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      The enigmatic linguistic cerebellum: clinical relevance and unanswered questions on nonmotor speech and language deficits in cerebellar disorders

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          Abstract

          Clinical case descriptions and experimental evidence dating back to the early part of the 19th century from time to time documented a range of nonmotor cognitive and affective impairments following cerebellar pathology. However, a causal relationship between disruption of nonmotor cognitive and affective skills and cerebellar disease was dismissed for several decades and the classical view of the cerebellum as a mere coordinator of autonomic and somatic sensorimotor function prevailed for more than two centuries in behavioural neuroscience. The ignorance of early clinical evidence suggesting a much richer and complex role for the cerebellum than a pure sensorimotor one is remarkable given that in addition: 1) the cerebellum contains more neurons than the rest of the combined cerebral cortex and 2) no other structure has as many connections with other parts of the brain as the cerebellum. During the past decades, the long-standing view of the cerebellum as pure coordinator of sensorimotor function has been substantially modified. From the late 1970s onwards, major advances were made in elucidating the many functional neuroanatomical connections of the cerebellum with the supratentorial association cortices that subserve nonmotor language, cognition and affect. Combined with evidence derived from experimental functional neuroimaging studies in healthy subjects and neurophysiological and neuropsychological research in patients, the role of the cerebellum has been substantially extended to include that of a crucial modulator of cognitive and affective processes. In addition to its long-established role in coordinating motor aspects of speech production, clinical and experimental studies with patients suffering from etiologically different cerebellar disorders have identified involvement of the cerebellum in a variety of nonmotor language functions, including motor speech planning, language dynamics and verbal fluency, phonological and semantic word retrieval, expressive and receptive syntax processing, various aspects of reading and writing and aphasia-like phenomena. Despite considerable efforts currently devoted to further refine typology and anatomoclinical configurations of nonmotor linguistic dysfunctions linked to cerebellar pathology, the exact underlying pathophysiological mechanisms of cerebellar involvement remain to be elucidated.

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          Consensus paper: Language and the cerebellum: an ongoing enigma.

          In less than three decades, the concept "cerebellar neurocognition" has evolved from a mere afterthought to an entirely new and multifaceted area of neuroscientific research. A close interplay between three main strands of contemporary neuroscience induced a substantial modification of the traditional view of the cerebellum as a mere coordinator of autonomic and somatic motor functions. Indeed, the wealth of current evidence derived from detailed neuroanatomical investigations, functional neuroimaging studies with healthy subjects and patients and in-depth neuropsychological assessment of patients with cerebellar disorders shows that the cerebellum has a cardinal role to play in affective regulation, cognitive processing, and linguistic function. Although considerable progress has been made in models of cerebellar function, controversy remains regarding the exact role of the "linguistic cerebellum" in a broad variety of nonmotor language processes. This consensus paper brings together a range of different viewpoints and opinions regarding the contribution of the cerebellum to language function. Recent developments and insights in the nonmotor modulatory role of the cerebellum in language and some related disorders will be discussed. The role of the cerebellum in speech and language perception, in motor speech planning including apraxia of speech, in verbal working memory, in phonological and semantic verbal fluency, in syntax processing, in the dynamics of language production, in reading and in writing will be addressed. In addition, the functional topography of the linguistic cerebellum and the contribution of the deep nuclei to linguistic function will be briefly discussed. As such, a framework for debate and discussion will be offered in this consensus paper.
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            Is there a dysexecutive syndrome?

            The role of the frontal lobes has often been described as a 'paradox' or a 'riddle'. Ascribed to this region has been the loftiest of functions (e.g. executive; seat of wisdom); others contested that the frontal lobes played no special role. There has also been controversy about the unity or diversity of functions related to the frontal lobes. Based on the analysis of the effects of lesions of the frontal lobes, we propose that there are discrete categories of functions within the frontal lobes, of which 'executive' functioning is one. Within the executive category, the data do not support the concept of an undifferentiated central executive/supervisory system. The results are better explained as impairments in a collection of anatomically and functionally independent but interrelated attentional control processes. Evidence for three separate frontal attentional processes is presented. For each process, we present an operational description, the data supporting the distinctiveness of each process and the evidence for impairments of each process after lesions in specific frontal regions. These processes and their coarse frontal localizations are energization-superior medial, task setting-left lateral and monitoring-right lateral. The strength of the findings lies in replication: across different tasks; across different cognitive modalities (e.g. reaction time paradigms, memory); and across different patient groups. This convergence minimizes the possibility that any of the findings are limited to a specific task or to a specific set of patients. Although distinct, these processes are flexibly assembled in response to context, complexity and intention over real time into different networks within the frontal regions and between frontal and posterior regions.
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              The lateralized linguistic cerebellum: a review and a new hypothesis.

              During the past 2 decades the collaboration across disciplines and the methodologic and conceptual advances of contemporary neuroscience have brought about a substantial modification of the traditional view of the cerebellum as a mere coordinator of autonomic and somatic motor functions. Growing insights in the neuroanatomy of the cerebellum and its interconnections, evidence from functional neuroimaging and neurophysiological research, and advancements in clinical and experimental neuropsychology have established the view that the cerebellum participates in a much wider range of functions than conventionally accepted. This increase of insight has brought to the fore that the cerebellum modulates cognitive functioning of at least those parts of the brain to which it is reciprocally connected. This article reviews the recently acknowledged role of the cerebellum in cognition and addresses in more detail experimental and clinical data disclosing the modulatory role of the cerebellum in various non-motor language processes such as lexical retrieval, syntax, and language dynamics. In agreement with the findings indicating a topographical organization of the cerebellar structures involved in language pathology we advance the concept of a "lateralized linguistic cerebellum." In our view crossed cerebral diaschisis processes, reflecting a functional depression of supratentorial language areas due to reduced input via cerebellocortical pathways, might represent the relevant pathomechanism for linguistic deficits associated with cerebellar pathology. Copyright 2001 Elsevier Science.
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                Author and article information

                Contributors
                peter.marien5@telenet.be
                Alanb4154@gmail.com
                Journal
                Cerebellum Ataxias
                Cerebellum Ataxias
                Cerebellum & Ataxias
                BioMed Central (London )
                2053-8871
                1 September 2014
                1 September 2014
                2014
                : 1
                : 12
                Affiliations
                [ ]Clinical and Experimental Neurolinguistics, CLIN, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium
                [ ]Department of Neurology and Memory Clinic, ZNA Middelheim General Hospital, Lindendreef 1, 2020 Antwerp, Belgium
                [ ]Department of Psychology, Swansea University, Swansea, Wales UK
                [ ]Department of Psychology, Aberystwyth University, Aberystwyth, Wales UK
                Article
                11
                10.1186/2053-8871-1-12
                4552409
                26331036
                2c8a2be7-7272-414f-a521-822b5c56bf10
                © Mariën and Beaton; licensee BioMed Central Ltd. 2014

                This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 29 April 2014
                : 18 June 2014
                Categories
                Review
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                © The Author(s) 2014

                cerebellum,language,speech,apraxia of speech,verbal fluency,syntax,phonology,semantics,aphasia,agraphia,dyslexia,functional topography,imaging,fmri,spect

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