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Ciricugno A, Oldrati V, Cattaneo Z, Leggio M, Urgesi C, Olivito G. Cerebellar Neurostimulation for Boosting Social and Affective Functions: Implications for the Rehabilitation of Hereditary Ataxia Patients. CEREBELLUM (LONDON, ENGLAND) 2024; 23:1651-1677. [PMID: 38270782 PMCID: PMC11269351 DOI: 10.1007/s12311-023-01652-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 01/26/2024]
Abstract
Beyond motor deficits, spinocerebellar ataxia (SCA) patients also suffer cognitive decline and show socio-affective difficulties, negatively impacting on their social functioning. The possibility to modulate cerebello-cerebral networks involved in social cognition through cerebellar neurostimulation has opened up potential therapeutic applications for ameliorating social and affective difficulties. The present review offers an overview of the research on cerebellar neurostimulation for the modulation of socio-affective functions in both healthy individuals and different clinical populations, published in the time period 2000-2022. A total of 25 records reporting either transcranial magnetic stimulation (TMS) or transcranial direct current stimulation (tDCS) studies were found. The investigated clinical populations comprised different pathological conditions, including but not limited to SCA syndromes. The reviewed evidence supports that cerebellar neurostimulation is effective in improving social abilities in healthy individuals and reducing social and affective symptoms in different neurological and psychiatric populations associated with cerebellar damage or with impairments in functions that involve the cerebellum. These findings encourage to further explore the rehabilitative effects of cerebellar neurostimulation on socio-affective deficits experienced by patients with cerebellar abnormalities, as SCA patients. Nevertheless, conclusions remain tentative at this stage due to the heterogeneity characterizing stimulation protocols, study methodologies and patients' samples.
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Affiliation(s)
- Andrea Ciricugno
- IRCCS Mondino Foundation, 27100, Pavia, Italy.
- Department of Brain and Behavioral Science, University of Pavia, 27100, Pavia, Italy.
| | - Viola Oldrati
- Scientific Institute, IRCCS Eugenio Medea, 23842, Bosisio Parini, Italy
| | - Zaira Cattaneo
- IRCCS Mondino Foundation, 27100, Pavia, Italy
- Department of Human and Social Sciences, University of Bergamo, 24129, Bergamo, Italy
| | - Maria Leggio
- Department of Psychology, Sapienza University of Rome, 00185, Rome, Italy
- Ataxia Laboratory, Fondazione Santa Lucia IRCCS, 00179, Rome, Italy
| | - Cosimo Urgesi
- Scientific Institute, IRCCS Eugenio Medea, 23842, Bosisio Parini, Italy
- Laboratory of Cognitive Neuroscience, Department of Languages and Literatures, Communication, Education and Society, University of Udine, 33100, Udine, Italy
| | - Giusy Olivito
- Department of Psychology, Sapienza University of Rome, 00185, Rome, Italy
- Ataxia Laboratory, Fondazione Santa Lucia IRCCS, 00179, Rome, Italy
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2
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Li T, Le W, Jankovic J. Linking the cerebellum to Parkinson disease: an update. Nat Rev Neurol 2023; 19:645-654. [PMID: 37752351 DOI: 10.1038/s41582-023-00874-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 09/28/2023]
Abstract
Parkinson disease (PD) is characterized by heterogeneous motor and non-motor symptoms, resulting from neurodegeneration involving various parts of the central nervous system. Although PD pathology predominantly involves the nigral-striatal system, growing evidence suggests that pathological changes extend beyond the basal ganglia into other parts of the brain, including the cerebellum. In addition to a primary involvement in motor control, the cerebellum is now known to also have an important role in cognitive, sleep and affective processes. Over the past decade, an accumulating body of research has provided clinical, pathological, neurophysiological, structural and functional neuroimaging findings that clearly establish a link between the cerebellum and PD. This Review presents an overview and update on the involvement of the cerebellum in the clinical features and pathogenesis of PD, which could provide a novel framework for a better understanding the heterogeneity of the disease.
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Affiliation(s)
- Tianbai Li
- Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Weidong Le
- Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, China.
- Institute of Neurology, Sichuan Academy of Medical Sciences, Sichuan Provincial Hospital, Chengdu, China.
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA.
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3
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Pierce JE, Thomasson M, Voruz P, Selosse G, Péron J. Explicit and Implicit Emotion Processing in the Cerebellum: A Meta-analysis and Systematic Review. CEREBELLUM (LONDON, ENGLAND) 2023; 22:852-864. [PMID: 35999332 PMCID: PMC10485090 DOI: 10.1007/s12311-022-01459-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
The cerebellum's role in affective processing is increasingly recognized in the literature, but remains poorly understood, despite abundant clinical evidence for affective disruptions following cerebellar damage. To improve the characterization of emotion processing and investigate how attention allocation impacts this processing, we conducted a meta-analysis on task activation foci using GingerALE software. Eighty human neuroimaging studies of emotion including 2761 participants identified through Web of Science and ProQuest databases were analyzed collectively and then divided into two categories based on the focus of attention during the task: explicit or implicit emotion processing. The results examining the explicit emotion tasks identified clusters within the posterior cerebellar hemispheres (bilateral lobule VI/Crus I/II), the vermis, and left lobule V/VI that were likely to be activated across studies, while implicit tasks activated clusters including bilateral lobules VI/Crus I/II, right Crus II/lobule VIII, anterior lobule VI, and lobules I-IV/V. A direct comparison between these categories revealed five overlapping clusters in right lobules VI/Crus I/Crus II and left lobules V/VI/Crus I of the cerebellum common to both the explicit and implicit task contrasts. There were also three clusters activated significantly more for explicit emotion tasks compared to implicit tasks (right lobule VI, left lobule VI/vermis), and one cluster activated more for implicit than explicit tasks (left lobule VI). These findings support previous studies indicating affective processing activates both the lateral hemispheric lobules and the vermis of the cerebellum. The common and distinct activation of posterior cerebellar regions by tasks with explicit and implicit attention demonstrates the supportive role of this structure in recognizing, appraising, and reacting to emotional stimuli.
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Affiliation(s)
- Jordan E Pierce
- Cognitive and Affective Neuroscience Laboratory, Center for Brain, Biology, and Behavior, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Marine Thomasson
- Clinical and Experimental Neuropsychology Laboratory, Department of Psychology, University of Geneva, 40 bd du Pont d'Arve, 1205, Geneva, Switzerland
- Neuropsychology Unit, Neurology Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Philippe Voruz
- Clinical and Experimental Neuropsychology Laboratory, Department of Psychology, University of Geneva, 40 bd du Pont d'Arve, 1205, Geneva, Switzerland
- Neuropsychology Unit, Neurology Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Garance Selosse
- Clinical and Experimental Neuropsychology Laboratory, Department of Psychology, University of Geneva, 40 bd du Pont d'Arve, 1205, Geneva, Switzerland
| | - Julie Péron
- Clinical and Experimental Neuropsychology Laboratory, Department of Psychology, University of Geneva, 40 bd du Pont d'Arve, 1205, Geneva, Switzerland.
- Neuropsychology Unit, Neurology Department, University Hospitals of Geneva, Geneva, Switzerland.
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4
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Kang L, Wang W, Zhang N, Nie Z, Gong Q, Yao L, Tu N, Feng H, Zong X, Bai H, Wang G, Bu L, Wang F, Liu Z. Superior temporal gyrus and cerebellar loops predict nonsuicidal self-injury in major depressive disorder patients by multimodal neuroimaging. Transl Psychiatry 2022; 12:474. [PMID: 36357369 PMCID: PMC9649804 DOI: 10.1038/s41398-022-02235-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/22/2022] [Accepted: 10/25/2022] [Indexed: 11/12/2022] Open
Abstract
In major depressive disorder (MDD) patients, nonsuicidal self-injury (NSSI) is a common comorbidity, and it is important to clarify the underlying neurobiology. Here, we investigated the association of NSSI with brain function and structure in MDD patients. A total of 260 MDD patients and 132 healthy controls (HCs) underwent resting-state functional magnetic resonance imaging and three-dimensional T1-weighted structural scans. NSSI behaviour was assessed through interviews. Voxel-based morphometry analysis (VBM), regional homogeneity analysis (ReHo), functional connectome topology properties and network-based statistics were used to detect the differences in neuroimaging characteristics. Finally, the random forest method was used to evaluate whether these factors could predict NSSI in MDD. Compared with HCs, MDD patients with a history of NSSI showed significant right putamen grey matter volume (GMV), right superior orbital frontal cortex ReHo, left pallidum degree centrality, and putamen-centre function network differences. Compared to MDD subjects without NSSI, those with past NSSI showed significant right superior temporal gyrus (STG) GMV, right lingual gyrus ReHo, sigma and global efficiency, and cerebellum-centre function network differences. The right STG GMV and cerebellum-centre function network were more important than other factors in predicting NSSI behaviour in MDD. MDD patients with a history of NSSI have dysregulated spontaneous brain activity and structure in regions related to emotions, pain regulation, and the somatosensory system. Importantly, right STG GMV and cerebellar loops may play important roles in NSSI in MDD patients.
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Affiliation(s)
- Lijun Kang
- grid.412632.00000 0004 1758 2270Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wei Wang
- grid.412632.00000 0004 1758 2270Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Nan Zhang
- grid.412632.00000 0004 1758 2270Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhaowen Nie
- grid.412632.00000 0004 1758 2270Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qian Gong
- grid.412632.00000 0004 1758 2270Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lihua Yao
- grid.412632.00000 0004 1758 2270Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ning Tu
- grid.412632.00000 0004 1758 2270PET/CT/MRI and Molecular Imaging Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Hongyan Feng
- grid.412632.00000 0004 1758 2270PET/CT/MRI and Molecular Imaging Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiaofen Zong
- grid.412632.00000 0004 1758 2270Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Hanping Bai
- grid.412632.00000 0004 1758 2270Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Gaohua Wang
- grid.412632.00000 0004 1758 2270Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lihong Bu
- PET/CT/MRI and Molecular Imaging Center, Renmin Hospital of Wuhan University, Wuhan, China.
| | - Fei Wang
- Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China. .,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, China.
| | - Zhongchun Liu
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China. .,Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan, China.
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Olivito G, Lupo M, Siciliano L, Gragnani A, Saettoni M, Pancheri C, Panfili M, Pignatelli F, Delle Chiaie R, Leggio M. Theory of mind profile and cerebellar alterations in remitted bipolar disorder 1 and 2: a comparison study. Front Behav Neurosci 2022; 16:971244. [PMID: 36160679 PMCID: PMC9492864 DOI: 10.3389/fnbeh.2022.971244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/18/2022] [Indexed: 11/21/2022] Open
Abstract
The literature on social cognition abilities in bipolar disorder (BD) is controversial about the occurrence of theory of mind (ToM) alterations. In addition to other cerebral structures, such as the frontal and limbic areas, the processing of socially relevant stimuli has also been attributed to the cerebellum, which has been demonstrated to be involved in the above-mentioned disorder. Nevertheless, the cerebellar contribution to ToM deficits in bipolar patients needs to be elucidated further. To this aim, two tests assessing different components of ToM were used to evaluate the ability to appreciate affective and mental states of others in 17 individuals with a diagnosis of BD type 1 (BD1) and 13 with BD type 2 (BD2), both in the euthymic phase, compared to healthy matched controls. Cerebellar gray matter (GM) volumes were extracted and compared between BD1 and controls and BD2 and controls by using voxel-based morphometry. The results showed that BD1 patients were compromised in the cognitive and advanced components of ToM, while the BD2 ToM profile resulted in a more widespread compromise, also involving affective and automatic components. Both overlapping and differing areas of cerebellar GM reduction were found. The two groups of patients presented a pattern of GM reduction in cerebellar portions that are known to be involved in the affective and social domains, such as the vermis and Crus I and Crus II. Interestingly, in both BD1 and BD2, positive correlations were detected between lower ToM scores and decreased volumes in the cerebellum. Overall, BD2 patients showed a more compromised ToM profile and greater cerebellar impairment than BD1 patients. The different patterns of structural abnormalities may account for the different ToM performances evidenced, thus leading to divergent profiles between BD1 and BD2.
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Affiliation(s)
- Giusy Olivito
- Ataxia Laboratory, Fondazione Santa Lucia IRCCS, Rome, Italy
- Department of Psychology, Sapienza University of Rome, Rome, Italy
- *Correspondence: Giusy Olivito
| | - Michela Lupo
- Servizio di Tutela della Salute Mentale e Riabilitazione dell’Età Evolutiva ASL, Rome, Italy
| | - Libera Siciliano
- Ataxia Laboratory, Fondazione Santa Lucia IRCCS, Rome, Italy
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Andrea Gragnani
- Scuola di Psicoterapia Cognitiva (SPC), Grosseto, Italy
- Associazione Psicologia Cognitiva (APC)/Scuola di Psicoterapia Cognitiva (SPC), Rome, Italy
| | - Marco Saettoni
- Scuola di Psicoterapia Cognitiva (SPC), Grosseto, Italy
- Unità Funzionale Salute Mentale Adulti ASL Toscana Nord-Ovest Valle del Serchio, Pisa, Italy
| | - Corinna Pancheri
- Department of Neuroscience and Mental Health–Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Matteo Panfili
- Department of Neuroscience and Mental Health–Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Roberto Delle Chiaie
- Department of Neuroscience and Mental Health–Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Maria Leggio
- Ataxia Laboratory, Fondazione Santa Lucia IRCCS, Rome, Italy
- Department of Psychology, Sapienza University of Rome, Rome, Italy
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6
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Pierce JE, Péron J. The basal ganglia and the cerebellum in human emotion. Soc Cogn Affect Neurosci 2021; 15:599-613. [PMID: 32507876 PMCID: PMC7328022 DOI: 10.1093/scan/nsaa076] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 04/03/2020] [Accepted: 06/02/2020] [Indexed: 12/26/2022] Open
Abstract
The basal ganglia (BG) and the cerebellum historically have been relegated to a functional role in producing or modulating motor output. Recent research, however, has emphasized the importance of these subcortical structures in multiple functional domains, including affective processes such as emotion recognition, subjective feeling elicitation and reward valuation. The pathways through the thalamus that connect the BG and cerebellum directly to each other and with extensive regions of the cortex provide a structural basis for their combined influence on limbic function. By regulating cortical oscillations to guide learning and strengthening rewarded behaviors or thought patterns to achieve a desired goal state, these regions can shape the way an individual processes emotional stimuli. This review will discuss the basic structure and function of the BG and cerebellum and propose an updated view of their functional role in human affective processing.
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Affiliation(s)
- Jordan E Pierce
- Clinical and Experimental Neuropsychology Laboratory, University of Geneva, 1205 Geneva, Switzerland
| | - Julie Péron
- Clinical and Experimental Neuropsychology Laboratory, University of Geneva, 1205 Geneva, Switzerland.,Neuropsychology Unit, Neurology Department, University Hospitals of Geneva, 1205 Geneva, Switzerland
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7
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McKenna MC, Chipika RH, Li Hi Shing S, Christidi F, Lope J, Doherty MA, Hengeveld JC, Vajda A, McLaughlin RL, Hardiman O, Hutchinson S, Bede P. Infratentorial pathology in frontotemporal dementia: cerebellar grey and white matter alterations in FTD phenotypes. J Neurol 2021; 268:4687-4697. [PMID: 33983551 PMCID: PMC8563547 DOI: 10.1007/s00415-021-10575-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/19/2021] [Accepted: 04/19/2021] [Indexed: 12/16/2022]
Abstract
The contribution of cerebellar pathology to cognitive and behavioural manifestations is increasingly recognised, but the cerebellar profiles of FTD phenotypes are relatively poorly characterised. A prospective, single-centre imaging study has been undertaken with a high-resolution structural and diffusion tensor protocol to systematically evaluate cerebellar grey and white matter alterations in behavioural-variant FTD(bvFTD), non-fluent variant primary progressive aphasia(nfvPPA), semantic-variant primary progressive aphasia(svPPA), C9orf72-positive ALS-FTD(C9 + ALSFTD) and C9orf72-negative ALS-FTD(C9-ALSFTD). Cerebellar cortical thickness and complementary morphometric analyses were carried out to appraise atrophy patterns controlling for demographic variables. White matter integrity was assessed in a study-specific white matter skeleton, evaluating three diffusivity metrics: fractional anisotropy (FA), axial diffusivity (AD) and radial diffusivity (RD). Significant cortical thickness reductions were identified in: lobule VII and crus I in bvFTD; lobule VI VII, crus I and II in nfvPPA; and lobule VII, crus I and II in svPPA; lobule IV, VI, VII and Crus I and II in C9 + ALSFTD. Morphometry revealed volume reductions in lobule V in all groups; in addition to lobule VIII in C9 + ALSFTD; lobule VI, VIII and vermis in C9-ALSFTD; lobule V, VII and vermis in bvFTD; and lobule V, VI, VIII and vermis in nfvPPA. Widespread white matter alterations were demonstrated by significant fractional anisotropy, axial diffusivity and radial diffusivity changes in each FTD phenotype that were more focal in those with C9 + ALSFTD and svPPA. Our findings indicate that FTD subtypes are associated with phenotype-specific cerebellar signatures with the selective involvement of specific lobules instead of global cerebellar atrophy.
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Affiliation(s)
- Mary Clare McKenna
- Computational Neuroimaging Group, Trinity Biomedical Sciences Institute, Trinity College Dublin, Peter Bede, Room 5.43, Pearse Street, Dublin 2, Ireland
| | - Rangariroyashe H Chipika
- Computational Neuroimaging Group, Trinity Biomedical Sciences Institute, Trinity College Dublin, Peter Bede, Room 5.43, Pearse Street, Dublin 2, Ireland
| | - Stacey Li Hi Shing
- Computational Neuroimaging Group, Trinity Biomedical Sciences Institute, Trinity College Dublin, Peter Bede, Room 5.43, Pearse Street, Dublin 2, Ireland
| | - Foteini Christidi
- Computational Neuroimaging Group, Trinity Biomedical Sciences Institute, Trinity College Dublin, Peter Bede, Room 5.43, Pearse Street, Dublin 2, Ireland
| | - Jasmin Lope
- Computational Neuroimaging Group, Trinity Biomedical Sciences Institute, Trinity College Dublin, Peter Bede, Room 5.43, Pearse Street, Dublin 2, Ireland
| | - Mark A Doherty
- Complex Trait Genomics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, Dublin 2, Ireland
| | - Jennifer C Hengeveld
- Complex Trait Genomics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, Dublin 2, Ireland
| | - Alice Vajda
- Complex Trait Genomics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, Dublin 2, Ireland
| | - Russell L McLaughlin
- Complex Trait Genomics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, Dublin 2, Ireland
| | - Orla Hardiman
- Computational Neuroimaging Group, Trinity Biomedical Sciences Institute, Trinity College Dublin, Peter Bede, Room 5.43, Pearse Street, Dublin 2, Ireland
| | | | - Peter Bede
- Computational Neuroimaging Group, Trinity Biomedical Sciences Institute, Trinity College Dublin, Peter Bede, Room 5.43, Pearse Street, Dublin 2, Ireland. .,Department of Neurology, St James's Hospital, Dublin, Ireland.
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8
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Lupo M, Olivito G, Gragnani A, Saettoni M, Siciliano L, Pancheri C, Panfili M, Bozzali M, Delle Chiaie R, Leggio M. Comparison of Cerebellar Grey Matter Alterations in Bipolar and Cerebellar Patients: Evidence from Voxel-Based Analysis. Int J Mol Sci 2021; 22:ijms22073511. [PMID: 33805296 PMCID: PMC8036397 DOI: 10.3390/ijms22073511] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/26/2021] [Indexed: 12/18/2022] Open
Abstract
The aim of this study was to compare the patterns of cerebellar alterations associated with bipolar disease with those induced by the presence of cerebellar neurodegenerative pathologies to clarify the potential cerebellar contribution to bipolar affective disturbance. Twenty-nine patients affected by bipolar disorder, 32 subjects affected by cerebellar neurodegenerative pathologies, and 37 age-matched healthy subjects underwent a 3T MRI protocol. A voxel-based morphometry analysis was used to show similarities and differences in cerebellar grey matter (GM) loss between the groups. We found a pattern of GM cerebellar alterations in both bipolar and cerebellar groups that involved the anterior and posterior cerebellar regions (p = 0.05). The direct comparison between bipolar and cerebellar patients demonstrated a significant difference in GM loss in cerebellar neurodegenerative patients in the bilateral anterior and posterior motor cerebellar regions, such as lobules I-IV, V, VI, VIIIa, VIIIb, IX, VIIb and vermis VI, while a pattern of overlapping GM loss was evident in right lobule V, right crus I and bilateral crus II. Our findings showed, for the first time, common and different alteration patterns of specific cerebellar lobules in bipolar and neurodegenerative cerebellar patients, which allowed us to hypothesize a cerebellar role in the cognitive and mood dysregulation symptoms that characterize bipolar disorder.
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Affiliation(s)
- Michela Lupo
- Ataxia Laboratory, Fondazione Santa Lucia IRCCS, 00179 Rome, Italy; (G.O.); (M.L.)
- Correspondence: ; Tel.: +39-065-150-1115
| | - Giusy Olivito
- Ataxia Laboratory, Fondazione Santa Lucia IRCCS, 00179 Rome, Italy; (G.O.); (M.L.)
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy
| | - Andrea Gragnani
- Scuola di Psicoterapia Cognitiva SPC, 58100 Grosseto, Italy; (A.G.); (M.S.)
- Associazione Psicologia Cognitiva (APC)/Scuola di Psicoterapia Cognitiva (SPC), 00185 Rome, Italy
| | - Marco Saettoni
- Scuola di Psicoterapia Cognitiva SPC, 58100 Grosseto, Italy; (A.G.); (M.S.)
- Unità Funzionale Salute Mentale Adulti ASL Toscana Nord-Ovest Valle del Serchio, 56121 Pisa, Italy
| | - Libera Siciliano
- PhD Program in Behavioral Neuroscience, Sapienza University of Rome, 00185 Rome, Italy;
| | - Corinna Pancheri
- Departement of Neuroscience and Mental Health–Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy; (C.P.); (M.P.); (R.D.C.)
| | - Matteo Panfili
- Departement of Neuroscience and Mental Health–Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy; (C.P.); (M.P.); (R.D.C.)
| | - Marco Bozzali
- Clinical Imaging Science Center, Brighton and Sussex Medical School, Brighton BN1 9RR, UK;
| | - Roberto Delle Chiaie
- Departement of Neuroscience and Mental Health–Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy; (C.P.); (M.P.); (R.D.C.)
| | - Maria Leggio
- Ataxia Laboratory, Fondazione Santa Lucia IRCCS, 00179 Rome, Italy; (G.O.); (M.L.)
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy
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9
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Schmahmann JD. Emotional disorders and the cerebellum: Neurobiological substrates, neuropsychiatry, and therapeutic implications. HANDBOOK OF CLINICAL NEUROLOGY 2021; 183:109-154. [PMID: 34389114 DOI: 10.1016/b978-0-12-822290-4.00016-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
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 have demonstrated 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 cerebellar incorporation into circuits that subserve cognition and emotion mandates a deeper understanding of the cerebellum by practitioners in behavioral neurology and neuropsychiatry because it impacts the understanding and diagnosis of disorders of emotion and intellect and has potential for novel cerebellar-based approaches to therapy.
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Affiliation(s)
- Jeremy D Schmahmann
- Ataxia Center, Cognitive Behavioral Neurology Unit, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
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10
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Zheng R, Chen Y, Jiang Y, Wen M, Zhou B, Li S, Wei Y, Yang Z, Wang C, Cheng J, Zhang Y, Han S. Dynamic Altered Amplitude of Low-Frequency Fluctuations in Patients With Major Depressive Disorder. Front Psychiatry 2021; 12:683610. [PMID: 34349681 PMCID: PMC8328277 DOI: 10.3389/fpsyt.2021.683610] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/14/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Major depressive disorder (MDD) has demonstrated abnormalities of static intrinsic brain activity measured by amplitude of low-frequency fluctuation (ALFF). Recent studies regarding the resting-state functional magnetic resonance imaging (rs-fMRI) have found the brain activity is inherently dynamic over time. Little is known, however, regarding the temporal dynamics of local neural activity in MDD. Here, we investigated whether temporal dynamic changes in spontaneous neural activity are influenced by MDD. Methods: We recruited 81 first-episode, drug-naive MDD patients and 64 age-, gender-, and education-matched healthy controls who underwent rs-fMRI. A sliding-window approach was then adopted for the estimation of dynamic ALFF (dALFF), which was used to measure time-varying brain activity and then compared between the two groups. The relationship between altered dALFF variability and clinical variables in MDD patients was also analyzed. Results: MDD patients showed increased temporal variability (dALFF) mainly focused on the bilateral thalamus, the bilateral superior frontal gyrus, the right middle frontal gyrus, the bilateral cerebellum posterior lobe, and the vermis. Furthermore, increased dALFF variability values in the right thalamus and right cerebellum posterior lobe were positively correlated with MDD symptom severity. Conclusions: The overall results suggest that altered temporal variability in corticocerebellar-thalamic-cortical circuit (CCTCC), involved in emotional, executive, and cognitive, is associated with drug-naive, first-episode MDD patients. Moreover, our study highlights the vital role of abnormal dynamic brain activity in the cerebellar hemisphere associated with CCTCC in MDD patients. These findings may provide novel insights into the pathophysiological mechanisms of MDD.
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Affiliation(s)
- Ruiping Zheng
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuan Chen
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yu Jiang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengmeng Wen
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Bingqian Zhou
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuying Li
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yarui Wei
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhengui Yang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Caihong Wang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jingliang Cheng
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yong Zhang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shaoqiang Han
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Van Overwalle F, Manto M, Cattaneo Z, Clausi S, Ferrari C, Gabrieli JDE, Guell X, Heleven E, Lupo M, Ma Q, Michelutti M, Olivito G, Pu M, Rice LC, Schmahmann JD, Siciliano L, Sokolov AA, Stoodley CJ, van Dun K, Vandervert L, Leggio M. Consensus Paper: Cerebellum and Social Cognition. CEREBELLUM (LONDON, ENGLAND) 2020; 19:833-868. [PMID: 32632709 PMCID: PMC7588399 DOI: 10.1007/s12311-020-01155-1] [Citation(s) in RCA: 179] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The traditional view on the cerebellum is that it controls motor behavior. Although recent work has revealed that the cerebellum supports also nonmotor functions such as cognition and affect, only during the last 5 years it has become evident that the cerebellum also plays an important social role. This role is evident in social cognition based on interpreting goal-directed actions through the movements of individuals (social "mirroring") which is very close to its original role in motor learning, as well as in social understanding of other individuals' mental state, such as their intentions, beliefs, past behaviors, future aspirations, and personality traits (social "mentalizing"). Most of this mentalizing role is supported by the posterior cerebellum (e.g., Crus I and II). The most dominant hypothesis is that the cerebellum assists in learning and understanding social action sequences, and so facilitates social cognition by supporting optimal predictions about imminent or future social interaction and cooperation. This consensus paper brings together experts from different fields to discuss recent efforts in understanding the role of the cerebellum in social cognition, and the understanding of social behaviors and mental states by others, its effect on clinical impairments such as cerebellar ataxia and autism spectrum disorder, and how the cerebellum can become a potential target for noninvasive brain stimulation as a therapeutic intervention. We report on the most recent empirical findings and techniques for understanding and manipulating cerebellar circuits in humans. Cerebellar circuitry appears now as a key structure to elucidate social interactions.
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Affiliation(s)
- Frank Van Overwalle
- Department of Psychology and Center for Neuroscience, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium
| | - Mario Manto
- Mediathèque Jean Jacquy, Service de Neurologie, CHU-Charleroi, Charleroi, Belgium
- Service des Neurosciences, Université de Mons, Mons, Belgium
| | - Zaira Cattaneo
- University of Milano-Bicocca, 20126 Milan, Italy
- IRCCS Mondino Foundation, Pavia, Italy
| | - Silvia Clausi
- Ataxia Laboratory, IRCCS Fondazione Santa Lucia, 00179 Rome, Italy
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | | | - John D. E. Gabrieli
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, USA
| | - Xavier Guell
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, USA
- Ataxia Unit, Cognitive Behavioral Neurology Unit, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Elien Heleven
- Department of Psychology and Center for Neuroscience, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium
| | - Michela Lupo
- Ataxia Laboratory, IRCCS Fondazione Santa Lucia, 00179 Rome, Italy
| | - Qianying Ma
- Department of Psychology and Center for Neuroscience, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium
| | - Marco Michelutti
- Service de Neurologie & Neuroscape@NeuroTech Platform, Département des Neurosciences Cliniques, Centre Hospitalier Universitaire Vaudois (CHUV), Service de Neurologie Lausanne, Lausanne, Switzerland
- Department of Neurosciences, University of Padua, Padua, Italy
| | - Giusy Olivito
- Ataxia Laboratory, IRCCS Fondazione Santa Lucia, 00179 Rome, Italy
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Min Pu
- Department of Psychology and Center for Neuroscience, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium
| | - Laura C. Rice
- Department of Psychology and Department of Neuroscience, American University, Washington, DC USA
| | - Jeremy D. Schmahmann
- Ataxia Unit, Cognitive Behavioral Neurology Unit, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Libera Siciliano
- Program in Behavioral Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Arseny A. Sokolov
- Service de Neurologie & Neuroscape@NeuroTech Platform, Département des Neurosciences Cliniques, Centre Hospitalier Universitaire Vaudois (CHUV), Service de Neurologie Lausanne, Lausanne, Switzerland
- Department of Neurology, University Neurorehabilitation, University Hospital Inselspital, University of Bern, Bern, Switzerland
- Wellcome Centre for Human Neuroimaging, Institute of Neurology, University College London (UCL), London, UK
- Neuroscape Center, Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA USA
| | - Catherine J. Stoodley
- Department of Psychology and Department of Neuroscience, American University, Washington, DC USA
| | - Kim van Dun
- Neurologic Rehabilitation Research, Rehabilitation Research Institute (REVAL), Hasselt University, 3590 Diepenbeek, Belgium
| | - Larry Vandervert
- American Nonlinear Systems, 1529 W. Courtland Avenue, Spokane, WA 99205-2608 USA
| | - Maria Leggio
- Ataxia Laboratory, IRCCS Fondazione Santa Lucia, 00179 Rome, Italy
- Department of Psychology, Sapienza University of Rome, Rome, Italy
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12
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Functional Changes of Mentalizing Network in SCA2 Patients: Novel Insights into Understanding the Social Cerebellum. THE CEREBELLUM 2020; 19:235-242. [PMID: 31925668 DOI: 10.1007/s12311-019-01081-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In recent years, increasing evidence of the cerebellar role in social cognition has emerged. The cerebellum has been shown to modulate cortical activity of social brain regions serving as a regulator of function-specific mentalizing and mirroring processes. In particular, a mentalizing area in the posterior cerebellum, specifically Crus II, is preferentially recruited for more complex and abstract forms of social processing, together with mentalizing cerebral areas including the dorsal medial prefrontal cortex (dmPFC), the temporo-parietal junction (TPJ), and the precuneus. In the present study, the network-based statistics approach was used to assess functional connectivity (FC) differences within this mentalizing cerebello-cerebral network associated with a specific cerebellar damage. To this aim, patients affected by spinocerebellar ataxia type 2 (SCA2), a neurodegenerative disease specifically affecting regions of the cerebellar cortex, and age-matched healthy subjects have been enrolled. The dmPFC, left and right TPJ, the precuneus, and the cerebellar Crus II were used as regions of interest to construct the mentalizing network to be analyzed and evaluate pairwise functional relations between them. When compared with controls, SCA2 patients showed altered internodal connectivity between dmPFC, left (L-) and right (R-) TPJ, and right posterior cerebellar Crus II.The present results indicate that FC changes affect a function-specific mentalizing network in patients affected by cerebellar damage. In particular, they allow to better clarify functional alteration mechanisms driven by the cerebellar damage associated with SCA2 suggesting that selective cortico-cerebellar functional disconnections may underlie patients' social impairment in domain-specific complex and abstract forms of social functioning.
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13
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Gong J, Wang J, Qiu S, Chen P, Luo Z, Wang J, Huang L, Wang Y. Common and distinct patterns of intrinsic brain activity alterations in major depression and bipolar disorder: voxel-based meta-analysis. Transl Psychiatry 2020; 10:353. [PMID: 33077728 PMCID: PMC7573621 DOI: 10.1038/s41398-020-01036-5] [Citation(s) in RCA: 164] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 09/13/2020] [Accepted: 10/01/2020] [Indexed: 01/08/2023] Open
Abstract
Identification of intrinsic brain activity differences and similarities between major depression (MDD) and bipolar disorder (BD) is necessary. However, results have not yet yielded consistent conclusions. A meta-analysis of whole-brain resting-state functional MRI (rs-fMRI) studies that explored differences in the amplitude of low-frequency fluctuation (ALFF) between patients (including MDD and BD) and healthy controls (HCs) was conducted using seed-based d mapping software. Systematic literature search identified 50 studies comparing 1399 MDD patients and 1332 HCs, and 15 studies comparing 494 BD patients and 593 HCs. MDD patients displayed increased ALFF in the right superior frontal gyrus (SFG) (including the medial orbitofrontal cortex, medial prefrontal cortex [mPFC], anterior cingulate cortex [ACC]), bilateral insula extending into the striatum and left supramarginal gyrus and decreased ALFF in the bilateral cerebellum, bilateral precuneus, and left occipital cortex compared with HCs. BD showed increased ALFF in the bilateral inferior frontal gyrus, bilateral insula extending into the striatum, right SFG, and right superior temporal gyrus (STG) and decreased ALFF in the bilateral precuneus, left cerebellum (extending to the occipital cortex), left ACC, and left STG. In addition, MDD displayed increased ALFF in the left lingual gyrus, left ACC, bilateral precuneus/posterior cingulate gyrus, and left STG and decreased ALFF in the right insula, right mPFC, right fusiform gyrus, and bilateral striatum relative to BD patients. Conjunction analysis showed increased ALFF in the bilateral insula, mPFC, and decreased ALFF in the left cerebellum in both disorders. Our comprehensive meta-analysis suggests that MDD and BD show a common pattern of aberrant regional intrinsic brain activity which predominantly includes the insula, mPFC, and cerebellum, while the limbic system and occipital cortex may be associated with spatially distinct patterns of brain function, which provide useful insights for understanding the underlying pathophysiology of brain dysfunction in affective disorders, and developing more targeted and efficacious treatment and intervention strategies.
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Affiliation(s)
- Jiaying Gong
- grid.412601.00000 0004 1760 3828Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630 China ,grid.488525.6Department of Radiology, Six Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510655 China
| | - Junjing Wang
- grid.440718.e0000 0001 2301 6433Department of Applied Psychology, Guangdong University of Foreign Studies, Guangzhou, 510006 China
| | - Shaojuan Qiu
- grid.412601.00000 0004 1760 3828Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630 China
| | - Pan Chen
- grid.412601.00000 0004 1760 3828Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630 China
| | - Zhenye Luo
- grid.412601.00000 0004 1760 3828Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630 China
| | - Jurong Wang
- grid.412601.00000 0004 1760 3828Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630 China
| | - Li Huang
- grid.412601.00000 0004 1760 3828Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630 China
| | - Ying Wang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China.
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Zhao L, Luo Z, Qiu S, Jia Y, Zhong S, Chen G, Lai S, Qi Z, Luo X, Huang G, Huang L, Wang Y. Abnormalities of aquaporin-4 in the cerebellum in bipolar II disorder: An ultra-high b-values diffusion weighted imaging study. J Affect Disord 2020; 274:136-143. [PMID: 32469796 DOI: 10.1016/j.jad.2020.05.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 04/03/2020] [Accepted: 05/10/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Cumulative evidence indicated the cerebellum is involved in the pathophysiology of bipolar disorder (BD). It was reported that the apparent diffusion coefficient from ultra-high b-values (ADCuh) could reflect the function of aquaporin-4 (AQP4) which was involved in neurological disorders. However, no studies have reported the AQP4 alteration in the cerebellum in BD. Therefore, this study aimed to investigate the ADCuh and AQP4 in the cerebellum in BD-II. METHODS Fifty patients with BD-II as well as 43 healthy controls underwent enhance diffusion weighted imaging (eDWI) with ultra-high b-values. The eDWI parameters including ADCuh , pure water diffusion (D) and pseudodiffusion (D*) was measured using regions-of-interest analysis in the superior cerebellar peduncles (SCP), middle cerebellar peduncles (MCP) , cerebellar hemisphere, dentate nuclei, tonsil and vermis of the cerebellum. RESULTS BD-II exhibited increased ADCuh values in the bilateral SCP, cerebellar hemisphere, tonsil and right dentate nuclei, and increased D* and D in the bilateral SCP, and decreased D* in the tonsil. Additionally, there were positive correlations between Hamilton Rating Scale for Depression-24 scores and bilateral ADCuh values in the SCP and cerebellar hemisphere. CONCLUSIONS The alteration of the ADCuh values in the cerebellum may reflect the changes of the AQP4, especially the abnormality of eDWI parameters in the SCP may be a key neurobiological feature of BD-II. The current results provide a novel insight to look into the pathophysiology mechanisms underlying BD-II.
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Affiliation(s)
- Lianping Zhao
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China; Department of Radiology, Gansu Provincial Hospital, Gansu 730000, China
| | - Zhenye Luo
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Shaojuan Qiu
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Yanbin Jia
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Shuming Zhong
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Guanmao Chen
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Shunkai Lai
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Zhangzhang Qi
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Xiaomei Luo
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Gang Huang
- Department of Radiology, Gansu Provincial Hospital, Gansu 730000, China
| | - Li Huang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Ying Wang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China; Clinical Experimental Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China.
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Taskiran-Sag A, Uzuncakmak Uyanik H, Uyanik SA, Oztekin N. Prospective investigation of cerebellar cognitive affective syndrome in a previously non-demented population of acute cerebellar stroke. J Stroke Cerebrovasc Dis 2020; 29:104923. [PMID: 32689613 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104923] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/19/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE In this prospective study, we aimed to investigate the presence and evolution of cerebellar cognitive affective syndrome in a cohort of isolated cerebellar stroke with no known cognitive or psychiatric impairment. We tried to distinguish the unconfounded effect of cerebellar lesions on neuropsychological processing. METHODS After a meticulous exclusion procedure based on possible confounders, we recruited 14 patients and 13 age-matched healthy controls to the study, prospectively. All of the patients had a detailed initial neuropsychological assessment at the first week and a follow-up assessment at the 4th month after stroke. RESULTS The prevalence of cognitive or behavioral-affective abnormalities in our cohort were 86% and 64% respectively. The patients exhibited mild and transient affective-behavioral abnormalities except for depressive symptoms that persisted in the subacute stage. They scored lower in general cognitive performance as revealed by mini mental test (p=0.001). Memory, executive functions, attention and working memory, central processing speed, and linguistic abilities were impaired (p<0.001; p=0.001; p=0.007; p=0.05; p<0.001 respectively). Improvement was evident only in memory domain of the cognitive functions in the subacute stage. Cognitive impairment was more likely with a medial or posterolateral infarct (p=0.014). Behavioral-affective abnormalities were not associated with a specific location in our cohort. Age seemed to negatively correlate with the recovery in general cognitive performance on the follow-up. CONCLUSIONS These findings show that acute denervation of cerebellocortical projections leads to mild affective-behavioral abnormalities, and full-blown cerebellar cognitive affective syndrome is rare. However, cognition was significantly affected after an acute cerebellar infarct even in a previously healthy, non-demented pure population.
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Affiliation(s)
- Aslihan Taskiran-Sag
- Department of Neurology, Ankara Numune Training and Research Hospital, Sihhiye, 06100 Ankara, Turkey.
| | - Handan Uzuncakmak Uyanik
- Department of Neurology, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Sadik Ahmet Uyanik
- Department of Radiology, Faculty of Medicine, Istanbul Okan University, Istanbul, Turkey
| | - Nese Oztekin
- Department of Neurology, Ankara Numune Training and Research Hospital, Sihhiye, 06100 Ankara, Turkey
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Argyropoulos GPD, van Dun K, Adamaszek M, Leggio M, Manto M, Masciullo M, Molinari M, Stoodley CJ, Van Overwalle F, Ivry RB, Schmahmann JD. The Cerebellar Cognitive Affective/Schmahmann Syndrome: a Task Force Paper. CEREBELLUM (LONDON, ENGLAND) 2020; 19:102-125. [PMID: 31522332 PMCID: PMC6978293 DOI: 10.1007/s12311-019-01068-8] [Citation(s) in RCA: 139] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Sporadically advocated over the last two centuries, a cerebellar role in cognition and affect has been rigorously established in the past few decades. In the clinical domain, such progress is epitomized by the "cerebellar cognitive affective syndrome" ("CCAS") or "Schmahmann syndrome." Introduced in the late 1990s, CCAS reflects a constellation of cerebellar-induced sequelae, comprising deficits in executive function, visuospatial cognition, emotion-affect, and language, over and above speech. The CCAS thus offers excellent grounds to investigate the functional topography of the cerebellum, and, ultimately, illustrate the precise mechanisms by which the cerebellum modulates cognition and affect. The primary objective of this task force paper is thus to stimulate further research in this area. After providing an up-to-date overview of the fundamental findings on cerebellar neurocognition, the paper substantiates the concept of CCAS with recent evidence from different scientific angles, promotes awareness of the CCAS as a clinical entity, and examines our current insight into the therapeutic options available. The paper finally identifies topics of divergence and outstanding questions for further research.
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Affiliation(s)
| | - Kim van Dun
- Rehabilitation Research Center REVAL, UHasselt, Hasselt, Belgium
| | - Michael Adamaszek
- Clinical and Cognitive Neurorehabilitation, Center of Neurology and Neurorehabilitation, Klinik Bavaria Kreischa, An der Wolfsschlucht 1-2, 01703 Kreischa, Germany
| | - Maria Leggio
- Department of Psychology, Sapienza University of Rome, Rome, Italy
- Ataxia Laboratory, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Mario Manto
- Department of Neurology, CHU-Charleroi, 6000 Charleroi, Belgium
- Department of Neurosciences, University of Mons, 7000 Mons, Belgium
| | - Marcella Masciullo
- SPInal REhabilitation Lab (SPIRE), IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Marco Molinari
- Neuro-Robot Rehabilitation Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | | | | | - Richard B. Ivry
- Department of Psychology, University of California, Berkeley, CA USA
| | - Jeremy D. Schmahmann
- Ataxia Unit, Cognitive Behavioral Neurology Unit, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
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17
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Cerebellar dentate nucleus functional connectivity with cerebral cortex in Alzheimer's disease and memory: a seed-based approach. Neurobiol Aging 2020; 89:32-40. [PMID: 32081466 DOI: 10.1016/j.neurobiolaging.2019.10.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 10/02/2019] [Accepted: 10/02/2019] [Indexed: 12/27/2022]
Abstract
Alzheimer's disease (AD) is a chronic neurodegenerative disorder characterized by specific patterns of gray and white matter damage and cognitive/behavioral manifestations. The cerebellum has also been implicated in the pathophysiology of AD. Because the cerebellum is known to have strong functional connectivity (FC) with associative cerebral cortex regions, it is possible to hypothesize that it is incorporated into intrinsic FC networks relevant to cognitive manifestation of AD. In the present study, the cerebellar dentate nucleus, the largest cerebellar nucleus and the major output channel to the cerebral cortex, was chosen as the region of interest to test potential cerebellocerebral FC alterations and correlations with patients' memory impairment in a group of patients with AD. Compared to controls, patients with AD showed an increase in FC between the dentate nucleus and regions of the lateral temporal lobe. This study demonstrates that lower memory performances in AD may be related to altered FC within specific cerebellocortical functional modules, thus suggesting the cerebellar contribution to AD pathophysiology and typical memory dysfunctions.
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18
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Cerebellum and cognition in Friedreich ataxia: a voxel-based morphometry and volumetric MRI study. J Neurol 2019; 267:350-358. [PMID: 31641877 DOI: 10.1007/s00415-019-09582-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 09/25/2019] [Accepted: 10/14/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Recent studies have suggested the presence of a significant atrophy affecting the cerebellar cortex in Friedreich ataxia (FRDA) patients, an area of the brain long considered to be relatively spared by neurodegenerative phenomena. Cognitive deficits, which occur in FRDA patients, have been associated with cerebellar volume loss in other conditions. The aim of this study was to investigate the correlation between cerebellar volume and cognition in FRDA. METHODS Nineteen FRDA patients and 20 healthy controls (HC) were included in this study and evaluated via a neuropsychological examination. Cerebellar global and lobular volumes were computed using the Spatially Unbiased Infratentorial Toolbox (SUIT). Furthermore, a cerebellar voxel-based morphometry (VBM) analysis was also carried out. Correlations between MRI metrics and clinical data were tested via partial correlation analysis. RESULTS FRDA patients showed a significant reduction of the total cerebellar volume (p = 0.004), significantly affecting the Lobule IX (p = 0.001). At the VBM analysis, we found a cluster of significant reduced GM density encompassing the entire lobule IX (p = 0.003). When correlations were probed, we found a direct correlation between Lobule IX volume and impaired visuo-spatial functions (r = 0.58, p = 0.02), with a similar correlation that was found between the same altered function and results obtained at the VBM (r = 0.52; p = 0.03). CONCLUSIONS With two different image analysis techniques, we confirmed the presence of cerebellar volume loss in FRDA, mainly affecting the posterior lobe. In particular, Lobule IX atrophy correlated with worse visuo-spatial abilities, further expanding our knowledge about the physiopathology of cognitive impairment in FRDA.
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19
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Argyropoulos GPD, van Dun K, Adamaszek M, Leggio M, Manto M, Masciullo M, Molinari M, Stoodley CJ, Van Overwalle F, Ivry RB, Schmahmann JD. The Cerebellar Cognitive Affective/Schmahmann Syndrome: a Task Force Paper. CEREBELLUM (LONDON, ENGLAND) 2019. [PMID: 31522332 DOI: 10.1007/s12311‐019‐01068‐8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Sporadically advocated over the last two centuries, a cerebellar role in cognition and affect has been rigorously established in the past few decades. In the clinical domain, such progress is epitomized by the "cerebellar cognitive affective syndrome" ("CCAS") or "Schmahmann syndrome." Introduced in the late 1990s, CCAS reflects a constellation of cerebellar-induced sequelae, comprising deficits in executive function, visuospatial cognition, emotion-affect, and language, over and above speech. The CCAS thus offers excellent grounds to investigate the functional topography of the cerebellum, and, ultimately, illustrate the precise mechanisms by which the cerebellum modulates cognition and affect. The primary objective of this task force paper is thus to stimulate further research in this area. After providing an up-to-date overview of the fundamental findings on cerebellar neurocognition, the paper substantiates the concept of CCAS with recent evidence from different scientific angles, promotes awareness of the CCAS as a clinical entity, and examines our current insight into the therapeutic options available. The paper finally identifies topics of divergence and outstanding questions for further research.
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Affiliation(s)
| | - Kim van Dun
- Rehabilitation Research Center REVAL, UHasselt, Hasselt, Belgium
| | - Michael Adamaszek
- Clinical and Cognitive Neurorehabilitation, Center of Neurology and Neurorehabilitation, Klinik Bavaria Kreischa, An der Wolfsschlucht 1-2, 01703, Kreischa, Germany
| | - Maria Leggio
- Department of Psychology, Sapienza University of Rome, Rome, Italy.,Ataxia Laboratory, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Mario Manto
- Department of Neurology, CHU-Charleroi, 6000, Charleroi, Belgium.,Department of Neurosciences, University of Mons, 7000, Mons, Belgium
| | - Marcella Masciullo
- SPInal REhabilitation Lab (SPIRE), IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179, Rome, Italy
| | - Marco Molinari
- Neuro-Robot Rehabilitation Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179, Rome, Italy
| | | | | | - Richard B Ivry
- Department of Psychology, University of California, Berkeley, CA, USA
| | - Jeremy D Schmahmann
- Ataxia Unit, Cognitive Behavioral Neurology Unit, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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20
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Lupo M, Siciliano L, Olivito G, Masciullo M, Bozzali M, Molinari M, Cercignani M, Silveri MC, Leggio M. Non-linear spelling in writing after a pure cerebellar lesion. Neuropsychologia 2019; 132:107143. [PMID: 31302109 DOI: 10.1016/j.neuropsychologia.2019.107143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 11/17/2022]
Abstract
The most common deficits in processing written language result from damage to the graphemic buffer system and refer to semantic and lexical problems or difficulties in phoneme-graphene conversion. However, a writing disorder that has not yet been studied in depth is the non-linear spelling phenomenon. Indeed, although some cases have been described, no report has exhaustively explained the cognitive mechanism and the anatomical substrates underlying this process. In the present study, we analyzed the modality of non-linear writing in a patient affected by a focal cerebellar lesion, who presented with an alteration of the normal trend to write the order of the letters. Based on this evidence, we analyzed the functional connectivity between the cerebellum and the brain network that subtends handwriting and demonstrated how the cerebellar lesion of the patient affected the connections between the cerebellum and cortical areas that support the anatomical system of writing. This is the first report of non-linear spelling in a patient with a lesion outside the fronto-parietal network, specifically with a focal cerebellar lesion. We propose that non-linear writing can be interpreted in view of the role of the cerebellum in timing and sequential processing. Thus, considering the current functional connectivity data, we hypothesize that the cerebellum might be relevant in the mechanism that allows the correct activation timing of letters within a string and placement of the letters in a specific sequential writing order.
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Affiliation(s)
- Michela Lupo
- Ataxia Laboratory, IRCCS Fondazione Santa Lucia, Rome, Italy.
| | - Libera Siciliano
- PhD Program in Behavioral Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Giusy Olivito
- Ataxia Laboratory, IRCCS Fondazione Santa Lucia, Rome, Italy; Neuroimaging Laboratory, IRCCS Fondazione Santa Lucia, Rome, Italy; Department of Psychology, Sapienza University of Rome, Rome, Italy
| | | | - Marco Bozzali
- Neuroimaging Laboratory, IRCCS Fondazione Santa Lucia, Rome, Italy; Clinical Imaging Science Center, Brighton and Sussex Medical School, Brighton, UK
| | - Marco Molinari
- Neurorehabilitation 1 and Spinal Center, Neuro-Robot Rehabilitation Lab, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Mara Cercignani
- Clinical Imaging Science Center, Brighton and Sussex Medical School, Brighton, UK
| | | | - Maria Leggio
- Ataxia Laboratory, IRCCS Fondazione Santa Lucia, Rome, Italy; Department of Psychology, Sapienza University of Rome, Rome, Italy
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21
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Lupo M, Siciliano L, Leggio M. From cerebellar alterations to mood disorders: A systematic review. Neurosci Biobehav Rev 2019; 103:21-28. [PMID: 31195001 DOI: 10.1016/j.neubiorev.2019.06.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 05/30/2019] [Accepted: 06/09/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Several studies have shown cerebellar abnormalities during depressive and manic states, although the specific cerebellar role in mood fluctuations remains poorly defined. Therefore, the study of pathologies characterized by frequent mood swings, such as bipolar disorder, is of great interest to investigate the relationship between the cerebellum and mood alterations. METHODS A systematic literature search on the occurrence of mood disorders in patients with cerebellar pathologies (1st research strategy) and on the presence of cerebellar alterations in mood disorders (2nd research strategy) was conducted using the PubMed electronic Internet database. For this systematic review all information was written based on the PRISMA-P statement. RESULTS The results of the 1st research strategy generated 9 articles, and in one of these, a direct correlation between cerebellar damage and the onset of mood disorder was reported. The 2nd research strategy generated 14 articles that were grouped according to the patient's mood phase (manic or depressive) or diagnosis (bipolar I or bipolar II). CONCLUSIONS The present review suggests that the cerebellum should be considered a key structure involved in the regulation of mood.
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Affiliation(s)
- Michela Lupo
- Ataxia Laboratory, IRCCS Fondazione Santa Lucia, Via Ardeatina 306-354, 00179, Rome, Italy.
| | - Libera Siciliano
- Sapienza University of Rome, Via dei Marsi 78, 00185, Rome, Italy.
| | - Maria Leggio
- Ataxia Laboratory, IRCCS Fondazione Santa Lucia, Via Ardeatina 306-354, 00179, Rome, Italy; Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185, Rome, Italy.
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22
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Gold AK, Toomey R. The role of cerebellar impairment in emotion processing: a case study. CEREBELLUM & ATAXIAS 2018; 5:11. [PMID: 30345063 PMCID: PMC6186118 DOI: 10.1186/s40673-018-0090-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 09/28/2018] [Indexed: 12/19/2022]
Abstract
Background Though the cerebellum’s role in visuospatial and fine motor functioning has been well-established over the last several years, the role of the cerebellum in emotion has more recently been a focus of scientific inquiry. Cerebellar impairment has been associated with deficits in emotional processing and is linked to a wide range of clinical behaviors including social withdrawal, blunted emotional expression, and impulsivity. In addition, cerebellar impairments have been associated with the onset of psychiatric disorders including major depressive disorder and, more recently, obsessive-compulsive disorder. Case presentation We describe a 32-year-old patient who presented to our clinic for a neuropsychological evaluation with a childhood history of a cerebellar brain tumor and detail-oriented, perfectionistic tendencies. Neuropsychological assessment data revealed impairments in visuospatial processing and in fine motor skills, likely stemming from the cerebellar tumor. Clinical assessment led to a diagnosis of obsessive-compulsive personality disorder and also suggested impairments in socio-emotional processing. Conclusions Our findings lend support to recent data which has suggested the impact of cerebellar impairment on emotional processing and related domains. Unlike many previous studies, however, our report focuses on an individual who, despite having marked impairments in certain domains, demonstrates a high level of functioning. We believe that this report holds important clinical relevance for proper diagnosis of cerebellar-related impairment and for the necessity of early intervention.
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Affiliation(s)
- Alexandra K Gold
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Avenue, 2nd Floor, Boston, MA USA
| | - Rosemary Toomey
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Avenue, 2nd Floor, Boston, MA USA
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Hydroxyurea Exposure and Development of the Cerebellar External Granular Layer: Effects on Granule Cell Precursors, Bergmann Glial and Microglial Cells. Neurotox Res 2018; 35:387-400. [PMID: 30276718 DOI: 10.1007/s12640-018-9964-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/17/2018] [Accepted: 09/21/2018] [Indexed: 12/20/2022]
Abstract
The current paper presents a histological analysis of the cell death in the cerebellar external granular layer (EGL) following the treatment with a single dose (2 mg/g) of hydroxyurea (HU). The rats were examined at postnatal days (P) 5, 10, and 15, and sacrificed at appropriate times ranging from 6 to 48 h after treatment administration. Studies were done in each cortical lobe (anterior, central, posterior, and inferior). The quantification of several parameters, such as density of 5-bromo-2'-deoxyuridine, TUNEL, vimentin, and tomato lectin-stained cells, revealed that HU compromises the viability of EGL cells. Our results indicate that P10 is a time of high vulnerability to injury. We also show here that the anterior and central lobes are the cortical regions most susceptible to the action of the HU. Additionally, our data also indicate that from 6 to 24 h after HU-exposure is a time-window of high sensibility to this agent. On the other hand, our ultrastructural analysis confirmed that HU administration produces the activation of apoptotic cellular events in the EGL, resulting in a substantial number of dying cells. Different stages of apoptosis can be observed in all cortical lobes at all investigated postnatal ages and survival times. Moreover, we observed that dying neuroblasts were covered by laminar processes of Bergmann glia, and that these unipolar astrocytes presented cytological features of phagocytes engulfing apoptotic bodies and cell debris. The electron microscopy study also revealed the participation of ameboid microglial cells in the phagocytosis of apoptotic cells in the regions of the EGL with extensive cell death.
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24
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Lupo M, Olivito G, Siciliano L, Masciullo M, Molinari M, Cercignani M, Bozzali M, Leggio M. Evidence of Cerebellar Involvement in the Onset of a Manic State. Front Neurol 2018; 9:774. [PMID: 30258401 PMCID: PMC6143664 DOI: 10.3389/fneur.2018.00774] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 08/27/2018] [Indexed: 11/13/2022] Open
Abstract
We described the cerebello-cerebral functional connectivity in a subject who developed a manic state after a cerebellar lesion. Whole brain investigation, performed by means of an advanced MRI examination, evidenced an isolated lesion involving the left lobules VI, VIIa (crus I), and IX and the posterior area of the vermis. The cerebello-cerebral functional connectivity analysis detected a pattern of altered connectivity in specific areas of the prefrontal-striatal-thalamic circuits that are typically altered in bipolar subjects during the manic state. Specifically, a pattern of hypo-connectivity was found between the cerebellum and cerebral regions known to be implicated in emotion modulation and social interaction. Conversely, a pattern of hyper-connectivity was found between the cerebellum and posterior cerebral cortical regions that are involved in sensorimotor functions. The present study represents the first evidence that dysregulation of cerebral networks consequent to a cerebellar lesion is at the root of bipolar disorder, at least the manic state, and provides a new framework for interpreting cerebellar modulation in the regulation of mood in specific psychiatric conditions.
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Affiliation(s)
- Michela Lupo
- Ataxia Laboratory, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Giusy Olivito
- Ataxia Laboratory, IRCCS Fondazione Santa Lucia, Rome, Italy.,Neuroimaging Laboratory, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Libera Siciliano
- Ataxia Laboratory, IRCCS Fondazione Santa Lucia, Rome, Italy.,Ph.D. Program in Behavioral Neuroscience, Sapienza University of Rome, Rome, Italy
| | | | - Marco Molinari
- Robotic Neurorehabilitation Lab, Neurorehabilitation 1 and Spinal Center, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Mara Cercignani
- Neuroimaging Laboratory, IRCCS Fondazione Santa Lucia, Rome, Italy.,Clinical Imaging Science Center, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Marco Bozzali
- Neuroimaging Laboratory, IRCCS Fondazione Santa Lucia, Rome, Italy.,Clinical Imaging Science Center, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Maria Leggio
- Ataxia Laboratory, IRCCS Fondazione Santa Lucia, Rome, Italy.,Department of Psychology, Sapienza University of Rome, Rome, Italy
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