Understanding the Cerebellar Disorders in Large Context: Dysmetria of Thought, Cerebellar Cognitive Affective Syndrome, and Ataxia. A Concise Review.

Understanding the Cerebellar Disorders in Large Context: Dysmetria of Thought, Cerebellar Cognitive Affective Syndrome, and Ataxia.

A Concise Review.

Many diseases involve the cerebellum and produce ataxia, which is characterized by incoordination of:

Balance,
Gait,
Extremity,
Eye movements, and
Dysarthria.

Cerebellar lesions do not always manifest with ataxic motor syndromes, however.

The cerebellar cognitive affective syndrome (CCAS) includes impairments in executive, visual-spatial, and linguistic abilities, with affective disturbance ranging from emotional blunting and depression, to disinhibition and psychotic features.

The cognitive and psychiatric components of the CCAS, together with the ataxic motor disability of cerebellar disorders, are conceptualized within the dysmetria of thought hypothesis.

Damage to the cerebellar component of the distributed neural circuit sub-serving sensorimotor, cognitive, and emotional processing disrupts the universal cerebellar transform, leading to the universal cerebellar impairment affecting the lesioned domain

The universal cerebellar impairment manifests as ataxia when the sensorimotor cerebellum is involved and as the CCAS when pathology is in the lateral hemisphere of the posterior cerebellum (involved in cognitive processing) or in the vermis (limbic cerebellum).

Cognitive and emotional disorders may accompany cerebellar diseases or be their principal clinical presentation, and this has significance for the diagnosis and management of patients with cerebellar dysfunction.

An effort has been made to survey the current understanding of the cerebellar role in cognitive and psychiatric disorders.

To place the consideration of the cerebellum in a larger context, however, it is attempted to first begin with a description of the cerebellar motor syndrome and a survey of the more common cerebellar diseases along with relevant ILLUSTRATIONS for better understanding.

Dr. H. K. Saboowala.

M.B.(Bom) .M.R.S.H.(London)

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