Cerebellum and Cognition

Cerebellum and Cognition
CEREBELLUM AND COGNITION

Elena Cano and Ismael Loinaz
Abstract: The scientific literature has traditionally defended only the involvem
ent of the cerebellum in motor functions. The traditional belief that the cerebe
llum is only a motor control device seems to have been overcome and a growing nu
mber of studies have shown that the cerebellum acts as diverse due to its struct
ural complexity and its multiple connections with different brain regions. This
review is intended to be an update of existing critical data on the involvement
of the cerebellum in different cognitive functions in diverse
psychopathology and how the neuroimaging studies and
cerebellar lesions contribute to better understanding the complex world cerebell
um.
INTRODUCTION Traditionally the cerebellum has been associated exclusively with m
otor functions and scientific literature available on the subject is extensive.
A growing number of empirical studies have begun to highlight the involvement of
the cerebellum in emotional and cognitive functions (Schmahmann, 2004). Underst
anding the human cerebellum has improved in recent decades thanks to the availab
ility of detailed anatomical images
1
provided by neuroimaging studies with MRI, and cerebellar activation with PET an
d fMRI studies of motor functions, sensory and cognitive / emotional (Fliessbach
, Trautner, Quesada, Elger and Weber, 2007). The three-dimensional atlas of the
human cerebellum by MRI were introduced almost a decade ago (Schmahmann et al.,
1999). The atlas of Schmahmann and colleagues has become a reference tool in ide
ntifying the cerebellar lobes and fissures in functional imaging studies. Howeve
r, deep cerebellar nuclei are difficult to access, so the study of the different
interfaces has been complicated. A recently published an atlas of MRI on human
cerebellar nuclei (Dimitrova et al., 2002) in a study designed especially for st
udying the anatomy of the deep cerebellar nuclei. We could not understand the co
mplexity of the cerebellum without regard to their anatomy, so dedicate a small
section cereblares connections. Anatomical studies on the cerebellum and its fun
ctions, especially those relating to motor connections have often been carried o
ut on primates (Ramnani, 2006) has recently increased the number of empirical st
udies that demonstrate the involvement of the cerebellum in cognitive and emotio
nal functions (Schmahmann and Caplan, 2006). The studies that have been investig
ated in patients with cerebellar damage have demonstrated the involvement of it
in executive functions, language (Chen and Desmond, 2005) and emotional regulati
on ("cerebellar cognitive-affective syndrome," SCAC) (Schmahmann and Sherman, 19
98). As outlined below, many studies have analyzed the involvement of the cerebe
llum in determinded psychopathology. Psychopathology in which most comprehensive
ly studied the involvement of cerebellar abnormalities in the etiology of schizo
phrenia has been (Paradiso, Andreasen et al., 2003), but also discuss their invo
lvement in trichotillomania (Keuthen et al., 2006, Swedo et al., 1991), Williams
Syndrome (Eckert et al., 2006, Jones et al., 2002) or autism (Townsend et al.,
2001).
2
Analyze the involvement of the cerebellum in cognitive functions such as languag
e, memory, attention, temporal perception and empathy.
ANATOMY OF THE CEREBELLUM AND ITS CONNECTIONS To better understand the involveme
nt of the cerebellum in different functions and pathologies, it is necessary to
understand some anatomical peculiarities of the cerebellum (Makris et al., 2005)
and its connections, which are precisely the cause of their functional diversit
y . In a recent review of the cerebellum in nonhuman primates (Ramnani, 2006) st
ates that despite the various trials that support the theory that the primate ce
rebellum contributes not only to motor control, but also to higher cognitive fun
ctions, there is still no consensus among professionals on how the cerebellum pr
ocesses such connections. The answer lies in the nature of the connections of th
e cerebellum with areas of the cortex, especially the prefrontal cortex and the
uniformity of their cellular organization. Understanding this cellular organizat
ion, you can extend the model of information processing of motor cortex to proce
ss information from the prefrontal cortex. The main processing unit of informati
on in the cerebellar cortex is the Purkinje cell,Âwhich integrates information
from two major relay stations precerebelares: pontine nucleus and inferior olive
. The diverse information processed by the cerebellum does not stem from differe
nces in local circuits, but the diverse nature of inputs, especially those from
the cerebral cortex. The cerebellum appears to be composed of multiple independe
nt anatomical modules, each forming a component of a closed anatomical loop that
sends and receives projections from a specific area of the cerebral cortex (Ram
nani, 2006). In addition to morphological or structural abnormalities of the cer
ebellum, other studies attempt to show the connections of the cerebellum to cere
bral cortical areas, especially with first-order cortical areas. The evidence in
this regard are becoming more extensive, having
3
demonstrated powerful connections of the cerebellum through the cerebellar nucle
i, with the primary motor cortex or the prefrontal cortex, the Purkinje cells of
the cerebellar nuclei exert an inhibitory effect mediated by the GABA system (O
liveri, Koch, Torriero and Caltagirone , 2005). The cerebellar nuclei receive af
ferents mainly from the cerebellar cortex, but the main source of efferents from
the cerebellum, are precisely the cerebellar nuclei (Schoch, Dimitrova, Gizewsk
i and Timmann, 2006). At the same time is described as afferents to the cerebell
um are much higher than the efferents from the cerebellum, which is interpreted
as a sign of the integrative role that has the cerebellum in the overall functio
ning of the central nervous system (Gottwald, Wilde, Mihajlovic and Mehdorn, 200
4 .) One of the ways in which they have demonstrated connections of the cerebell
um (and the type of modulation exerted) to the contralateral primary motor areas
has been using transcranial magnetic stimulation (TMS), measuring the response
using motor evoked potentials (in controls healthy). It has been observed that i
nhibition of the cerebellum following stimulation results in facilitation of evo
ked potentials in the contralateral primary motor cortex. This result shows that
the connections between cerebellum and primary motor areas are cross-connection
s, connections that exert inhibitory control over these areas (Oliveri et al., 2
005). In the same vein, a study conducted with healthy controls shows how, befor
e the development of a verbal fluency task (which takes place in silence), a rig
ht-handed person there is a significant activation in the right cerebellar hemis
phere, and activation frontoparietal cortex contralateral (left), while left-han
ded, activates the left cerebellar hemisphere with the right frontoparietal cort
ex (Hubrich-Ungureanu, Kaemmerer, Henn and Braus, 2002). It
demonstrates both the existence of connections with cortical areas directly invo
lved in cognitive processing, such as the fact that these connections take place
on a crusade. The demonstration of the connections with the first-order cortica
l areas consistent with the fact that, phylogenetically, the brain areas of asso
ciation and the neocerebellum have been developed in parallel.
4
In line with the connections between the cerebellum and the brain areas related
to language, to the evidence of dysfunction of cerebellar activity following the
injury of the brain areas related to language, it is proposed that the frontal
lesion may in a lower cerebral blood flow and a decreased metabolism in the cont
ralateral cerebellum. Given this scenario raises a job, measuring precisely the
blood oxygen level in these areas, while performing a verbal task in silence. Th
is study shows that in patients with aphasia, despite the absence of injury to t
he right cerebellar hemisphere, this is not working properly, proposing could be
due to lack of inputs from the frontal cortex affected. When, in the same study
, the task is repeated (and, therefore, verbal learning) changes were observed i
n oxygen consumption in the cerebellum both left and right frontooccipitales are
as, changes that correspond to the improvement in the performance of the task. G
iven these results, the authors propose two hypotheses to justify the role of th
e cerebellum in language: the cerebellum stores phonological information while p
erforming the task, and, second, that the cerebellum is involved in the detectio
n of errors in production tasks verbal (Connor et al., 2006). Following research
on the connections of the cerebellum,Âproposed that it participates in the lea
rning of procedures through a network that interconnects with the prefrontal are
as via the thalamus, a network composed of both excitatory connections as inhibi
tory connections, and it presents the hypothesis that injury to any node that ma
ke up this network, would upset the balance of excitatory-inhibitory connections
, which would be the deterioration in the performance of the function. Following
this theory, conducting a study in which performance is measured against the le
arning of a motor task, performed with one hand, in patients with cerebellar les
ion located in the cerebellar hemisphere contralateral to the hand, after applyi
ng transcranial magnetic stimulation low frequency (Torriero et. al., 2007). Thr
ough this study shows that cerebellar injury is accompanied by a decline in acti
vity in the contralateral prefrontal cortex (specifically the dorsolateral prefr
ontal cortex).
5
When stimulated by rTMS on prefrontal cortex contralateral to the lesion, the ta
sk performance suffers the most damage (about the deterioration of departure), i
n contrast, when stimulated the prefrontal cortex ipsilateral to the cerebellar
lesion and contralateral to the affected limb , learning of the task improvement
, which suggests that compensation is due to excess stimulation of the cortex re
ceives from the cerebellum intact, compared with less stimulation to the contral
ateral prefrontal area receives from the cerebellum injury. For the aforemention
ed reasons, we conclude that the cerebellum has connections with primary motor a
reas, as areas of language (specifically the frontoparietal cortex) and prefront
al cortical areas (particularly the dorsolateral cortex) in the case of cross co
nnections, to contralateral cerebral hemisphere. In line with the establishment
of the cerebellar connections with other brain areas, has made a study of functi
onal localization in this case from the motor component in the cerebellum. In th
is study proves the existence of somatotopic representation in the superior cere
bellar cortex, a finding that coincides with the result set from other studies.
(Schoch, 2006). According to this representation, lobules III and IV (vermis and
paravermis) are associated with ataxia in the lower extremities, while IV and V
I lobes (vermis, and hemispheres paravermis) are linked to upper limb ataxia, dy
sarthria is linked to the lobes V and VI (paravermis and hemispheres), the lobes
II and III (superior vermis) are associated with ataxic gait, while the postura
l ataxia is linked to the lobe III. These findings are consistent with the resul
ts obtained through functional neuroimaging. A second finding of this study is t
he demonstration that the prognosis for recovery of motor functions depends on w
here the injury settles, resulting in worse prognosis those functions which were
created in the cerebellar nuclei.
6
PSYCHOPATHOLOGY AND CEREBELLUM Several studies have shown the existence of struc
tural alterations in the cerebellum in various disorders such as schizophrenia,
autism, attention deficit hyperactivity disorder or trichotillomania, conditions
that, in turn, share some symptoms with those listed by cerebellar lesions. Sch
izophrenia: In the group of schizophrenic subjects Paradiso
(Paradiso et al., 2003) observed by PET imaging study, these patients did not tr
igger the NL phylogenetic fear-danger while viewing unpleasant pictures. Similar
ly, the cerebellum of these patients, and the prefrontal cortex showed a
reduced activity during the evaluation of pleasant images, being unable to recog
nize them as such. A recent study conducted with a relatively large sample of pe
ople with first episode
schizophrenia, and so far had not made the same drug treatment showed a lower vo
lume of gray matter in various parts of the central nervous system, including th
e cerebellum is apparently significantly lower compared to previous studies (Chu
a et al., 2007). SÃndorme Williams: The Williams Syndrome (SW), the visuo-spati
al ability is particularly affected. SW neurobiological studies show an unusual
structure and activity in posterior regions of parietal, thalamic and cerebellar
, which are important to implement actions based on space (Eckert et al., 2006).
Individuals with Williams syndrome have a disproportionately large cerebellum,
particularly the cerebellar vermis, a
component of visual-spatial system (Jones et al., 2002). Trichotillomania: A gro
up of Keuthen (2006) explored the cerebellar volume in 14 patients diagnosed wit
h trichotillomania (TTM) according to DSM-IV. Was the first structural investiga
tion of the involvement of
cerebellum in the TTM. The sensory and affective variables play a role in the ac
tivation and maintenance of symptoms in this pathology. Studies carried out with
PET had demonstrated hypermetabolism
7
in left and right cerebellar areas in patients with TMD (Swedo et al., 1991). Th
e TMD is a disorder considered as belonging to the spectrum of obsessive-compuls
ive disorder are identified motor routines, stereotyped behaviors, behaviors whi
ch lead to the study of the cerebellum as the site of coordinated control of mot
or sequences. The results of this study show that patients diagnosed with tricho
tillomania have a cerebellar cortical volume lower than healthy individuals, thi
s remains lower cerebellar volume in both hemispheres, and cerebellum when exami
ned by subterritories (Keuthen et al., 2006 .) In this study, there was a compar
tmentalization of the cerebellum in 10 functional groupings: group related to po
sture and balance, emocionalautonÃ³mico cluster, clusters sensorimotor, oculomot
or groups (right and left) or cognitive clusters. Cortical volume was observed s
ignificantly low in emotional-autonomic group, a finding that is interpreted as
related to anxiety that patients have with pre-form trichotillomania pull hair,
or if they resist it, or at the pleasure generated by the tug. There was also a
significantly lower in the cognitive cluster, which is interpreted in the contex
t of the present deterioration in patients with trichotillomania executive-type
cognitive functions and planning, allocating a significant contribution to these
functions of the cerebellum. Lower volumes also been identified in the oculomot
or groups, which the authors propose in relation to the presence of visual stimu
li that trigger the behavior of the hair growth spurt or the display of colors a
nd textures identifying motivating the choice of either strand hair. The results
obtained in the study of Keuthen and collaborators confirmed the hypothesis: th
ere were significant differences between patients and controls in the total volu
me of the cerebellum, this being lower in those affected. Autism: Another exampl
e is that of autism, which also appear in stereotyped and repetitive motor behav
iors. It has been reported that approximately 95% of autopsies performed in pati
ents with
8
autism, have structural abnormalities in the objectified (Gottwald et al, 2003).
In connection with this disorder have been several structural studies, one of t
he most recent studies show that the cerebellum of patients with autism having a
smaller volume of gray matter, while there is an increase volume of gray matter
in areas as the right and left medial gyrus or prefrontal gyrus (Rojas et al.,
2006).
COGNITIVE FUNCTIONS Language: Recent studies have shown how patients with cerebe
llar damage present in language disorders (Ravizza et al., 2006, Chen and Desmon
d, 2005; Akil, Statham, GÃ¶tz., Bramley and Whittle, 2005). Often in neuroimagin
g research, the cerebellum has appeared active in processes of verbal working me
mory (verbal working memory, MTV). Ravizza et al, recently designed a study to d
etermine whether damage to the cerebellum were associated with damage affecting
the range of tasks MTV. They studied 15 patients with cerebellar damage, focusin
g on those with unilateral lesions. During his several experiments found that pa
tients appeared modest but consistently affected in immediate verbal retrieval t
asks (Experiments 1 and 3) and that their deficits were aggravated when introduc
ing the delay before recall (Experiment 2). These results are consistent with re
sults from neuroimaging studies, and mild illness in MTV standardized test is co
nsistent with clinical observations that suggest that the cerebellar damage appe
ars not typically associated with deficits in short-term memory (Ravizza et al.
2006). In Akil et al. (2005) described cerebellar mutism. This is a rare, often
tends to occur in children after surgery of the posterior fossa. In his brief re
port, discussed the unusual case of a preoperative cerebellar mutism in an adult
in the context of a
9
cognitive affective syndrome caused by cystic hemangioblastoma. Cerebellar musti
smo The term refers to a anarthria resulting in severe damage of fluency, articu
lation and modulation of speech. The exact mechanism underlying the silence is u
nknown, but they have mentioned the dentate nucleus lesions of the middle pedunc
le (brachium pontis) of dento-thalamic tracts and ruptures of the inferior vermi
s to cause
(Janssen et al., 1998; Mewasingh, Khadim, Christophe, and Dan Christiaens, 2003;
Ozgur, Berberian, Aryan, Meltzer and Levy, 2006). Chen and Desmond (2005) condu
cted a study using fMRI to demonstrate the involvement of the cerebellum on MTV,
finding areas of common activation in verbal working tasks and tasks of articul
atory control, as well as regions that are activated only for the memory of work
. We found activation in Broca's area (BA 44 / 6) and the superior cerebellar he
misphere for both the working memory to the test motor. But only during MTV acti
vation found in the inferior parietal lobe and right inferior cerebellum. Their
findings provide evidence to postulate the existence of two networks of cerebro-
cerebellar working for MTV. On one hand the network of frontal-superior cerebell
ar control and articulatory network of phonological storage parietalinferior. Fu
rther studies to confirm the existence of this modulatory influences between the
cerebellum and brain cortical areas related to phonological processing, recipro
cal influences between the two areas, cortical areas related to language (with p
honological processing) have noted that the the fusiform gyrus which has a more
powerful connections with the cerebellum. Given this evidence, the authors propo
se that the cerebellum acts in a process of amplification and refinement of the
patterns of activation of cortical areas, through loops established by the recip
rocal connections between areas. It also justifies the greater connection to the
fusiform gyrus, suggesting that the cerebellum exerts a role in the processing
of orthographic representations (Booth, Wood, Lu, Houk, and Bitan, 2007).
10
This evidence and the demonstration by functional magnetic resonance imaging stu
dies that the cerebellum in children with dyslexia has a smaller size (anterior
right lobe) have the approach that the cerebellum is related to language process
ing, and reading processing (Booth et al., 2007). Memory: It has been described,
for example, a deterioration in the memory of patients with cerebellar lesion i
n the case of a general memory impairment, and deterioration in visual memory an
d the evocation in this deterioration has noted that this is more marked when th
e task requires a greater effort by the patient (Gottwaldet al., 2004). Note: Se
veral studies have shown the involvement of care in patients with cerebellar les
ions (Gottwald et al., 2004). In fact, we have demonstrated the existence of str
uctural alterations in the cerebellum in patients diagnosed with Attention Hyper
activity Disorder. In this sense, both demonstrated a clear impairment of divide
d attention and working memory, this term as an executive system of organization
of the new incoming information, both intimately connected with selective atten
tion as divided attention. However there is no evidence of selective attention i
mpairment in patients with cerebellar injury. That is, cognitive performance is
affected when the processing of stimuli requires a parallel processing system, o
r when an exchange is required between modes of processing, a finding that suppo
rts the theory of the dysmetria of thought (Schmahmann, 2004) . Assessing the co
gnitive performance of patients with cerebellar lesions, several studies have sh
own that the deterioration was more marked when the lesion was located in the ri
ght hemisphere, in contrast, patients whose lesion involved the left cerebellar
hemisphere showed no involvement of any verbal functions . This is explained by
the
11
connection of the right cerebellar hemisphere with the left cerebral hemisphere,
the dominant language (Gottwald, Mihajlovic, Wilde and Mehdorn, 2003). Dysmetri
a of thought: The theory of the dysmetria of thought is to objectify both altera
tions of motor functions, but most of the cognitive functions in patients with c
erebellar lesionsÂsuggesting that the cerebellar lesion does not eliminate the
cognitive function but disrupts the normal development of the same. This suggest
s, in turn, an integrative role of the cerebellum in brain function, in which th
e cerebellum would prepare the way before any stimuli, optimizing processing (Sc
hmahmann, 2004). Perception and temporal processing in recent years there have b
een several studies to elucidate the possible involvement of the cerebellum in t
he perception or representation of time. This line of research began to identify
behaviors that depend on temporal processing, which are affected in patients su
ffering from lesions in the cerebellum, as conditioned learning or control over
agonist and antagonist muscles to develop a movement. Regarding this fact, sever
al authors propose the metaphor of the clock as time control system by the accum
ulation of pulses, a system that would depend on the attention to make represent
ation, which would then stored in working memory. Based on this information, and
for the purpose of identifying whether cerebelol injury damages the "timer" (Ha
rrington, Lee, Boyd, Rapcsak, and Knight, 2004), designed a study in which they
intend to observe the impact of injury cerebellar temporal production tasks and
time perception tasks. Their findings concluded that cerebellar damage did not a
ffect significantly the performance of any of the two tasks, also noted that, wh
en there were deficits in the performance of the tests, these were associated wi
th damage to the upper and middle cerebellar lobes and it was only deficits in t
asks of production.
12
These results lead the authors to conclude that deficits in temporal processing
in case of injury of the cerebellum should be related to alterations in other co
gnitive processes required by the temporal processing tasks. Then we have develo
ped new work addressing this issue, with results opposite to those described by
Hamilton et al. In order to evaluate the processing time have developed four ran
ges or time scales, based on functional aspects, namely, microseconds, milliseco
nds, seconds, and rhythm circardiano. For example, motor control and development
of motor behavior or control of the language would be processed in the range of
milliseconds, while the reasoning would be processed in the range of seconds (K
och et al., 2006). Following this line of work, there seems to be consensus at t
he time of linking the cerebellum to the mechanism of "internal clock" with the
basal ganglia (Lee et al., 2007). Based on this classification and on the assump
tion that the cerebellum is involved in temporal processing in the range of mill
iseconds for a study using transcranial magnetic stimulation over the cerebellum
(Koch et al., 2006). The results indicate that the cerebellum is necessary for
processing in the range of milliseconds, while not involved in processing in sec
onds, proving more important the role of the left lateral cerebellum. Also get a
link right dorsolateral prefrontal cortex in processing at intervals over the s
econd, suggesting the existence of a network for conscious perception of time wi
th a dissociation within the range of processing. He had previously developed a
model whereby there is an automatic processing system and a cognitive system, th
e first intervene in temporal processing in milliseconds, and could be related w
ith the movements, while the second part in the extent intervals within seconds.
The first system would allow the completion of the task in a more automatic, in
contrast, the second system would undertake the task with greater cognitive req
uirement.
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A recent study, which is also used transcranial magnetic stimulation (Lee et al.
, 2007), was found linking
cerebellum perception in the sub-second range, while not objectified in the rang
e suprasegundos intervention, according to the results obtained by the authors o
f the preceding article. Other authors (Lee et al., 2007) observed (also by tran
scranial stimulation
magnetic) that stimulation of the dorsolateral prefrontal cortex altered process
ing in the range suprasegundo without affecting the processing sub-second range.
This is consistent with the approach regarding the temporal processing network
in which the cerebellum participates as well as the dorsolateral prefrontal cort
ex,Âand possibly explain the result, and could explain the reason why patients
affected by cerebellar injury with impaired processing in both the sub-second ra
nge as the range suprasegundo. Therefore, the authors conclude that the cerebell
um does not act as internal clock, but consider the cerebellum as part of a temp
oral processing system that would also include the basal ganglia, thalamus and p
refrontal cortex. Another way in which addresses this issue has been studying ce
rebellar function in patients suffering from other disorders, which, as describe
d at the beginning of the exhibition, there are similarities, in this case with
schizophrenia, whereas the study of the cerebellum in this condition may help to
elucidate the involvement of the cerebellum in processing time. This approach i
s based on the fact that in this disorder are a number of symptoms that can be i
nterpreted as symptoms secondary to alterations in the temporal coordination of
behavior cognitive, perceptual or motor, or alteration of information processing
, such as alterations in the train of thought, and the fact that patients with s
chizophrenia also have impaired executive functions and visuospatial problems (B
rown et al., 2005). In addition, it has been observed that the volume of cerebel
lum correlates with increased cognitive impairment, supporting the theory of the
dysmetria of thought. The findings of the study (comparison of controls and sch
izophrenic patients in a conditioning task)
14
showed that schizophrenia patients showed a deterioration in the learning of the
conditioned response, suggesting a deficit in the circuit responsible for the a
cquisition of this response, which is thought that the cerebellum is a core elem
ent. Also found a high variability for each subject to perform the task, which i
s consistent with the hypothesis of deterioration in temporal processing. Was ru
led out in this paper that the results were skewed by changes in attentional or
memory. In addition to what is the involvement of the cerebellum in executive fu
nctions, are yielding evidence of their involvement in other types of cognitive
functions. Through a study which intends to healthy patients to imagine themselv
es in a future situation, it was observed that among the various areas of the ce
ntral nervous system that showed increased activation, premotor cortex and the l
ateral or posterior medial parietal cortex also were activated specific areas of
the cerebellum, mainly the back, areas that are activated when it is necessary
to imagine or simulate the movements of the body, and, also related to spatial m
emory and attention. We therefore propose that one of the keys to imagine the fu
ture is the simulation of representations (the body) in storage, which suggests
that the image of oneself in the future is based on the reactivation of represen
tations of the past (Szpunar , Watson, and McDermott, 2007). Empathy: In a study
of empathy, in which the task was passive viewing of faces and hands, in imitat
ion active in the development of a specific motor behavior it was observed that,
over the task of imitation (both faces and hands) activation occurred cerebella
r areas. This is consistent with the hypothesis above, on the question of repres
entation. (Leslie, Johnson-Frey and Grafton, 2004).
15
INJURY cerebellar cerebellar lesions do not always manifest as ataxia. Schmahman
n and colleagues conducted a study with 20
patients with cerebellar lesions (Schmahmann and Sherman, 1998). They concluded
the existence of a pattern of clinically significant behavioral changes they cal
led Cerebellar cognitive-affective syndrome.
(SCAC), characterized by: a) disturbance of executive function, including defici
ts in planning, abstract reasoning, working memory and reduced verbal fluency, 2
) damage in spatial cognition, including visual-spatial disorganization, memory
impairment visual-spatial, 3) changes in personality, uninhibited or inappropria
te behavior, 4) language difficulties, including disprosodia, agrammatism, mild
anomia. The net effect of these disorders in cognitive function is a general dec
line in global intellectual function. The damage includes SCAC executive skills,
visual-spatial and linguistic minorities, including affective disorders from em
otional weakness and depression, to disinhibition and psychotic features. The co
gnitive and psychiatric components SCACÂwith disability
cerebellar ataxia disorder are conceptualized within the dysmetria of thought hy
pothesis (Schmahmann, 2004). Cerebellar damage is
manifests as ataxia when the sensorimotor cerebellum is involved and as SCAC, wh
en the pathology is located in the posterior cerebellar hemisphere side (involve
d in cognitive processing) or in the vermis. Schmahmann at work also reviews non
-motor aspects of cerebellar function. Has recently been shown that patients wit
h cerebellar damage have also intellectual and mood changes (Konarski, McIntyre,
Grupp and Kennedy, 2005). Clinical studies identify the relationship between ce
rebellum and personality, aggression and emotion, and link psychosis (especially
schizophrenia) with a growth in the fourth ventricle, a smaller cerebellar verm
is and cerebellar atrophy, found up to 40% of schizophrenic subjects (Suppriam e
t al., 2000). Hokkanen, kauranes, Roine, Salonen, and Kotila (2006) investigated
the neuropsychological functioning of patients with cerebellar infarction and
16
assessed the laterality of cognitive symptoms. They analyzed 26 patients with ce
rebellar lesions exclusively in the acute phase and three months, and compared w
ith 14 controls. They focused on four domains: 1) visuospatial functions / motor
, 2) episodic memory, 3) working memory and 4) execution / attentional shift. St
atistical differences in visuospatial function, as well as episodic memory and w
orking. They concluded that patients with left cerebellar lesion were slower in
visuospatial tasks, whereas those who suffered injury right, had difficulties in
verbal memory compared with controls. Cerebellar infarcts subtle cognitive dama
ge occasioned, perhaps initially associated with deficits in working memory. The
se symptoms appear to be mediated by the contralateral cortical hemisphere, cere
bellar infarcts
left hemispheric dysfunction producing right, and right cerebellar infarct produ
cing left cerebellar dysfunction.
CEREBELLUM AND EMOTIONAL EXPERIENCE Two lines of research have demonstrated the
association cerebeloemociÃ³n in humans: studies of lesions and functional neuroi
maging studies. Lesions of the posterior lobe and cerebellar vermis are associat
ed with emotional weakness, as well as damages in a variety of cognitive domains
including executive function, spatial cognition and language (Schmahmann and Sh
erman, 1998). Neuroimaging studies have shown cerebellar activation during emoti
onal processing (Paradiso et al., 2003). But lesion studies alone can not fully
explain the basic mechanisms of emotional disruption in patients with cerebellar
damage. Collaborate and Turner have recently published the first study that has
used functional neuroimaging (PET) in combination with lesions to determine the
involvement of the cerebellum in processing emotional material. (Turner et al.,
2007). Stop It examined six patients with cerebellar infarction, while reacting
to visual stimuli evoking pleasant and unpleasant emotions. They discovered a p
henomenon
17
interesting lesions of the cerebellum does not seem to affect the normal ability
to experience negative emotions, but are associated with a reduced ability to e
xperience positive emotions. While patients with cerebellar lesions may experien
ce unpleasant feelings in response to frightening stimuli, fail to recruit struc
tures
of normal brain would be involved in this task (eg amygdala) instead activated a
lternate limbic circuit which includes ventromedial prefrontal cortex, insula an
d cingulate gyrus. Still remains unclear why despite an adaptation of new circui
ts when the cerebellum is damaged, positive emotional responses were reduced whi
le the negatives were preserved. There is evidence that lesions in the posterior
lobe of the cerebellum and vermis are associated with blunted affect, in fact,
have been observed in patients with cerebellar lesion in which the affective sym
ptoms is checked, the vermis was systematically affected. (Turner et al., 2007).
An example of the relationship between the cerebellum and the excitement is tha
t depression is one of the main problems in patients suffering from spinocerebel
lar ataxia. Another example is the youngest of the vermis volume in patients, be
ing diagnosed with bipolar disorder, have had multiple depressive episodes (Schm
ahmann, 2004).
Subsequently raised the possibility that this alteration in the volume of the ve
rmis may be an artifact secondary to a neurotoxic effect of antidepressants on t
he cerebellar region. (Mills, Delbello, Adler and Strakowski, 2005). All this, t
ogether with identification of connections between areas of the midline of the c
erebellum with regions of the limbic system, the description of manic episodes i
n patients with cerebellar injury or structural abnormalities of the cerebellum
in bipolar disorder patients suggests that the cerebellar vermis plays an import
ant role in mood regulation. In the above line in a functional neuroimaging stud
y has described the existence of structural alterations in
18
patients diagnosed with bipolar disorder in those regions of the vermis which ha
ve connections with the limbic system areas, such as the anterior cingulate cort
ex, amygdala, hippocampus, and even with the hypothalamus (Mills et al., 2005).
Before this evidence and to the findings of neuroimaging studies in which it det
ects an increase in the activity of the cerebellum with emotional demands, studi
es have emerged that seek to examine the role of the cerebellum in emotion. One
study this aspect in patients affected by cerebellar injury. It was noted that p
atients are able to identify the emotional significance of the stimulus, but hav
e an impaired ability to experience, so subjective, the emotional charge of it,
mainly when it comes to pleasant stimuli, evoking joy, on the contrary there is
no deterioration in the ability to perceive stimuli that evoke fear. In addition
, this study shows that, although patients respond emotionally unpleasant stimul
i, they do not activate the brain areas that are generally activated in this sit
uation, but that activate brain areas "alternatives." These findings lead the au
thors to propose that the cerebellum plays a role as coordinator of the activity
, so that, before his injury, alternate nodes are activated to develop an adapti
ve response, which is in agreement with the results of other studies (Turner et
al., 2007). Using a functional neuroimaging study which sought to demonstrate ho
w the music enhances the emotional intensity of feeling to an image (image compa
red to no music), it was noted that precisely in this situation of empowerment o
f the stimulus, the cerebellum was among the activated areas. The authors interp
ret this activation on the basis of connections that the cerebellum receives fro
m the coming of the pons and anterior cingulate cortex, an area whose involvemen
t in emotional processing is demonstrated. With respect to these connections is
hypothesized that these projections to the cerebellum as guide or guide you in c
oordinating the various action programs in response to emotional stimuli (Baumga
rtner, Lutz, Schmidt, and Jancke, 2006).
19
It has also raised a possible role of cerebellum in behaviors related to substan
ce abuse, specifically cocaine use to the description, by neuroimaging of cerebe
llar activation when viewing or imagining experiences related to consumption, an
d before the activation of the cerebellum in "craving." In particular, cerebella
r vermis appears to be the most relevant in this regard. Thus, activation of the
vermis has been found in cocaine-related stimuli to the substance, the areas ac
tivated in the vermis, although it is related to oculomotor activity, only indiv
iduals were activated in cocaine users. These findings are consistent with the f
inding of an enrichment in dopamine transporter protein in the activated areas,
precisely because of this fact the authors suggest that the cerebellar vermis ma
y be one of the sites of action of substances that interact with the dopamine tr
ansporter (Anderson et al., 2006).
CONCLUSION: After the collection of scientific literature that have had the oppo
rtunity to analyze, has been proved the involvement of the cerebellum in higher
cognitive functions, resulting in alterations of the same as the SCAC when there
are injuries or developmental abnormalities, being associated with certain psyc
hopathologies such as schizophrenia or ADHD, and emotional reactions mediating d
eterminded.ÂThe application of new technologies in the study of the human brain
has opened the door to endless knowledge so far limited to some extent the unde
rstanding of human behavior. A detailed understanding of brain structures allows
a specific and effective clinical application, and in the future we will have t
o recycle many of the theories that today direct knowledge.
20
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25

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