Cerebellar dysfunction correlates with cognitive impairment in MS

#MSBlog: Do you have cerebellar dysfunction? You may be interested to find out!

Epub: Cerasa et al. MR imaging and cognitive correlates of relapsing-remitting multiple sclerosis patients with cerebellar symptoms. J Neurol. 2012 Dec 28.

Background: MS is frequently associated with cognitive impairments and cerebellar dysfunction. Recent evidence from this group demonstrated that MSers with cerebellar damages have selective cognitive impairment related to attention and language abilities.

"The cerebellum is the small brain that is located at the back of the brain. It controls many of our motor functions and more recently been found to have a role in cognition. People with cerebellar dysfunction have poor balance and co-ordination, slurred speech, jumping eyes or nystagmus and a tremor."

Objective: In this study the investigators correlated the anatomical abnormalities in RRMSers with (RR-MSc) and without (RR-MSnc) cerebellar signs. 

Methods: 12 RR-MSc and 14 demographically, clinically, and radiologically, matched RR-MSnc and 20 controls were investigated. All MSers underwent neuropsychological assessment. After refilling of FLAIR lesions on the 3D T1-weighted images, VBM was performed using SPM8 and DARTEL. A correlation analysis was performed between VBM results and neuropsychological variables characterizing RR-MSc patients.

Results: Despite a similar clinical status, RR-MSc were characterized by more severe cognitive damages in attention and language domains with respect to RR-MSnc and controls. With respect to controls, RR-MSnc were characterized by a specific atrophy of the bilateral thalami that became more widespread (including motor cortex) in the RR-MSc group (FWE < 0.05). However, consistent with their well-defined neuropsychological deficits, RR-MSc group showed atrophies in the prefrontal and temporal cortical areas when directly compared with RR-MSnc group.

Conclusion: These results demonstrated that RR-MSers with cerebellar signs were characterized by a distinct neuroanatomical profile, mainly involving cortical regions underpinning executive functions and verbal fluency

"I have always had an inkling about this! When I was a trainee neurologist I was struck by how slow people with cerebellar dysfunction thinking was. They tend to be vague and can't recall the correct temporal sequence of events. For example, they find it difficult to tell you when they had a relapse or their last fall. In addition, MSers with cerebellar dysfunction tend to do poorly. We treat cerebellar dysfunction as a poor prognostic sign. Disappointingly, we don't have any effective treatment for cerebellar dysfunction. For example, the symptomatic treatments we use to control the tremor are not effective and are associated with side effects. The main treatment is physical therapy."

"It is better to try and prevent cerebellar damage by treating early and aggressively."

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