Emotional Communication Disorders in Cerebellar Disease
Condition: Cerebellar Diseases
MeSH terms: Cerebellar Diseases
Study type: Observational

Summary: 
      The cerebellum has been linked to cognitive and emotional functions and there is increasing
      evidence that damage to posterior portions of the cerebellum can result in frontal-executive,
      visuospatial, and verbal deficits, including dysprosodia, and affective changes including
      blunting of affect or disinhibited and inappropriate behavior. Based on preliminary clinical
      observations and tests performed in the investigator's clinic, disorders of emotional
      communication may also be associated with cerebellar dysfunction. Emotional communication
      includes the production and comprehension of facial and prosodic expressions and is critical
      to maintaining positive and supportive relationships. Deficits in emotional communication can
      have devastating effects on relationships and on quality of life for those affected. Although
      deficits in affect and prosody have been reported in association with posterior cerebellar
      disorders, there are currently no studies systematically investigating emotional
      communication in individuals with cerebellar dysfunction. It is known that the cerebellum has
      strong connections with the cerebral cortex, especially the frontal lobes, and that cortical
      damage from stroke or neurodegenerative disease can result in disorders of emotional
      communication. Impairments in the integrity of cerebellar-cerebral networks from cerebellar
      disease may produce similar deficits in emotional communication. The purpose of this study is
      to systematically investigate and describe deficits in emotional communication in a series of
      patients with cerebellar disease. Participants will be individuals diagnosed with posterior
      cerebellar degeneration or damage from a non-hemorrhagic infarction, and age-matched
      neurologically healthy controls. Assessment will include a battery of tests of
      neuropsychological function as well as tests of emotional communication. Comprehension of
      emotional facial and prosodic expressions will be assessed as well as production of emotional
      communication. The expected outcomes will be to identify and describe deficits in production
      and comprehension of emotional prosodic and facial expressions and to describe the
      relationship between deficits in emotional communication and cerebellar atrophy with magnetic
      resonance imaging imaging (MRI) using voxel based morphometry (VBM).
    

Detailed description: 
      The specific aims of this proposal will investigate the hypothesis that cerebellar damage is
      associated with emotional communication deficits.

        -  Determine whether posterior cerebellar damage results in deficits in the production or
           comprehension of emotional facial expressions and/or vocal prosodic expressions

        -  Determine whether posterior cerebellar damage results in alterations in intensity of
           reaction to emotionally evocative pictures or emotionally evocative words

        -  Investigate the relationship between performance on tests of emotional communication and
           left versus right cerebellar atrophy with magnetic resonance imaging imaging (MRI) using
           voxel based morphometry (VBM) analysis

      All subjects (cerebellar and control) will be given the following testing in a single session
      of lasting 3 to 3 and a half hours. Included will be tests to assess reading ability, naming
      ability, several tests of memory, a test of ability to discriminate between faces, tests of
      mental flexibility, and standardized questionnaires for depression, anxiety and emotional
      empathy. The tests include:

        1. Wechsler Test of Adult Reading

        2. Montreal Cognitive Assessment

        3. Beck Depression Inventory - 2

        4. Wisconsin Card Sorting test

        5. Toronto Alexithymia Scale

        6. Multi-Dimensional Emotional Empathy Scale

      All subjects will also be given tests assessing emotional communication ability. Tests of
      recognition and expression of emotional tones of voice and facial expression will be
      performed. Expression of facial expressions and tones of voice will be video recorded so that
      blinded raters can compare the accuracy and intensity of facial expressions and tones of
      voice between the participants. Training for the raters will include familiarization with the
      descriptions of features for each emotion with respect to changes in pitch, loudness, and
      rate for prosody and changes in facial features for facial expression. Both intra- and
      inter-judge reliability will be calculated for these blinded judges. To supplement this
      perceptual analysis, the participant's responses will be recorded using VisiPitch IV
      software, a clinical instrument that performs sound analyses and calculates the variation in
      the range of fundamental frequency (i.e., pitch variation) across each sentence. The ability
      to manipulate pitch to produce varying prosodic contours is the most salient acoustical
      feature of affective prosody.

      We will also assess intensity ratings and descriptions of emotional pictures and words using
      materials that have established rating norms. Participants will be shown a series of pictures
      and asked to rate the emotional intensity of the picture. They will also be asked to give a
      brief description of the picture. They will then be given a list of words, one at a time, and
      asked to rate the emotional intensity of these words.

      Some of the cerebellar participants will also be asked to participate in a magnetic resonance
      imaging (MRI) scan of the brain if the testing listed above shows deficits in understanding
      or producing emotional facial expressions or tones of voice and if there are no reasons that
      would prevent them from being able to enter a scanner (determined by a standard MRI screen
      form). Healthy control participants may also be asked to participate in a magnetic resonance
      imaging (MRI) scan of the brain and if there are no reasons that would prevent them from
      being able to enter a scanner. The imaging data will be used to investigate if there is a
      relationship between our experimental subjects' performance on tests of emotional expression
      and left versus right cerebellar atrophy-injury in the cerebellar lobules with MRI imaging
      using a voxel based morphometry (VBM) approach. The same data from controls will be used for
      comparison. Neuroimaging data collection will be done using a Philips Achieva 3T scanner
      (Amsterdam, Netherlands) and a 32-channel SENSE head coil. Imaging collected will include
      anatomical T1-weighted imaging scans. Structural MP-RAGE T1-weighted scans will be acquired
      with 130-1.0 mm sagittal slices, FOV=240 mm (AP)-180 mm (FH), matrix= 256-192, TR= 9.90 ms,
      TE= 4.60 ms, Flip Angle= 8, voxel size= 1.0x 0.94x 0.94 mm. Structural data will be analyzed
      with FSL-VBM, an optimized VBM protocol carried out with FSL tools. First, structural images
      will be brain-extracted and grey matter-segmented before being registered to the MNI 152
      standard space using non-linear registration The resulting images will be averaged and
      flipped along the x-axis to create a left-right symmetric, study-specific grey matter
      template. Second, all native grey matter images will be non-linearly registered to this
      study-specific template and "modulated" to correct for local expansion (or contraction) due
      to the non-linear component of the spatial transformation. The modulated grey matter images
      were then smoothed with an isotropic Gaussian kernel with a sigma of 6 mm. Finally, voxelwise
      GLM will be applied using permutation-based non-parametric testing, correcting for multiple
      comparisons across space.
    

Intervention name(s): Testing of emotional communication ability; magnetic resonance imaging (MRI) of the brain
Intervention type(s): Behavioral; Procedure
Intervention description(s): Assessment of comprehension and expression of emotional facial and prosodic expressions and assessment of emotional reactivity via ratings of emotionally evocative pictures and words.; Cerebellar participants who score at least 1 and a 1/2 standard deviations below the mean on the Florida Affect Battery and who have no contra-indications to scanning will be given an MRI. Healthy control participants who are willing and able to be scanned will also be given an MRI of the brain to use for analysis comparison.
Observational model: Case-Control
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        The ataxia subjects will be recruited from the University of Florida Medical Center. The
        age matched controls have all been recruited and tested at this point.
      
Keywords: Cerebellar Ataxia; Emotions; Affective Prosody; Facial Expression; Magnetic Resonance Imaging