associated tremor/ataxia syndrome: phenotypic comparisons with other movement disorders. Clin Neuropsychol 2016; 30:849-900. [PMID: 27414076 PMCID: PMC7336900 DOI: 10.1080/13854046.2016.1202239] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 06/12/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The purpose of this paper is to review the typical cognitive and motor impairments seen in fragile X-associated tremor/ataxia syndrome (FXTAS), essential tremor (ET), Parkinson disease (PD), spinocerebellar ataxias (SCAs), multiple system atrophy (MSA), and progressive supranuclear palsy (PSP) in order to enhance diagnosis of FXTAS patients. METHODS We compared the cognitive and motor phenotypes of FXTAS with each of these other movement disorders. Relevant neuropathological and neuroimaging findings are also reviewed. Finally, we describe the differences in age of onset, disease severity, progression rates, and average lifespan in FXTAS compared to ET, PD, SCAs, MSA, and PSP. We conclude with a flow chart algorithm to guide the clinician in the differential diagnosis of FXTAS. RESULTS By comparing the cognitive and motor phenotypes of FXTAS with the phenotypes of ET, PD, SCAs, MSA, and PSP we have clarified potential symptom overlap while elucidating factors that make these disorders unique from one another. In summary, the clinician should consider a FXTAS diagnosis and testing for the Fragile X mental retardation 1 (FMR1) gene premutation if a patient over the age of 50 (1) presents with cerebellar ataxia and/or intention tremor with mild parkinsonism, (2) has the middle cerebellar peduncle (MCP) sign, global cerebellar and cerebral atrophy, and/or subcortical white matter lesions on MRI, or (3) has a family history of fragile X related disorders, intellectual disability, autism, premature ovarian failure and has neurological signs consistent with FXTAS. Peripheral neuropathy, executive function deficits, anxiety, or depression are supportive of the diagnosis. CONCLUSIONS Distinct profiles in the cognitive and motor domains between these movement disorders may guide practitioners in the differential diagnosis process and ultimately lead to better medical management of FXTAS patients.
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Affiliation(s)
- Erin E Robertson
- a Department of Anatomy and Cell Biology , Rush University , Chicago , IL , USA
| | - Deborah A Hall
- b Department of Neurological Sciences , Rush University , Chicago , IL , USA
| | - Andrew R McAsey
- a Department of Anatomy and Cell Biology , Rush University , Chicago , IL , USA
| | - Joan A O'Keefe
- a Department of Anatomy and Cell Biology , Rush University , Chicago , IL , USA
- b Department of Neurological Sciences , Rush University , Chicago , IL , USA
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