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Cerebellar Contributions to Motor and Cognitive Control in Multiple Sclerosis✰✰✰

Published:January 05, 2022DOI:https://doi.org/10.1016/j.apmr.2021.12.010

      Highlights

      • The cerebellum is a common site for multiple sclerosis–related disability.
      • Greater superior cerebellar peduncle, middle cerebellar peduncle, and lobule volume is associated with better motor and cognitive function.
      • Greater diffusivity of superior cerebellar peduncle is related to better motor and cognitive function.
      • Understanding structure-function relationships is key for targeted therapeutics in multiple sclerosis.

      Abstract

      Objective

      To evaluate relationships between specific cerebellar regions and common clinical measures of motor and cognitive function in persons with multiple sclerosis (PwMS).

      Design

      Cross-sectional.

      Setting

      Laboratory.

      Participants

      Twenty-nine PwMS and 28 age- and sex-matched controls without multiple sclerosis (MS) (N=57).

      Interventions

      Not applicable.

      Main Outcome Measures

      Both diffusion and lobule magnetic resonance imaging analyses and common clinical measures of motor and cognitive function were used to examine structure-function relationships in the cerebellum.

      Results

      PwMS demonstrate significantly worse motor and cognitive function than controls, including weaker strength, slower walking, and poorer performance on the Symbol Digit Modalities Test, but demonstrate no differences in cerebellar volume. However, PwMS demonstrate significantly worse diffusivity (mean diffusivity: P=.0003; axial diffusivity: P=.0015; radial diffusivity: P=.0005; fractional anisotropy: P=.016) of the superior cerebellar peduncle, the primary output of the cerebellum. Increased volume of the motor lobules (I-V, VIII) was significantly related to better motor (P<.022) and cognitive (P=.046) performance, and increased volume of the cognitive lobules (VI-VII) was also related to better motor (P<.032) and cognitive (P=.008) performance, supporting the role of the cerebellum in both motor and cognitive functioning.

      Conclusions

      These data highlight the contributions of the cerebellum to both motor and cognitive function in PwMS. Using novel neuroimaging techniques to examine structure-function relationships in PwMS improves our understanding of individualized differences in this heterogeneous group and may provide an avenue for targeted, individualized rehabilitation aimed at improving cerebellar dysfunction in MS.

      Keywords

      List of abbreviations:

      2MWT (2-minute walk test), AD (axial diffusivity), DTI (diffusion tensor imaging), FA (fractional anisotropy), ICP (inferior cerebellar peduncle), MCP (middle cerebellar peduncle), MD (mean diffusivity), MRI (magnetic resonance imaging), MS (multiple sclerosis), PwMS (persons with multiple sclerosis), RD (radial diffusivity), SCP (superior cerebellar peduncle), SDMT (Symbol Digit Modalities Test), SSST (Six Spot Step Test), T25FW (timed 25-foot walk), TUG (Timed Up and Go)
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