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Disruption of Neural Pathways
n important article published by Drs. Jeremy D. Schmahmann and Janet Sherman in Brain 1998; Volume 121, pages 561-79, provides additional evidence supporting Dr. Levinson's initial theories.
Drs. Schahmann and Sherman looked at 20 patients with diseases confined to the cerebellum, and evaluated the nature and severity of the changes in the neurological and mental function.
Using anatomic neuroimaging, neurologic examinations, bedside mental status exams, and neuropsychological testing, they noted that behavioral changes were clinically prominent in patients with lesions involving the posterior lobe of the cerebellum and the vermis.
They specifically noted that in some cases, the behavioral changes were most noticeable aspects of the presentation. They characterized these changes as the impairment of executive functions such as planning, verbal fluency, abstract reasoning, and working memory. There were difficulties with spatial cognition, including visual-spatial organization and memory; personality changes with blunting of affect and disinhibition or inappropriate behavior; and agrammarism and dysprosodia.
Patients that had lesions in the anterior cerebellum were noted to have mild changes, if any. They are calling this newly defined clinical entity as the Cerebellar Cognitive Affective Syndrome.
They find that this constellation of deficits is suggestive of disruption of the cereballar modulation of neural paths that link the prefrontal, posterior parietal, superior temporal lobe, and limbic cortices with the cerebellum. These findings are similar to those that Dr. Levinson has discovered nearly 30 years ago.
