Causally Mapping the Cerebellum in Children and Young Adults: from Motor to Cognition

While the cerebellum's role in orchestrating motor execution and routines is well established, its functional role in supporting cognition is less clear. Previous studies claim that motricity and cognition are mapped in different areas of the cerebellar cortex, with an anterior/posterior dichotomy. However, most of the studies supporting this claim either use correlational methods (neuroimaging) or are lesion studies that did not consider central covariates (such as age, gender, treatment presence, and deep nuclei impairment) known to influence motor and cognitive recoveries in patients. Here, we used voxel-based lesion-symptom mapping (VLSM) on children and young adults having undergone cerebellar tumor resection. This approach allows to control for these covariates and evaluate causal relationships between brain anatomy and behavioral performances to disentangle the anatomic substrate of motor and cognitive functions. VLSM analyses showed that both motor and cognitive impairments were greater in children and young adults with lesions of the posterior cerebellum. These results highlight distinct and overlapping structural correlates of motor and cognitive performance in the cerebellum and are consistent with structural and functional hypotheses of integration of the cerebellum in motor and cognitive functions.