Cerebellum and semantic memory: A TMS study using the DRM paradigm

No Evidence for Semantic Prediction Deficits in Individuals With Cerebellar Degeneration

Cerebellar involvement in language processing has received considerable attention in the neuroimaging and neuropsychology literatures. Building off the motor control literature, one account of this involvement centers on the idea of internal models. In the context of language, this hypothesis suggests that the cerebellum is essential for building semantic models that, in concert with the cerebral cortex, help anticipate or predict linguistic input. To date, supportive evidence has primarily come from neuroimaging studies showing that cerebellar activation increases in contexts in which semantic predictions are generated and violated. Taking a neuropsychological approach, we put the internal model hypothesis to the test, asking if individuals with cerebellar degeneration (n = 14) show reduced sensitivity to semantic prediction. Using a sentence verification task, we compare reaction time to sentences that vary in terms of cloze probability. We also evaluated a more constrained variant of the prediction hypothesis, asking if the cerebellum facilitates the generation of semantic predictions when the content of a sentence refers to a dynamic rather than static mental transformation. The results failed to support either hypothesis: Compared to matched control participants (n = 17), individuals with cerebellar degeneration showed a similar reduction in reaction time for sentences with high cloze probability and no selective impairment in predictions involving dynamic transformations. These results challenge current theorizing about the role of the cerebellum in language processing, pointing to a misalignment between neuroimaging and neuropsychology research on this topic.

False memories in forensic psychology: do cognition and brain activity tell the same story?

One of the most important problems in forensic psychology is the impossibility of reliably discriminating between true and false memories when the only prosecution evidence comes from the memory of a witness or a victim. Unfortunately, both children and adults can be persuaded that they have been victims of past criminal acts, usually of a sexual nature. In adults, suggestion often occurs in the context of suggestive therapies based on the belief that traumatic events are repressed, while children come to believe and report events that never occurred as a result of repeated suggestive questioning. Cognitive Researchers have designed false memory paradigms (i.e., misinformation effect, Deese-Roediger-McDermott paradigm, event implantation paradigm) to first form false memories and then determine whether it is possible to reliably differentiate between false and true memories. In the present study, we review the contribution of cognitive research to the formation of false memories and the neuropsychological approaches aimed to discriminate between true and false memories. Based on these results, we analyze the applicability of the cognitive and neuropsychological evidence to the forensic setting.

Does context matter for memory? Testing the effectiveness of learning by imagining situated interactions with objects

Mounting evidence supports the efficacy of mental imagery for verbal information retention. Motor imagery, imagining oneself interacting physically with the object to be learned, emerges as an optimal form compared to less physically engaging imagery. Yet, when engaging in mental imagery, it occurs within a specific context that may affect imagined actions and consequently impact the mnemonic benefits of mental imagery. In a first study, participants were given instructions for incidental learning: mental rehearsal, visual imagery, motor imagery or situated motor imagery. The latter, which involved imagining physical interaction with an item within a coherent situation, produced the highest proportion of correct recalls. This highlights memory's role in supporting situated actions and offers the possibility for further developing the mnemonic potential of embodied mental imagery. Furthermore, item-level analysis showed that individuals who engaged in situated motor imagery remembered words primarily due to the sensorimotor characteristics of the words' referent. A second study investigating the role of inter-item distinctiveness in this effect failed to determine the extent to which the situational and motor elements need to be distinctive in order to be considered useful retrieval cues and produce an optimal memory performance.

From vector spaces to DRM lists: False Memory Generator, a software for automated generation of lists of stimuli inducing false memories

The formation of false memories is one of the most widely studied topics in cognitive psychology. The Deese-Roediger-McDermott (DRM) paradigm is a powerful tool for investigating false memories and revealing the cognitive mechanisms subserving their formation. In this task, participants first memorize a list of words (encoding phase) and next have to indicate whether words presented in a new list were part of the initially memorized one (recognition phase). By employing DRM lists optimized to investigate semantic effects, previous studies highlighted a crucial role of semantic processes in false memory generation, showing that new words semantically related to the studied ones tend to be more erroneously recognized (compared to new words less semantically related). Despite the strengths of the DRM task, this paradigm faces a major limitation in list construction due to its reliance on human-based association norms, posing both practical and theoretical concerns. To address these issues, we developed the False Memory Generator (FMG), an automated and data-driven tool for generating DRM lists, which exploits similarity relationships between items populating a vector space. Here, we present FMG and demonstrate the validity of the lists generated in successfully replicating well-known semantic effects on false memory production. FMG potentially has broad applications by allowing for testing false memory production in domains that go well beyond the current possibilities, as it can be in principle applied to any vector space encoding properties related to word referents (e.g., lexical, orthographic, phonological, sensory, affective, etc.) or other type of stimuli (e.g., images, sounds, etc.).

Harmonic memory signals in the human cerebral cortex induced by semantic relatedness of words

When we memorize multiple words simultaneously, semantic relatedness among those words assists memory. For example, the information about "apple", "banana," and "orange" will be connected via a common concept of "fruits" and become easy to retain and recall. Neural mechanisms underlying this semantic integration in verbal working memory remain unclear. Here I used electroencephalography (EEG) and investigated neural signals when healthy human participants memorized five nouns semantically related (Sem trial) or not (NonSem trial). The regularity of oscillatory signals (8-30 Hz) during the retention period was found to be lower in NonSem than Sem trials, indicating that memorizing words unrelated to each other induced a non-harmonic (irregular) waveform in the temporal cortex. These results suggest that (i) semantic features of a word are retained as a set of neural oscillations at specific frequencies and (ii) memorizing words sharing a common semantic feature produces harmonic brain responses through a resonance or integration (sharing) of the oscillatory signals.

Mixed Aphasia Caused by Bilateral Cerebellar Infarcts: a Case Report

Although neuroanatomical and physiological understanding of the cerebellum has evolved over recent decades and continues to develop, there is much that remains to be expounded upon, especially with regard to nonmotor roles. Neurocognitive and language processing is one area where involvement of the cerebellum is no longer in question, but the extent and mechanism of this relationship have yet to be defined. For example, which of the cerebellar hemispheres is involved continues to be debated. We present a case wherein a thrombus in the basilar artery led to bihemispheric cerebellar strokes with profound mixed effects on the patient's language and cognition. To the authors' knowledge, this is the first reported case of bilateral cerebellar strokes resulting in a mixed aphasia reported in scientific literature. This demonstrates the importance of continued research into a model for cerebellar function and the clinical impact of lesions to various cerebellar regions.

A meta-analysis of non-invasive brain stimulation (NIBS) effects on cerebellar-associated cognitive processes

Non-invasive brain stimulation (NIBS) techniques, including transcranial magnetic stimulation (TMS) and transcranial electrical stimulation (tES), have provided valuable insights into the role of the cerebellum in cognitive processes. However, replicating findings from studies involving cerebellar stimulation poses challenges. This meta-analysis investigates the impact of NIBS on cognitive processes associated with the cerebellum. We conducted a systematic search and analyzed 66 studies and 91 experiments involving healthy adults who underwent either TMS or transcranial direct current stimulation (tDCS) targeting the cerebellum. The results indicate that anodal tDCS applied to the medial cerebellum enhances cognitive performance. In contrast, high-frequency TMS disrupts cognitive performance when targeting the lateral cerebellar hemispheres or when employed in online protocols. Similarly, low-frequency TMS and continuous theta burst stimulation (cTBS) diminish performance in offline protocols. Moreover, high-frequency TMS impairs accuracy. By identifying consistent effects and moderators of modulation, this meta-analysis contributes to improving the replicability of studies using NIBS on the cerebellum and provides guidance for future research aimed at developing effective NIBS interventions targeting the cerebellum.

Semantic and episodic processes differently predict false memories in the DRM task

There is a fervent debate about the processes underpinning false memories formation. Seminal theories have suggested that semantic memory would be involved in false memories production, while episodic memory would counter their formation. Yet, direct evidence corroborating such view is still lacking. Here, we tested this possibility by asking participants to perform the Deese-Roediger-McDermott (DRM) task, a typical false memory paradigm, in which they had to study lists of words and subsequently to recognize and distinguish them from new words (i.e., the false memory items). The same participants were also required to perform a semantic task and an episodic-source memory task. Our results showed that a higher number of false memories in the DRM task occurred for those participants with better semantic memory abilities, while a lower number of false memories occurred for participants with better episodic abilities. These findings support a key role of semantic processes in false memory formation and, more generally, help clarify the specific contribution of different memory systems to false recognitions.

Neural evidence of switch processes during semantic and phonetic foraging in human memory

Humans may retrieve words from memory by exploring and exploiting in "semantic space" similar to how nonhuman animals forage for resources in physical space. This has been studied using the verbal fluency test (VFT), in which participants generate words belonging to a semantic or phonetic category in a limited time. People produce bursts of related items during VFT, referred to as "clustering" and "switching." The strategic foraging model posits that cognitive search behavior is guided by a monitoring process which detects relevant declines in performance and then triggers the searcher to seek a new patch or cluster in memory after the current patch has been depleted. An alternative body of research proposes that this behavior can be explained by an undirected rather than strategic search process, such as random walks with or without random jumps to new parts of semantic space. This study contributes to this theoretical debate by testing for neural evidence of strategically timed switches during memory search. Thirty participants performed category and letter VFT during functional MRI. Responses were classified as cluster or switch events based on computational metrics of similarity and participant evaluations. Results showed greater hippocampal and posterior cerebellar activation during switching than clustering, even while controlling for interresponse times and linguistic distance. Furthermore, these regions exhibited ramping activity which increased during within-patch search leading up to switches. Findings support the strategic foraging model, clarifying how neural switch processes may guide memory search in a manner akin to foraging in patchy spatial environments.

Effects of Cerebellar Transcranial Direct Current Stimulation in Patients with Stroke: a Systematic Review

BACKGROUND

The cerebellum is involved in regulating motor, affective, and cognitive processes. It is a promising target for transcranial direct current stimulation (tDCS) intervention in stroke.

OBJECTIVES

To review the current evidence for cerebellar tDCS (ctDCS) in stroke, its problems, and its future directions.

METHODS

We searched the Web of Science, MEDLINE, CINAHL, EMBASE, Cochrane Library, and PubMed databases. Eligible studies were identified after a systematic literature review of the effects of ctDCS in stroke patients. The changes in assessment scale scores and objective indicators after stimulation were reviewed.

RESULTS

Eleven studies were included in the systematic review, comprising 169 stroke patients. Current evidence suggests that anode tDCS on the right cerebellar hemisphere does not appear to enhance language processing in stroke patients. Compared with the sham group, stroke patients showed a significant improvement in the verb generation task after cathodal ctDCS stimulation. However, with regard to naming, two studies came to the opposite conclusion. The contralesional anodal ctDCS is expected to improve standing balance but not motor learning in stroke patients. The bipolar bilateral ctDCS protocol to target dentate nuclei (PO10h and PO9h) had a positive effect on standing balance, goal-directed weight shifting, and postural control in stroke patients.

CONCLUSIONS

ctDCS appears to improve poststroke language and motor dysfunction (particularly gait). However, the evidence for these results was insufficient, and the quality of the relevant studies was low. ctDCS stimulation parameters and individual factors of participants may affect the therapeutic effect of ctDCS. Researchers need to take a more regulated approach in the future to conduct studies with large sample sizes. Overall, ctDCS remains a promising stroke intervention technique that could be used in the future.

Individual differences in theory of mind correlate with the occurrence of false memory: A study with the DRM task

Although long-term memory and Theory of Mind (ToM) are closely related across the whole lifespan, little is known about the relationship between ToM and semantic memory. Clinical studies have documented the co-occurrence of ToM impairments and semantic memory abnormalities in individuals with autism or semantic dementia. However, to date, no study has directly investigated the existence of a relationship between ToM and semantic memory in the typical population. We addressed this gap on a sample of 103 healthy adults (M age = 22.96 years; age range = 19-35 years). Participants completed a classical false memory task tapping on semantic processes, the Deese-Roediger-McDermott (DRM) task, and two ToM tasks, the Triangles and the Reading the Mind in the Eyes task. They also completed the vocabulary scale from the Wechsler Adult Intelligence Scale. Results showed that participants' semantic performance in the DRM task was significantly related to that in the Triangles task. Specifically, the higher participants' ToM in the Triangles task, the higher participants' reliance on semantic memory while making false memories in the DRM task. Our findings are consistent with the Fuzzy Trace Theory and the Weak Central Coherence account and suggest that a (partially) common cognitive process responsible for global versus detailed-focus information processing could underlie these two abilities.

Disruption to left inferior frontal cortex modulates semantic prediction effects in reading and subsequent memory: Evidence from simultaneous TMS-EEG

Readers use prior context to predict features of upcoming words. When predictions are accurate, this increases the efficiency of comprehension. However, little is known about the fate of predictable and unpredictable words in memory or the neural systems governing these processes. Several theories suggest that the speech production system, including the left inferior frontal cortex (LIFC), is recruited for prediction but evidence that LIFC plays a causal role is lacking. We first examined the effects of predictability on memory and then tested the role of posterior LIFC using transcranial magnetic stimulation (TMS). In Experiment 1, participants read category cues, followed by a predictable, unpredictable, or incongruent target word for later recall. We observed a predictability benefit to memory, with predictable words remembered better than unpredictable words. In Experiment 2, participants performed the same task with electroencephalography (EEG) while undergoing event-related TMS over posterior LIFC using a protocol known to disrupt speech production, or over the right hemisphere homologue as an active control site. Under control stimulation, predictable words were better recalled than unpredictable words, replicating Experiment 1. This predictability benefit to memory was eliminated under LIFC stimulation. Moreover, while an a priori ROI-based analysis did not yield evidence for a reduction in the N400 predictability effect, mass-univariate analyses did suggest that the N400 predictability effect was reduced in spatial and temporal extent under LIFC stimulation. Collectively, these results provide causal evidence that the LIFC is recruited for prediction during silent reading, consistent with prediction-through-production accounts.

Neurocognitive and cerebellar function in ADHD, autism and spinocerebellar ataxia

The cerebellum plays a major role in balance, motor control and sensorimotor integration, but also in cognition, language, and emotional regulation. Several neuropsychiatric disorders such as attention deficit-hyperactivity disorder (ADHD), autism spectrum disorder (ASD), as well as neurological diseases such as spinocerebellar ataxia type 3 (SCA3) are associated with differences in cerebellar function. Morphological abnormalities in different cerebellar subregions produce distinct behavioral symptoms related to the functional disruption of specific cerebro-cerebellar circuits. The specific contribution of the cerebellum to typical development may therefore involve the optimization of the structure and function of cerebro-cerebellar circuits underlying skill acquisition in multiple domains. Here, we review cerebellar structural and functional differences between healthy and patients with ADHD, ASD, and SCA3, and explore how disruption of cerebellar networks affects the neurocognitive functions in these conditions. We discuss how cerebellar computations contribute to performance on cognitive and motor tasks and how cerebellar signals are interfaced with signals from other brain regions during normal and dysfunctional behavior. We conclude that the cerebellum plays a role in many cognitive functions. Still, more clinical studies with the support of neuroimaging are needed to clarify the cerebellum's role in normal and dysfunctional behavior and cognitive functioning.

Item-Level Scores on the Boston Naming Test as an Independent Predictor of Perirhinal Volume in Individuals with Mild Cognitive Impairment

We explored the methodological value of an item-level scoring procedure applied to the Boston Naming Test (BNT), and the extent to which this scoring approach predicts grey matter (GM) variability in regions that sustain semantic memory. Twenty-seven BNT items administered as part of the Alzheimer's Disease Neuroimaging Initiative were scored according to their "sensorimotor interaction" (SMI) value. Quantitative scores (i.e., the count of correctly named items) and qualitative scores (i.e., the average of SMI scores for correctly named items) were used as independent predictors of neuroanatomical GM maps in two sub-cohorts of 197 healthy adults and 350 mild cognitive impairment (MCI) participants. Quantitative scores predicted clusters of temporal and mediotemporal GM in both sub-cohorts. After accounting for quantitative scores, the qualitative scores predicted mediotemporal GM clusters in the MCI sub-cohort; clusters extended to the anterior parahippocampal gyrus and encompassed the perirhinal cortex. This was confirmed by a significant yet modest association between qualitative scores and region-of-interest-informed perirhinal volumes extracted post hoc. Item-level scoring of BNT performance provides complementary information to standard quantitative scores. The concurrent use of quantitative and qualitative scores may help profile lexical-semantic access more precisely, and might help detect changes in semantic memory that are typical of early-stage Alzheimer's disease.

Age-Related Changes in Episodic Processing of Scenes: A Functional Activation and Connectivity Study

The posterior-to-anterior shift in aging (PASA) effect is seen as a compensatory model that enables older adults to meet increased cognitive demands to perform comparably as their young counterparts. However, empirical support for the PASA effect investigating age-related changes in the inferior frontal gyrus (IFG), hippocampus, and parahippocampus has yet to be established. 33 older adults and 48 young adults were administered tasks sensitive to novelty and relational processing of indoor/outdoor scenes in a 3-Tesla MRI scanner. Functional activation and connectivity analyses were applied to examine the age-related changes on the IFG, hippocampus, and parahippocampus among low/high-performing older adults and young adults. Significant parahippocampal activation was generally found in both older (high-performing) and young adults for novelty and relational processing of scenes. Younger adults had significantly greater IFG and parahippocampal activation than older adults, and greater parahippocampal activation compared to low-performing older adults for relational processing-providing partial support for the PASA model. Observations of significant functional connectivity within the medial temporal lobe and greater negative left IFG-right hippocampus/parahippocampus functional connectivity for young compared to low-performing older adults for relational processing also supports the PASA effect partially.

Distinct multivariate structural brain profiles are related to variations in short- and long-delay memory consolidation across children and young adults

From early to middle childhood, brain regions that underlie memory consolidation undergo profound maturational changes. However, there is little empirical investigation that directly relates age-related differences in brain structural measures to memory consolidation processes. The present study examined memory consolidation of intentionally studied object-location associations after one night of sleep (short delay) and after two weeks (long delay) in normally developing 5-to-7-year-old children (n = 50) and young adults (n = 39). Behavioural differences in memory retention rate were related to structural brain measures. Our results showed that children, in comparison to young adults, retained correctly learnt object-location associations less robustly over short and long delay. Moreover, using partial least squares correlation method, a unique multivariate profile comprised of specific neocortical (prefrontal, parietal, and occipital), cerebellar, and hippocampal head and subfield structures in the body was found to be associated with variation in short-delay memory retention. A different multivariate profile comprised of a reduced set of brain structures, mainly consisting of neocortical (prefrontal, parietal, and occipital), hippocampal head, and selective hippocampal subfield structures (CA1-2 and subiculum) was associated with variation in long-delay memory retention. Taken together, the results suggest that multivariate structural pattern of unique sets of brain regions are related to variations in short- and long-delay memory consolidation across children and young adults.

Hands-on false memories: a combined study with distributional semantics and mouse-tracking

Although mouse-tracking has been seen as a real-time window into different aspects of human decision-making processes, currently little is known about how the decision process unfolds in veridical and false memory retrieval. Here, we directly investigated decision-making processes by predicting participants' performance in a mouse-tracking version of a typical Deese-Roediger-McDermott (DRM) task through distributional semantic models, a usage-based approach to meaning. Participants were required to study lists of associated words and then to perform a recognition task with the mouse. Results showed that mouse trajectories were extensively affected by the semantic similarity between the words presented in the recognition phase and the ones previously studied. In particular, the higher the semantic similarity, the larger the conflict driving the choice and the higher the irregularity in the trajectory when correctly rejecting new words (i.e., the false memory items). Conversely, on the temporal evolution of the decision, our results showed that semantic similarity affects more complex temporal measures indexing the online decision processes subserving task performance. Together, these findings demonstrate that semantic similarity can affect human behavior at the level of motor control, testifying its influence on online decision-making processes. More generally, our findings complement previous seminal theories on false memory and provide insights into the impact of the semantic memory structure on different decision-making components.

Dynamic changes in neural representations underlie the repetition effect on false memory

Restudying word lists (e.g., dream, awake, and bed) strengthens true memory of the studied words and reduces false memory for unstudied but semantically related lures (e.g., sleep). Yet, the neural mechanisms involved in this repetition effect on false memory remain unclear. Possible mechanisms involve item-specific and semantic neural representations at encoding, and the memory strength between encoding and retrieval. This study first replicated the behavioral results (Exp. 1) and then investigated various neural mechanisms by using slow event-related functional magnetic resonance imaging (fMRI) and representational similarity analysis (Exp. 2). Behavioral results confirmed that restudy improved true memory and reduced false memory. The fMRI results showed that restudy induced item-specific neural representations at encoding in the left occipital pole, but reduced neural overlap between semantic representations at encoding in the left temporal pole. Individual differences in these two encoding neural mechanisms were correlated with the behavioral measure of false memory, with greater restudy-induced representational changes at encoding (item-specific neural representations and reduced neural overlap between semantic representations) being associated with lower false memory. Moreover, restudy enhanced the memory strength between encoding and retrieval in the visuoparietal cortex but reduced it in the frontal cortex. These findings suggest that dynamic changes in neural representations underlie the repetition effect on false memory, supporting a dual-coding neural framework.

Environmental Enrichment Enhances Cerebellar Compensation and Develops Cerebellar Reserve

The brain is able to change its structure and function in response to environmental stimulations. Several human and animal studies have documented that enhanced stimulations provide individuals with strengthened brain structure and function that allow them to better cope with damage. In this framework, studies based on the exposure of animals to environmental enrichment (EE) have provided indications of the mechanisms involved in such a beneficial action. The cerebellum is a very plastic brain region that responds to every experience with deep structural and functional rearrangement. The present review specifically aims to collect and synthesize the evidence provided by animal models on EE exposure effects on cerebellar structure and function by considering the studies on healthy subjects and on animals exposed to EE both before and after damage involving cerebellar functionality. On the whole, the evidence supports the role of EE in enhancing cerebellar compensation and developing cerebellar reserve. However, since studies addressing this issue are still scarce, large areas of inconsistency and lack of clarity remain. Further studies are required to provide suggestions on possible mechanisms of enhancement of compensatory responses in human patients following cerebellar damage.

Mapping of Language-and-Memory Networks in Patients With Temporal Lobe Epilepsy by Using the GE2REC Protocol

Preoperative mapping of language and declarative memory functions in temporal lobe epilepsy (TLE) patients is essential since they frequently encounter deterioration of these functions and show variable degrees of cerebral reorganization. Due to growing evidence on language and declarative memory interdependence at a neural and neuropsychological level, we propose the GE2REC protocol for interactive language-and-memory network (LMN) mapping. GE2REC consists of three inter-related tasks, sentence generation with implicit encoding (GE) and two recollection (2REC) memory tasks: recognition and recall. This protocol has previously been validated in healthy participants, and in this study, we showed that it also maps the LMN in the left TLE (N = 18). Compared to healthy controls (N = 19), left TLE (LTLE) showed widespread inter- and intra-hemispheric reorganization of the LMN through reduced activity of regions engaged in the integration and the coordination of this meta-network. We also illustrated how this protocol could be implemented in clinical practice individually by presenting two case studies of LTLE patients who underwent efficient surgery and became seizure-free but showed different cognitive outcomes. This protocol can be advantageous for clinical practice because it (a) is short and easy to perform; (b) allows brain mapping of essential cognitive functions, even at an individual level; (c) engages language-and-memory interaction allowing to evaluate the integrative processes within the LMN; (d) provides a more comprehensive assessment by including both verbal and visual modalities, as well as various language and memory processes. Based on the available postsurgical data, we presented preliminary results obtained with this protocol in LTLE patients that could potentially inform the clinical practice. This implies the necessity to further validate the potential of GE2REC for neurosurgical planning, along with two directions, guiding resection and describing LMN neuroplasticity at an individual level.

The Human Cerebellum as a Hub of the Predictive Brain

Although the cerebellum has long been believed to be involved uniquely in sensorimotor processes, recent research works pointed to its participation in a wide range of cognitive predictive functions. Here, we review the available evidence supporting a generalized role of the cerebellum in predictive computation. We then discuss the anatomo-physiological properties that make the cerebellum the ideal hub of the predictive brain. We further argue that cerebellar involvement in cognition may follow a continuous gradient, with higher cerebellar activity occurring for tasks relying more on predictive processes, and outline the empirical scenarios to probe this hypothesis.

Probing cerebellar involvement in cognition through a meta-analysis of TMS evidence

Traditionally, the cerebellum has been linked to motor coordination, but growing evidence points to its involvement in a wide range of non-motor functions. Though the number of studies using transcranial magnetic stimulation (TMS) to investigate cerebellar involvement in cognitive processes is growing exponentially, these findings have not yet been synthesized in a meta-analysis. Here, we used meta-analysis to estimate the effects of cerebellar TMS on performance in cognitive tasks for healthy participants. Outcomes included participants' accuracy and response times (RTs) of several non-motor tasks performed either during or after the administration of TMS. We included overall 41 studies, of which 44 single experiments reported effects on accuracy and 41 on response times (RTs). The meta-analyses showed medium effect sizes (for accuracy: d = 0.61 [95% CI = 0.48, .073]; for RTs: d = 0.40 [95% CI = 0.30, 0.49]), with leave-one-out analyses indicating that cumulative effects were robust, and with moderate heterogeneity. For both accuracy and RTs, the effect of TMS was moderated by the stimulation paradigm adopted but not by the cognitive function investigated, while the timing of the stimulation moderated only the effects on RTs. Further analyses on lateralization revealed no moderation effects of the TMS site. Taken together, these findings indicate that TMS administered over the cerebellum is able to modulate cognitive performance, affecting accuracy or RTs, and suggest that the various stimulation paradigms play a key role in determining the efficacy of cerebellar TMS.

A narrative review on non-invasive stimulation of the cerebellum in neurological diseases

IMPORTANCE

The cerebellum plays an important role in motor, cognitive, and affective functions owing to its dense interconnections with basal ganglia and cerebral cortex. This review aimed at summarizing the non-invasive cerebellar stimulation (NICS) approaches used to modulate cerebellar output and treat cerebellar dysfunction in the motor domain.

OBSERVATION

The utility of NICS in the treatment of cerebellar and non-cerebellar neurological diseases (including Parkinson's disease, dementia, cerebellar ataxia, and stroke) is discussed. NICS induces meaningful clinical effects from repeated sessions alone in both cerebellar and non-cerebellar diseases. However, there are no conclusive data on this issue and several concerns need to be still addressed before NICS could be considered a valuable, standard therapeutic tool.

CONCLUSIONS AND RELEVANCE

Even though some challenges must be overcome to adopt NICS in a wider clinical setting, this tool might become a useful strategy to help patients with lesions in the cerebellum and cerebral areas that are connected with the cerebellum whether one could enhance cerebellar activity with the intention of facilitating the cerebellum and the entire, related network, rather than attempting to facilitate a partially damaged cortical region or inhibiting the homologs' contralateral area. The different outcome of each approach would depend on the residual functional reserve of the cerebellum, which is confirmed as a critical element to be probed preliminary in order to define the best patient-tailored NICS.