Zusammenfassung
Seit fast 20 Jahren wird eine mögliche Bedeutung des Kleinhirns für nichtmotorische Funktionen diskutiert. Aus den Befunden einer stetig zunehmenden Zahl von Läsions- und funktionellen Bildgebungsstudien wird eine Rolle des Kleinhirns für Sprache, visuell-räumliche Leistungen, Exekutivfunktionen einschließlich des Arbeitsgedächtnisses und für Aufmerksamkeit sowie Affekt und Verhalten abgeleitet. Für eine Reihe psychiatrischer Erkrankungen, z. B. für Autismus und Schizophrenie, wird ein Zusammenhang zwischen strukturellen Anomalien des Kleinhirns und Krankheitssymptomen angenommen. Inwieweit das Kleinhirn für kognitive Prozesse eine Rolle spielt und ob sich daraus eine klinische Relevanz ergibt, ist nach wie vor umstritten. Eine Reihe häufig zitierter Befunde, z. B. von bestimmten Aufmerksamkeits- und Sprachaufgaben, ließen sich in gut kontrollierten Studien nicht replizieren oder durch motorische Anteile der jeweiligen Aufgabe erklären. Neben dem Einfluss motorischer Defizite ist nicht abschließend geklärt, inwieweit unspezifische Ursachen, z. B. Hydrozephalus, Depression, aber auch globale Effekte auf den Hirnstoffwechsel neuropsychologische Testergebnisse, insbesondere bei fokalen Kleinhirnläsionen, erklären. Begleitende extrazerebelläre Läsionen sind nicht immer sicher auszuschließen. Auf der anderen Seite ist es durchaus möglich, dass das Kleinhirn spezifische Funktionen bei einem Teil kognitiver Aufgaben übernimmt. Ein gut untersuchtes Beispiel ist die Bedeutung des Kleinhirns für temporäre Aspekte bei der Sprachperzeption und -produktion einschließlich des inneren Sprechens. Ob die Beteiligung des Kleinhirns am inneren Sprechen und damit möglicherweise an allen Arbeitsgedächtnisaufgaben zu klinisch relevanten kognitiven Defiziten führt, ist nicht geklärt. Unabhängig von der Frage, ob nachweisbare Defizite primär auf die Schädigung des Kleinhirns zurückzuführen sind, ist es sinnvoll, bei Patienten mit Kleinhirnerkrankungen auf mögliche begleitende neuropsychologische Auffälligkeiten zu achten.
Abstract
Cerebellar involvement in a wide range of cognitive tasks, including language, visuo-spatial functions, attention, executive operations as well as affect and behaviour has been proposed almost 20 years ago. An increasing number of human lesion and functional brain imaging studies appear to support the hypothesis that the cerebellum contributes to non-motor functions. Likewise cognitive and behavioural changes in psychiatric disorders, such as autism and schizophrenia, have been linked to structural cerebellar abnormalities. The „cerebellum and cognition” hypothesis, however, is still a matter of ongoing controversial discussion. Frequently cited early findings, for example examining specific attention and language tasks, have not been replicated in later studies or have been explained by motor components of the tasks. In addition to impaired motor function, it is unclear to what extent deficits in neuropsychological tests are caused by unspecific effects, such as hydrocephalus, depression or global effects on brain metabolism, in particular following focal cerebellar lesions. Effects of extracerebellar lesions have to be considered, too. On the other hand, the cerebellum may be involved in specific operations in certain cognitive tasks. One example, which has been studied in detail, is a likely role of the cerebellum in the computation of temporal aspects of verbal utterances in the domains of both speech production, including inner speech, and speech perception. Whether disorders of inner speech are related to significant clinical signs of cognitive dysfunction remains to be determined. Regardless of the question whether possible cognitive deficits are caused primarily by cerebellar dysfunction, it appears useful to carefully assess neuropsychological functions in patients with cerebellar disorders.
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Prof. Dr. med. Dagmar Timmann
Neurologische Klinik · Universität Duisburg-Essen
Hufelandstraße 55
45138 Essen
Email: Dagmar.Timmann@uni-essen.de
