Journal
CEREBELLUM
Volume 21, Issue 2, Pages 208-218Publisher
SPRINGER
DOI: 10.1007/s12311-021-01290-3
Keywords
Cerebellar cognitive affective syndrome; Cerebellar cognitive affective syndrome scale; Lesion-symptom mapping; Cerebellar stroke; Magnetic resonance imaging
Categories
Funding
- CONACYT [A1-S-10669]
- PAPIIT-UNAM [IN220019]
- [CONACYT-697735]
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The study aimed to compare the effectiveness of the CCAS-S and MoCA tests in evaluating cognitive/affective impairments in patients with chronic acquired cerebellar lesions. While both tests showed adequate discrimination between patients and healthy volunteers, only impairments identified by the CCAS-S were significantly localized within the cerebellum. Specifically, patients with chronic cerebellar lesions in right-lateralized posterolateral regions exhibited cognitive impairments associated with CCAS. This study extends the understanding of long-term CCAS and introduces multivariate LSM methods to identify clinically significant regions underlying chronic CCAS.
The cerebellar cognitive affective syndrome (CCAS) has been consistently described in patients with acute/subacute cerebellar injuries. However, studies with chronic patients have had controversial findings that have not been explored with new cerebellar-target tests, such as the CCAS scale (CCAS-S). The objective of this research is to prove and contrast the usefulness of the CCAS-S and the Montreal Cognitive Assessment (MoCA) test to evaluate cognitive/affective impairments in patients with chronic acquired cerebellar lesions, and to map the cerebellar areas whose lesions correlated with dysfunctions in these tests. CCAS-S and MoCA were administrated to 22 patients with isolated chronic cerebellar strokes and a matched comparison group. The neural bases underpinning both tests were explored with multivariate lesion-symptom mapping (LSM) methods. MoCA and CCAS-S had an adequate test performance with efficient discrimination between patients and healthy volunteers. However, only impairments determined by the CCAS-S resulted in significant regional localization within the cerebellum. Specifically, patients with chronic cerebellar lesions in right-lateralized posterolateral regions manifested cognitive impairments inherent to CCAS. These findings concurred with the anterior-sensorimotor/posterior-cognitive dichotomy in the human cerebellum and revealed clinically intra- and cross-lobular significant regions (portions of right lobule VI, VII, Crus I-II) for verbal tasks that overlap with the language functional boundaries in the cerebellum. Our findings prove the usefulness of MoCA and CCAS-S to reveal cognitive impairments in patients with chronic acquired cerebellar lesions. This study extends the understanding of long-term CCAS and introduces multivariate LSM methods to identify clinically intra- and cross-lobular significant regions underpinning chronic CCAS.
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