The cognitive cerebellum: a hub for motor, emotional, and executive control

For many decades, the cerebellum was regarded almost exclusively as a structure devoted to motor regulation, responsible for balance, coordination, and the fine-tuning of movement. This view began to change in the 1990s, when studies with patients with isolated cerebellar lesions revealed cognitive and affective disturbances that could not be solely explained by cortical dysfunction. Subsequent anatomical, neuroimaging, and clinical investigations demonstrated robust reciprocal connectivity between the cerebellum and prefrontal regions, while functional imaging confirmed cerebellar activation during cognitive tasks without any motor component. Cognitive impairment linked to cerebellar dysfunction is now recognized as a prominent feature of spinocerebellar ataxias, and it has also been reported in other major neurodegenerative disorders, including Huntington's disease, Parkinson's disease, and Alzheimer's disease. Therefore, the aim of the current narrative review is to synthesize and critically analyze the pathophysiological, neuropathological, genetic, clinical, and neuroimaging evidence that underscores the cerebellum's essential contributions to cognition.