Kognitive Funktionen des Kleinhirns^[*]

Zusammenfassung

Die wichtige Rolle des Kleinhirns für die Koordination von Bewegungen und motorische Lernvorgänge ist unbestritten. Patienten mit Erkrankungen des Kleinhirns suchen den Arzt aufgrund motorischer Probleme (Ataxie) auf. Seit fast drei Jahrzehnten wird intensiv untersucht, inwieweit das Kleinhirn zusätzlich kognitive Funktionen unterstützt. Dafür gibt es gute Gründe aus neuroanatomischen Studien. Obwohl es eine Vielzahl von neuropsychologischen Untersuchungsbefunden bei Patienten mit Kleinhirnerkrankungen gibt, ist die Einordnung dieser Befunde nicht einfach. Nur selten wird der Einfluss begleitender motorischer Symptome und möglicher extrazerebellärer Läsionen ausreichend gut kontrolliert. Die vorliegende Übersichtarbeit fasst die neuroanatomischen Befunde zusammen und versucht eine kritische Einordnung der in der Literatur beschriebenen Verhaltensdaten bei Patienten. Vieles spricht dafür, dass sowohl degenerative als auch fokale Erkrankungen des Kleinhirns zu bestimmten kognitiven Dysfunktionen führen können. Insbesondere Exekutivfunktionen, hier in erster Linie das Arbeitsgedächtnis, aber auch bestimmte höhere Sprachfunktionen scheinen betroffen zu sein. Die beobachteten Defizite bei erwachsenen Patienten sind jedoch überwiegend gering ausgeprägt. Sie können bei Patienten mit akuten Erkrankungen deutlicher sein.

Abstract

The role of the cerebellum in motor control and motor learning is well-recognised. Patients with cerebellar disease consult a doctor because of their motor dysfunction (ataxia). For nearly three decades intense research has been addressing the question to what extent the cerebellum may support cognitive functions. Neuroanatomic findings support the notion that posterolateral parts of the cerebellum contribute to cognition. Although there is a huge number of neuropsychological studies in patients with cerebellar disease, interpretation of findings is frequently hampered by the accompanying motor disorders and extracerebellar lesions. This review summarises the anatomic findings and attempts to give a critical evaluation of findings in human lesion studies. There are good reasons to believe that cerebellar disorders, both cerebellar degeneration and focal cerebellar lesions, may lead to certain cognitive dysfunctions. Disorders in executive function, in particular working memory, and certain higher language tasks are best documented. However, disorders in adults with chronic diseases tend to be mild. Dysfunction appears to be more prominent in patients with acute disease.

Schlüsselwörter

Kleinhirndegeneration - Kleinhirninfarkt - posterolaterales Kleinhirn - Exekutivfunktionen - Arbeitsgedächtnis - Agrammatismus

Key words

cerebellar degeneration - cerebellar stroke - posterolateral cerebellum - executive functions - working memory - agrammatism

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