Cerebellar microstructural and functional connectivity changes in patients with neuromyelitis optica spectrum disorders and their correlation with cognitive function: a female-dominated multimodal MRI study.

BACKGROUND

The cerebellum's role in neuromyelitis optica spectrum disorder (NMOSD) remains inadequately explored, despite its known contributions to cognition and motor function.

METHODS

This multimodal neuroimaging study integrated voxel-based morphometry (VBM), resting-state functional MRI (fMRI), and diffusion tensor imaging (DTI) to characterize cerebellar gray matter volume (GMV), microstructure, and functional connectivity (FC) in 29 NMOSD patients and 25 matched healthy controls. Clinical assessments included the Expanded Disability Status Scale (EDSS) and Montreal Cognitive Assessment (MoCA).

RESULTS

Patients exhibited significant cerebellar alterations, including GMV reduction in bilateral lobules VI/VIII and the vermis, decreased fractional anisotropy in Crus I, and altered FC between Crus I and occipital/frontal regions. Critically, the structural and microstructural impairments correlated with higher EDSS scores (* p < 0.05), while FC changes were associated with lower MoCA scores.

CONCLUSION

These findings implicate the cerebellum in both motor disability and cognitive impairment in NMOSD, providing novel evidence for cerebellar pathology as a contributor to disease progression.