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Shin JH, Kim H, Lee SY, Yoon WT, Park SW, Park S, Yoo D, Lee JY. Impaired cognitive flexibility and disrupted cognitive cerebellum in degenerative cerebellar ataxias. Brain Commun 2024; 6:fcae064. [PMID: 38454963 PMCID: PMC10919478 DOI: 10.1093/braincomms/fcae064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 12/27/2023] [Accepted: 02/22/2024] [Indexed: 03/09/2024] Open
Abstract
There is a clinically unmet need for a neuropsychological tool that reflects the pathophysiology of cognitive dysfunction in cerebellar degeneration. We investigated cognitive flexibility in degenerative cerebellar ataxia patients and aim to identify the pathophysiological correlates of cognitive dysfunction in relation to cerebellar cognitive circuits. We prospectively enrolled degenerative cerebellar ataxia patients with age-matched healthy controls who underwent 3 T 3D and resting-state functional MRI. All 56 participants were evaluated with the Scale for Assessment and Rating of Ataxia and neuropsychological tests including the Wisconsin Card Sorting Test, Trail Making Test, Montreal Cognitive Assessment and Mini-Mental State Examination. From MRI scans, we analysed the correlation of whole-brain volume and cortico-cerebellar functional connectivity with the Wisconsin Card Sorting Test performances. A total of 52 participants (29 ataxia patients and 23 healthy controls) were enrolled in this study. The Wisconsin Card Sorting Test scores (total error percentage, perseverative error percentage, non-perseverative error percentage and categories completed), Trail Making Test A and Montreal Cognitive Assessment were significantly impaired in ataxia patients (P < 0.05) compared to age-matched healthy controls. The Wisconsin Card Sorting Test error scores showed a significant correlation with the ataxia score (P < 0.05) controlling for age and sex. In volumetric analysis, the cerebellar right crus I, II, VIIb and VIII atrophy correlated with non-perseverative error percentage in the ataxia group. In functional connectivity analysis, the connectivity between crus I, II and VIIb of the cerebellum and bilateral superior parietal and superior temporal gyrus was significantly altered in ataxia patients. The functional connectivity between left crus II and VIIb of the cerebellum and dorsolateral prefrontal and superior frontal/parietal cortices showed a positive correlation with perseverative error percentage. The connectivity between left crus VIIb and pontine nucleus/middle cerebellar peduncle showed a significant negative correlation with non-perseverative error percentage in the ataxia group. The impaired cognitive flexibility represented by the Wisconsin Card Sorting Test was significantly impaired in degenerative cerebellar ataxia patients and correlated with disease severity. The Wisconsin Card Sorting Test performance reflects hypoactivity of the cognitive cerebellum and disrupted cortico-cerebellar connectivity in non-demented patients with degenerative cerebellar ataxia.
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Affiliation(s)
- Jung Hwan Shin
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center and Seoul National University College of Medicine, Seoul 07061, South Korea
- Department of Neurology, Seoul National University Hospital and Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Heejung Kim
- Department of Nuclear Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul 07061, South Korea
- Department of Neurology, Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul 03080, South Korea
| | - So Yeon Lee
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center and Seoul National University College of Medicine, Seoul 07061, South Korea
| | - Won Tae Yoon
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, South Korea
| | - Sun-Won Park
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center and Seoul National University College of Medicine, Seoul 07061, South Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Sangmin Park
- Department of Neurology, Eulji University Hospital, Eulji University School of Medicine, Daejeon 35233, South Korea
| | - Dallah Yoo
- Department of Neurology, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul 05278, South Korea
| | - Jee-Young Lee
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center and Seoul National University College of Medicine, Seoul 07061, South Korea
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Radmard S, Zesiewicz TA, Kuo SH. Evaluation of Cerebellar Ataxic Patients. Neurol Clin 2022; 41:21-44. [DOI: 10.1016/j.ncl.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ha H, Kim M, Chung B, Lee CH, Oh SH, Kang H, Kwon OY. A Novel KCND3 Variant in a Korean Family With SCA19. J Clin Neurol 2022; 18:90-92. [PMID: 35021282 PMCID: PMC8762501 DOI: 10.3988/jcn.2022.18.1.90] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/10/2021] [Accepted: 09/10/2021] [Indexed: 12/05/2022] Open
Affiliation(s)
- Hongmin Ha
- Department of Neurology, Gyeongsang National University Hospital, Jinju, Korea
| | - Minkyeong Kim
- Department of Neurology, Gyeongsang National University Hospital, Jinju, Korea.
| | - Bora Chung
- Department of Neurology, Gyeongsang National University Hospital, Jinju, Korea
| | - Chan Hyun Lee
- Department of Neurology, Gyeongsang National University Hospital, Jinju, Korea
| | - Seung Hwan Oh
- Department of Laboratory Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Heeyoung Kang
- Department of Neurology, Gyeongsang National University Hospital, Jinju, Korea.,Department of Neurology, Gyeongsang National University College of Medicine, Jinju, Korea.,Institute of Health Science, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Oh-Young Kwon
- Department of Neurology, Gyeongsang National University Hospital, Jinju, Korea.,Department of Neurology, Gyeongsang National University College of Medicine, Jinju, Korea.,Institute of Health Science, Gyeongsang National University College of Medicine, Jinju, Korea.
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