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<h2 id='how-alcohol-damages-cerebellum'>How does Alcohol damage your Cerebellum?</h2> <h2 id='how-alcohol-damages-cerebellum'>How does Alcohol damage your Cerebellum?</h2>
<p>Alcohol consumption has a detrimental effect on the motor functions of the cerebellum, in particular postural control and coordination. Damage to the cerebellum can also cause speech control problems and poor muscle coordination. For example, it is very common for patrol officers to check the driver’s ability to perform counting or walking exercises. This is why it is extremely dangerous to drive under the influence of alcohol since it could severely affect your visual and motor skills. </p> <p>Alcohol consumption has a detrimental effect on the motor functions of the cerebellum, in particular postural control and coordination. Damage to the cerebellum can also cause speech control problems and poor muscle coordination. For example, it is very common for patrol officers to check the driver’s ability to perform counting or walking exercises. This is why it is extremely dangerous to drive under the influence of alcohol since it could severely affect your visual and motor skills. </p>
<p>Brain imaging technology like computed tomography and magnetic resonance imaging (MRI) showed that heavy alcohol abuse is correlated to brain tissue shrinkage (significant loss of nerve cells) that could increase the risk of having a stroke. Moreover, long-term alcohol abuse can damage nerve signals that can result in permanent functional deficits in cognitive reasoning and mental balance. [<a href='#ref-7'>7</a>] For instance, chronic alcoholics might no longer recover their ability to perform smooth and rapid movements as a result of motor control deficits. Abstinence from alcohol may show significant signs of improvement although it depends on how reversible their brain tissue injury is.</p> <p>Brain imaging technology like computed tomography and magnetic resonance imaging (MRI) showed that heavy alcohol abuse is correlated to brain tissue shrinkage (significant loss of nerve cells) that could increase the risk of having a stroke. [<a href='#ref-7'>7</a>] Moreover, long-term alcohol abuse can damage nerve signals that can result in permanent functional deficits in cognitive reasoning and mental balance. For instance, chronic alcoholics might no longer recover their ability to perform smooth and rapid movements as a result of motor control deficits. Abstinence from alcohol may show significant signs of improvement although it depends on how reversible their brain tissue injury is. [<a href='#ref-7'>7</a>]</p>
<p>Past research shows how alcoholics perform poorly in visual and cognitive tasks that involve organizing information in the right temporal order. Lack of coordination between visual and motor skills could increase the danger of head injuries and accidental falls. Cerebellar degeneration can provoke severe adaptation issues to changes in visuospatial perception that makes them unable to walk straight or in the dark with their eyes closed. It can also have a significant impact in the cognitive control of self-movement and sense of position.</p> <p>Past research shows how alcoholics perform poorly in visual and cognitive tasks that involve organizing information in the right temporal order. Lack of coordination between visual and motor skills could increase the danger of head injuries and accidental falls. Cerebellar degeneration can provoke severe adaptation issues to changes in visuospatial perception that makes them unable to walk straight or in the dark with their eyes closed. It can also have a significant impact in the cognitive control of self-movement and sense of position. [<a href='#ref-8'>8</a>]</p>
<p>It is still unclear whether instability arising from alcohol abuse is directly caused from cerebellum dysfunction or from deficiency of the peripheral nervous system in body position and motor balance. Hence, more research is still needed to understand whether the cerebellar damage represents the prime cause of certain functional deficits in alcoholics. “New research must be conducted to determine if alcohol-related imbalance results from cerebellar pathology or from poor functioning of the peripheral nervous system in the body’s extremities, such as the hands and feet. Peripheral neuropathy can occur in alcoholics, resulting in decreased sensation that may lead to imbalance ” [<a href='#ref-7'>7</a>]. Knowledge of this kind would be crucial for quickening recovery processes.</p> <p>It is still unclear whether instability arising from alcohol abuse is directly caused from cerebellum dysfunction or from deficiency of the peripheral nervous system in body position and motor balance. Hence, more research is still needed to understand whether the cerebellar damage represents the prime cause of certain functional deficits in alcoholics. “New research must be conducted to determine if alcohol-related imbalance results from cerebellar pathology or from poor functioning of the peripheral nervous system in the body’s extremities, such as the hands and feet. Peripheral neuropathy can occur in alcoholics, resulting in decreased sensation that may lead to imbalance ” [<a href='#ref-7'>7</a>]. Knowledge of this kind would be crucial for quickening recovery processes.</p>
</section> </section>
<section class='column col-12'> <section class='column col-12'>
<h2 id='how-cerebellum-damage-affects-you'>How does damage and dysfunction of Cerebellum affect you?</h2> <h2 id='how-cerebellum-damage-affects-you'>How does damage and dysfunction of Cerebellum affect you?</h2>
<p>Damage to the cerebellum can cause a broad spectrum of motor and cognitive disturbances. It causes impairments in motor coordination and balance which lead to symptoms of clumsiness, irregular walking and feelings of dizziness. [1] Smooth and purposeful movements become difficult for subjects with cerebellar damage. [3]</p> <p>Damage to the cerebellum can cause a broad spectrum of motor and cognitive disturbances. It causes impairments in motor coordination and balance which lead to symptoms of clumsiness, irregular walking and feelings of dizziness. [<a href='#ref-13'>13</a>] Smooth and purposeful movements become difficult for subjects with cerebellar damage. [<a href='#ref-14'>14</a>]</p>
<p>Signs and symptoms can include a wide-based, uncoordinated walk; a back and forth tremor in the trunk of the body; uncoordinated movements of the arms and legs; slow and slurred speech and uncontrolled eye movements. This lack of coordination of motor movements is often referred to as Ataxia. [4] Subjects with left cerebellar damage report attention deficits while right cerebellar damage can lead to disrupted language skills. [1] </p> <p>Signs and symptoms can include a wide-based, uncoordinated walk; a back and forth tremor in the trunk of the body; uncoordinated movements of the arms and legs; slow and slurred speech and uncontrolled eye movements. This lack of coordination of motor movements is often referred to as Ataxia. [<a href='#ref-15'>15</a>] Subjects with left cerebellar damage report attention deficits while right cerebellar damage can lead to disrupted language skills. [<a href='#ref-13'>13</a>]</p>
<p>Since the cerebellum plays a role in cognition and emotion, cerebellar dysfunction also contributes to non-motor conditions such as certain neurodevelopmental disorders e.g. autism spectrum disorders. [3] Cerebellar abnormalities have been found in patients with ADHD, which is characterized by inattention, hyperactivity and impulsivity. Moreover neuroimaging studies show cerebellar differences in subjects with dyslexia. Dyslexic subjects have also shown a poorer performance on a variety of cerebellar motor tasks, which leads to the proposal that cerebellar dysfunction is a core neurobiological underpinning of dyslexia. It was found that early cerebellar damage leads to poorer outcomes than cerebellar damage in adulthood, which suggests that the cerebellum is important during development. [2]</p> <p>Since the cerebellum plays a role in cognition and emotion, cerebellar dysfunction also contributes to non-motor conditions such as certain neurodevelopmental disorders e.g. autism spectrum disorders. [<a href='#ref-14'>14</a>] Cerebellar abnormalities have been found in patients with ADHD, which is characterized by inattention, hyperactivity and impulsivity. Moreover neuroimaging studies show cerebellar differences in subjects with dyslexia. Dyslexic subjects have also shown a poorer performance on a variety of cerebellar motor tasks, which leads to the proposal that cerebellar dysfunction is a core neurobiological underpinning of dyslexia. It was found that early cerebellar damage leads to poorer outcomes than cerebellar damage in adulthood, which suggests that the cerebellum is important during development. [<a href='#ref-16'>16</a>]</p>
<p>Cerebellar damage caused by alcoholism specifically is one of the most common acquired forms of cerebellar ataxia. [5] The developing cerebellum is very sensitive to the toxic effects of alcohol. Children with fetal alcohol spectrum disorder, a group of conditions occurring when the mother consumed alcohol during pregnancy show many symptoms of cerebellar dysfunction. [6]</p> <p>Cerebellar damage caused by alcoholism specifically is one of the most common acquired forms of cerebellar ataxia. [<a href='#ref-17'>17</a>] The developing cerebellum is very sensitive to the toxic effects of alcohol. Children with fetal alcohol spectrum disorder, a group of conditions occurring when the mother consumed alcohol during pregnancy show many symptoms of cerebellar dysfunction. [<a href='#ref-18'>18</a>]</p>
</section> </section>
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<h2 id='assessment'>How to assess your Cerebellum function?</h2> <h2 id='assessment'>How to assess your Cerebellum function?</h2>
<h4>Neuropsychological and Medical Tests</h4> <h4>Neuropsychological and Medical Tests</h4>
<p>Since damage to the cerebellum impairs the ability to control motor movements clinical signs can be detected that occur throughout the body. In an examination of a patient the gait, posture and speech of the patient would be observed. [1] Patients with damage to the cerebellum may have abnormal posture and a broad-based gait. When scanning the speech an enunciation of individual syllables may occur. Nystagmus, abnormal eye movements can be detected by asking the patient to follow the movement of the examiner's finger. [2]</p> <p>Since damage to the cerebellum impairs the ability to control motor movements clinical signs can be detected that occur throughout the body. In an examination of a patient the gait, posture and speech of the patient would be observed. [<a href='#ref-19'>19</a>] Patients with damage to the cerebellum may have abnormal posture and a broad-based gait. When scanning the speech an enunciation of individual syllables may occur. Nystagmus, abnormal eye movements can be detected by asking the patient to follow the movement of the examiner's finger. [<a href='#ref-20'>20</a>]</p>
<p>In the ‘Finger to nose & finger to finger test’ the patient is first asked to fully extend the arm and then touch their nose and secondly asked to touch the examiner's finger and then their nose. The difficulty of this test can be increased by adding resistance to the patient's movements. Checking for rapid alternating movements is another way of detecting cerebellum damage. In this task the patient is asked to place one hand over the next and have them flip one hand back and forth as fast as possible. Patients with cerebellar damage show abnormalities in this task. The ‘Rebound phenomenon’ (of Stewart & Holmes) is a test where the patient pulls on the examiner’s hand until they slip the hand out of their grasp. Normally the muscles would contract and stop their arm from moving further. Patients with cerebellar damage are unable to quickly stop their arm from moving in the desired direction. <p>In the ‘Finger to nose & finger to finger test’ the patient is first asked to fully extend the arm and then touch their nose and secondly asked to touch the examiner's finger and then their nose. The difficulty of this test can be increased by adding resistance to the patient's movements. Checking for rapid alternating movements is another way of detecting cerebellum damage. In this task the patient is asked to place one hand over the next and have them flip one hand back and forth as fast as possible. Patients with cerebellar damage show abnormalities in this task. The ‘Rebound phenomenon’ (of Stewart & Holmes) is a test where the patient pulls on the examiner’s hand until they slip the hand out of their grasp. Normally the muscles would contract and stop their arm from moving further. Patients with cerebellar damage are unable to quickly stop their arm from moving in the desired direction.
Hypotonia is a condition that can be observed when checking the knee reflex. When the leg keeps swinging after the knee reflex is tested for more than 4 times this suggests damage to the cerebellum. [2]</p> Hypotonia is a condition that can be observed when checking the knee reflex. When the leg keeps swinging after the knee reflex is tested for more than 4 times this suggests damage to the cerebellum. [<a href='#ref-20'>20</a>]</p>
<h4>Assessment through Neuroimaging</h4> <h4>Assessment through Neuroimaging</h4>
<p>Magnetic resonance imaging is another way of detecting cerebellar damage. Alcoholic cerebellar degeneration is a cause for cerebellar atrophy which is a reduction of cerebellar volume and connections. [3] This cerebellar volume loss can be detected with neuroimaging techniques and can occur even in the absence of clinical signals such as ataxia. Cerebellar shrinkage occurs mostly for older alcoholics with at least a 10-year duration of alcoholism. [4]</p> <p>Magnetic resonance imaging is another way of detecting cerebellar damage. Alcoholic cerebellar degeneration is a cause for cerebellar atrophy which is a reduction of cerebellar volume and connections. [<a href='#ref-21'>21</a>] This cerebellar volume loss can be detected with neuroimaging techniques and can occur even in the absence of clinical signals such as ataxia. Cerebellar shrinkage occurs mostly for older alcoholics with at least a 10-year duration of alcoholism. [<a href='#ref-22'>22</a>]</p>
</section> </section>
<section class='column col-12'> <section class='column col-12'>
<h2 id='treatment-and-rehab'>Treatment and Rehabilitation</h2> <h2 id='treatment-and-rehab'>Treatment and Rehabilitation</h2>
<p>Loss of balance, dizziness, ...</p> <p>The best treatments for mitigating the effects of alcohol abuse on your body are abstinence, medication, motor and cognitive training and therapeutic counselling. Abstinence from alcohol is the quickest path to recovery as it frees the body of all toxic residues. Abstinence from alcohol may cause intense withdrawal symptoms that can last a few days. Alcoholics normally experience significant signs of improvement on their cognitive tests once the withdrawal period is over. For instance, verbal processing is one of the first areas of cognitive functioning to be fully resumed compared to others (within the first three weeks). The rate of recovery may vary according to various different factors such as the age of the patient or the type of cognitive function required for fulfilling a task. The recovery time for restoring all cognitive functions to normal may vary between weeks, months or even years. In some cases, patients with alcohol addiction may never fully recover their cognitive functions such as multitasking, attention span, decision making, self-restraint, emotion recognition etc. [<a href='#ref-9'>9</a>]</p>
<p>Recovery may not occur at a regular steady rate, so it is necessary to measure their overall cognitive and motor performance on a regular basis (two times per week for instance). The age of alcohol addicts is a crucial factor for measuring the rate of their recovery processes. In the case of younger alcoholics (40 or under), they will show significant recovery of all cognitive skills except for slight cognitive delays in extremely challenging tasks. Despite showing steady and progressive improvements on their cognitive tests, older alcoholics will nevertheless manifest considerable deficits over a longer time span in problem-solving and visuospatial activities Most research studies suggest that there is no correlation between the alcoholic’s drinking history and the rate of its recovery. Moreover, chronic alcoholics with more than 10 years of heavy drinking are not likely to experience slower recovery processes or more permanent damage to their cognitive systems than those who have no or little drinking history. In this respect, it is important to note how relapse to alcohol addiction after an indefinite period of sobriety is not necessarily contingent on the alcoholic’s drinking history [<a href='#ref-9'>9</a>]</p>
<p>Recovery may not occur at a regular steady rate, so it is necessary to measure their overall cognitive and motor performance on a regular basis (two times per week for instance). The age of alcohol addicts is a crucial factor for measuring the rate of their recovery processes. In the case of younger alcoholics (40 or under), they will show significant recovery of all cognitive skills except for slight cognitive delays in extremely challenging tasks. Despite showing steady and progressive improvements on their cognitive tests, older alcoholics will nevertheless manifest considerable deficits over a longer time span in problem-solving and visuospatial activities Most research studies suggest that there is no correlation between the alcoholic’s drinking history and the rate of its recovery. Moreover, chronic alcoholics with more than 10 years of heavy drinking are not likely to experience slower recovery processes or more permanent damage to their cognitive systems than those who have no or little drinking history. In this respect, it is important to note how relapse to alcohol addiction after an indefinite period of sobriety is not necessarily contingent on the alcoholic’s drinking history [<a href='#ref-9'>9</a>]</p>
<p>There is no actual medicine that can cure alcohol-related disorders completely but they can contribute to making alcohol undesirable. For instance, Acamprosate, Disulfiram and Naltrxone are all types of drugs that help reduce the yearning for alcohol as well as prevent the effects of a fall back. To be clear, the taste or smell of alcohol will make the patient feel nauseous and revolting. [<a href='#ref-10'>10</a>, <a href='#ref-11'>11</a>]</p>
<p>Research conducted from Klintsova and other colleagues measured the ability of rats with alcohol exposure to perform certain motor exercises like rope climbing as part of their motor training program within a period of 6 months. “These results suggest that complex motor skill learning improves some of the motor performance deficits produced by postnatal exposure to alcohol and can potentially serve as a model for rehabilitative intervention” [<a href='#ref-12'>12</a>]. Hence, the effects of motor training on rats could be useful for improving motor skills in patients with cerebellar dysfunction. For example, athletes and musicians with alcohol related cerebellar damage can aim at fully recovering their coordinated movements if they undertake such motor training processes. [<a href='#ref-9'>9</a>]</p>
<p>Research conducted from Klintsova and other colleagues measured the ability of rats with alcohol exposure to perform certain motor exercises like rope climbing as part of their motor training program within a period of 6 months. “These results suggest that complex motor skill learning improves some of the motor performance deficits produced by postnatal exposure to alcohol and can potentially serve as a model for rehabilitative intervention” [<a href='#ref-9'>9</a>]. Hence, the effects of motor training on rats could be useful for improving motor skills in patients with cerebellar dysfunction. For example, athletes and musicians with alcohol related cerebellar damage can aim at fully recovering their coordinated movements if they undertake such motor training processes.</p>
<p>Therapeutic counselling is crucial for regaining the cognitive and motor skills as they were prior to addiction. A counsellor also gives you valuable advice for staying sober in the long run. Alcohol addiction may have a strong impact on your family relations that the patient will need to seek for therapy in a rehab institution. This is why it is important to build a network of close friends that can boost your self-esteem. In this respect, a friendly environment helps the patient face the effects of a possible relapse with greater confidence. There are two types of counselling: in-patient and out-patient. The former is the best form of treatment for the patients that are not able to reduce the levels of alcohol by themselves. They are constantly monitored and guided throughout their rehabilitation. Out-patient rehab is rather meant for those people that have control over their mental health as they show milder symptoms [<a href='#ref-11'>11</a>].</p>
</section> </section>
@ -181,6 +188,21 @@ Hypotonia is a condition that can be observed when checking the knee reflex. Whe
<li id='ref-5'>Purves, D., Augustine, G. J., Fitzpatrick, D., Hall, W. C., LaMantia, A. S., &amp; White, L. E. (2011). Neuroscience, 5th edn. Sunderland, MA. pp. 417–423.</li> <li id='ref-5'>Purves, D., Augustine, G. J., Fitzpatrick, D., Hall, W. C., LaMantia, A. S., &amp; White, L. E. (2011). Neuroscience, 5th edn. Sunderland, MA. pp. 417–423.</li>
<li id='ref-6'>Ghez, C. (1985). Fahn S. The cerebellum. Principles of neural science, 2nd edition. pp. 502–522</li> <li id='ref-6'>Ghez, C. (1985). Fahn S. The cerebellum. Principles of neural science, 2nd edition. pp. 502–522</li>
<li id='ref-7'>Sullivan, E. V., Rosenbloom, M. J., Deshmukh, A., Desmond, J. E., & Pfefferbaum, A. (1995). Alcohol and the Cerebellum: Effects on Balance, Motor Coordination, and Cognition. Alcohol health and research world, 19(2), 138–141.</li> <li id='ref-7'>Sullivan, E. V., Rosenbloom, M. J., Deshmukh, A., Desmond, J. E., & Pfefferbaum, A. (1995). Alcohol and the Cerebellum: Effects on Balance, Motor Coordination, and Cognition. Alcohol health and research world, 19(2), 138–141.</li>
<li id='ref-8'>How Alcohol Compounds Its Damage to the Brain. (2020, November 23). Verywell Mind. https://www.verywellmind.com/alcohol-compounds-its-damage-to-the-brain-62747</li>
<li id='ref-9'>Goldman, M. S., Klisz, D. K., &amp; Williams, D. L. (1985). Experience-dependent recovery of cognitive functioning in young alcoholics. Addictive Behaviors, 10(2), 169–176. &lt;a href=&quot;https://doi.org/10.1016/0306-4603(85)90023-1&quot;&gt;https://doi.org/10.1016/0306-4603(85)90023-1&lt;/a&gt;</li>
<li id='ref-10'>Bezrutczyk, D. (2021, October 14). Alcohol-Related Brain Damage. Alcohol Rehab Guide. &lt;a href=&quot;https://www.alcoholrehabguide.org/resources/medical-conditions/alcohol-related-brain-damage/#&quot;&gt;https://www.alcoholrehabguide.org/resources/medical-conditions/alcohol-related-brain-damage/#&lt;/a&gt;</li>
<li id='ref-11'>Griffin, M. R. (2017, August 16). What Are the Treatments for Alcohol Use Disorder? &lt;a href=&quot;http://WebMD.https://www.webmd.com/mental-health/addiction/alcohol-use-disorder-treatments#2&quot;&gt;WebMD.https://www.webmd.com/mental-health/addiction/alcohol-use-disorder-treatments#2&lt;/a&gt;</li>
<li id='ref-12'>Klintsova, A. Y., Cowell, R. M., Swain, R. A., Napper, R. M., Goodlett, C. R., &amp; Greenough, W. T. (1998). Therapeutic effects of complex motor training on motor performance deficits induced by neonatal binge-like alcohol exposure in rats. Brain Research, 800(1), 48–61. &lt;a href=&quot;https://doi.org/10.1016/s0006-8993(98)00495-8&quot;&gt;https://doi.org/10.1016/s0006-8993(98)00495-8&lt;/a&gt;</li>
<li id='ref-13'>Baillieux, H.; De smet, H. J.; Dobbeleir, A.; Paquier, P. F.; De Deyn, P; Mariën, P. (2010). Cognitive and affective disturbances following focal cerebellar damage in adults: A neuropsychological and SPECT study. CORTEX, 46, 869-897.</li>
<li id='ref-14'>Reeber, Stacey ; Otis, Tom ; Sillitoe, Roy (2013) New roles for the cerebellum in health and disease. Frontiers in Systems Neuroscience, 14, 1662-5137.</li>
<li id='ref-15'>NIH Genetic and Rare Diseases Information Center (2014) Cerebellar Degeneration, Assesed: 05.11.2021</li>
<li id='ref-16'>Stoodley C. J. (2016). The Cerebellum and Neurodevelopmental Disorders. Cerebellum (London, England), 15(1), 34–37. &lt;a href=&quot;https://doi.org/10.1007/s12311-015-0715-3&quot;&gt;https://doi.org/10.1007/s12311-015-0715-3&lt;/a&gt;</li>
<li id='ref-17'>Shanmugarajah, P.D., Hoggard, N., Currie, S. et al. Alcohol-related cerebellar degeneration: not all down to toxicity?. cerebellum ataxias 3, 17 (2016). &lt;a href=&quot;https://doi.org/10.1186/s40673-016-0055-1&quot;&gt;https://doi.org/10.1186/s40673-016-0055-1&lt;/a&gt;</li>
<li id='ref-18'>Luo J. (2015). Effects of Ethanol on the Cerebellum: Advances and Prospects. Cerebellum (London, England), 14(4), 383–385. &lt;a href=&quot;https://doi.org/10.1007/s12311-015-0674-8&quot;&gt;https://doi.org/10.1007/s12311-015-0674-8&lt;/a&gt;</li>
<li id='ref-19'>Bargiela, David. Cerebellar examination. URL: &lt;a href=&quot;https://geekymedics.com/cerebellar-examination-osce-guide/&quot;&gt;https://geekymedics.com/cerebellar-examination-osce-guide/&lt;/a&gt; Assessed 05.11.2021</li>
<li id='ref-20'>Stanford Medicine 25 (2014) Introduction to the Cerebellar Exam. URL: &lt;a href=&quot;https://stanfordmedicine25.stanford.edu/the25/cerebellar.html&quot;&gt;https://stanfordmedicine25.stanford.edu/the25/cerebellar.html&lt;/a&gt; Assessed 05.11.2021</li>
<li id='ref-21'>Arora R. (2015). Imaging spectrum of cerebellar pathologies: a pictorial essay. Polish journal of radiology, 80, 142–150. &lt;a href=&quot;https://doi.org/10.12659/PJR.892878&quot;&gt;https://doi.org/10.12659/PJR.892878&lt;/a&gt;</li>
<li id='ref-22'>Sullivan, E. V., Rosenbloom, M. J., Deshmukh, A., Desmond, J. E., &amp; Pfefferbaum, A. (1995). Alcohol and the Cerebellum: Effects on Balance, Motor Coordination, and Cognition. Alcohol health and research world, 19(2), 138–141.</li>
</ol> </ol>
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<h2 id='how-alcohol-damages-cerebellum'>How does Alcohol damage your Cerebellum?</h2> <h2 id='how-alcohol-damages-cerebellum'>How does Alcohol damage your Cerebellum?</h2>
<p>Alcohol consumption has a detrimental effect on the motor functions of the cerebellum, in particular postural control and coordination. Damage to the cerebellum can also cause speech control problems and poor muscle coordination. For example, it is very common for patrol officers to check the driver’s ability to perform counting or walking exercises. This is why it is extremely dangerous to drive under the influence of alcohol since it could severely affect your visual and motor skills. </p> <p>Alcohol consumption has a detrimental effect on the motor functions of the cerebellum, in particular postural control and coordination. Damage to the cerebellum can also cause speech control problems and poor muscle coordination. For example, it is very common for patrol officers to check the driver’s ability to perform counting or walking exercises. This is why it is extremely dangerous to drive under the influence of alcohol since it could severely affect your visual and motor skills. </p>
<p>Brain imaging technology like computed tomography and magnetic resonance imaging (MRI) showed that heavy alcohol abuse is correlated to brain tissue shrinkage (significant loss of nerve cells) that could increase the risk of having a stroke. Moreover, long-term alcohol abuse can damage nerve signals that can result in permanent functional deficits in cognitive reasoning and mental balance. [<a href='#ref-7'>7</a>] For instance, chronic alcoholics might no longer recover their ability to perform smooth and rapid movements as a result of motor control deficits. Abstinence from alcohol may show significant signs of improvement although it depends on how reversible their brain tissue injury is.</p> <p>Brain imaging technology like computed tomography and magnetic resonance imaging (MRI) showed that heavy alcohol abuse is correlated to brain tissue shrinkage (significant loss of nerve cells) that could increase the risk of having a stroke. [<a href='#ref-7'>7</a>] Moreover, long-term alcohol abuse can damage nerve signals that can result in permanent functional deficits in cognitive reasoning and mental balance. For instance, chronic alcoholics might no longer recover their ability to perform smooth and rapid movements as a result of motor control deficits. Abstinence from alcohol may show significant signs of improvement although it depends on how reversible their brain tissue injury is. [<a href='#ref-7'>7</a>]</p>
<p>Past research shows how alcoholics perform poorly in visual and cognitive tasks that involve organizing information in the right temporal order. Lack of coordination between visual and motor skills could increase the danger of head injuries and accidental falls. Cerebellar degeneration can provoke severe adaptation issues to changes in visuospatial perception that makes them unable to walk straight or in the dark with their eyes closed. It can also have a significant impact in the cognitive control of self-movement and sense of position.</p> <p>Past research shows how alcoholics perform poorly in visual and cognitive tasks that involve organizing information in the right temporal order. Lack of coordination between visual and motor skills could increase the danger of head injuries and accidental falls. Cerebellar degeneration can provoke severe adaptation issues to changes in visuospatial perception that makes them unable to walk straight or in the dark with their eyes closed. It can also have a significant impact in the cognitive control of self-movement and sense of position. [<a href='#ref-8'>8</a>]</p>
<p>It is still unclear whether instability arising from alcohol abuse is directly caused from cerebellum dysfunction or from deficiency of the peripheral nervous system in body position and motor balance. Hence, more research is still needed to understand whether the cerebellar damage represents the prime cause of certain functional deficits in alcoholics. “New research must be conducted to determine if alcohol-related imbalance results from cerebellar pathology or from poor functioning of the peripheral nervous system in the body’s extremities, such as the hands and feet. Peripheral neuropathy can occur in alcoholics, resulting in decreased sensation that may lead to imbalance ” [<a href='#ref-7'>7</a>]. Knowledge of this kind would be crucial for quickening recovery processes.</p> <p>It is still unclear whether instability arising from alcohol abuse is directly caused from cerebellum dysfunction or from deficiency of the peripheral nervous system in body position and motor balance. Hence, more research is still needed to understand whether the cerebellar damage represents the prime cause of certain functional deficits in alcoholics. “New research must be conducted to determine if alcohol-related imbalance results from cerebellar pathology or from poor functioning of the peripheral nervous system in the body’s extremities, such as the hands and feet. Peripheral neuropathy can occur in alcoholics, resulting in decreased sensation that may lead to imbalance ” [<a href='#ref-7'>7</a>]. Knowledge of this kind would be crucial for quickening recovery processes.</p>
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<h2 id='assessment'>How to assess your Cerebellum function?</h2> <h2 id='assessment'>How to assess your Cerebellum function?</h2>
<h4>Neuropsychological and Medical Tests</h4> <h4>Neuropsychological and Medical Tests</h4>
<p>Since damage to the cerebellum impairs the ability to control motor movements clinical signs can be detected that occur throughout the body. In an examination of a patient the gait, posture and speech of the patient would be observed. [1] Patients with damage to the cerebellum may have abnormal posture and a broad-based gait. When scanning the speech an enunciation of individual syllables may occur. Nystagmus, abnormal eye movements can be detected by asking the patient to follow the movement of the examiner's finger. [2]</p> <p>Since damage to the cerebellum impairs the ability to control motor movements clinical signs can be detected that occur throughout the body. In an examination of a patient the gait, posture and speech of the patient would be observed. [<a href='#ref-19'>19</a>] Patients with damage to the cerebellum may have abnormal posture and a broad-based gait. When scanning the speech an enunciation of individual syllables may occur. Nystagmus, abnormal eye movements can be detected by asking the patient to follow the movement of the examiner's finger. [<a href='#ref-20'>20</a>]</p>
<p>In the ‘Finger to nose & finger to finger test’ the patient is first asked to fully extend the arm and then touch their nose and secondly asked to touch the examiner's finger and then their nose. The difficulty of this test can be increased by adding resistance to the patient's movements. Checking for rapid alternating movements is another way of detecting cerebellum damage. In this task the patient is asked to place one hand over the next and have them flip one hand back and forth as fast as possible. Patients with cerebellar damage show abnormalities in this task. The ‘Rebound phenomenon’ (of Stewart & Holmes) is a test where the patient pulls on the examiner’s hand until they slip the hand out of their grasp. Normally the muscles would contract and stop their arm from moving further. Patients with cerebellar damage are unable to quickly stop their arm from moving in the desired direction. <p>In the ‘Finger to nose & finger to finger test’ the patient is first asked to fully extend the arm and then touch their nose and secondly asked to touch the examiner's finger and then their nose. The difficulty of this test can be increased by adding resistance to the patient's movements. Checking for rapid alternating movements is another way of detecting cerebellum damage. In this task the patient is asked to place one hand over the next and have them flip one hand back and forth as fast as possible. Patients with cerebellar damage show abnormalities in this task. The ‘Rebound phenomenon’ (of Stewart & Holmes) is a test where the patient pulls on the examiner’s hand until they slip the hand out of their grasp. Normally the muscles would contract and stop their arm from moving further. Patients with cerebellar damage are unable to quickly stop their arm from moving in the desired direction.
Hypotonia is a condition that can be observed when checking the knee reflex. When the leg keeps swinging after the knee reflex is tested for more than 4 times this suggests damage to the cerebellum. [2]</p> Hypotonia is a condition that can be observed when checking the knee reflex. When the leg keeps swinging after the knee reflex is tested for more than 4 times this suggests damage to the cerebellum. [<a href='#ref-20'>20</a>]</p>
<h4>Assessment through Neuroimaging</h4> <h4>Assessment through Neuroimaging</h4>
<p>Magnetic resonance imaging is another way of detecting cerebellar damage. Alcoholic cerebellar degeneration is a cause for cerebellar atrophy which is a reduction of cerebellar volume and connections. [3] This cerebellar volume loss can be detected with neuroimaging techniques and can occur even in the absence of clinical signals such as ataxia. Cerebellar shrinkage occurs mostly for older alcoholics with at least a 10-year duration of alcoholism. [4]</p> <p>Magnetic resonance imaging is another way of detecting cerebellar damage. Alcoholic cerebellar degeneration is a cause for cerebellar atrophy which is a reduction of cerebellar volume and connections. [<a href='#ref-21'>21</a>] This cerebellar volume loss can be detected with neuroimaging techniques and can occur even in the absence of clinical signals such as ataxia. Cerebellar shrinkage occurs mostly for older alcoholics with at least a 10-year duration of alcoholism. [<a href='#ref-22'>22</a>]</p>
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<li id='ref-5'>{{ "Purves, D., Augustine, G. J., Fitzpatrick, D., Hall, W. C., LaMantia, A. S., & White, L. E. (2011). Neuroscience, 5th edn. Sunderland, MA. pp. 417–423." }}</li> <li id='ref-5'>{{ "Purves, D., Augustine, G. J., Fitzpatrick, D., Hall, W. C., LaMantia, A. S., & White, L. E. (2011). Neuroscience, 5th edn. Sunderland, MA. pp. 417–423." }}</li>
<li id='ref-6'>{{ "Ghez, C. (1985). Fahn S. The cerebellum. Principles of neural science, 2nd edition. pp. 502–522" }}</li> <li id='ref-6'>{{ "Ghez, C. (1985). Fahn S. The cerebellum. Principles of neural science, 2nd edition. pp. 502–522" }}</li>
<li id='ref-7'>Sullivan, E. V., Rosenbloom, M. J., Deshmukh, A., Desmond, J. E., & Pfefferbaum, A. (1995). Alcohol and the Cerebellum: Effects on Balance, Motor Coordination, and Cognition. Alcohol health and research world, 19(2), 138–141.</li> <li id='ref-7'>Sullivan, E. V., Rosenbloom, M. J., Deshmukh, A., Desmond, J. E., & Pfefferbaum, A. (1995). Alcohol and the Cerebellum: Effects on Balance, Motor Coordination, and Cognition. Alcohol health and research world, 19(2), 138–141.</li>
<li id='ref-8'>How Alcohol Compounds Its Damage to the Brain. (2020, November 23). Verywell Mind. https://www.verywellmind.com/alcohol-compounds-its-damage-to-the-brain-62747</li>
<li id='ref-9'>{{ "Goldman, M. S., Klisz, D. K., & Williams, D. L. (1985). Experience-dependent recovery of cognitive functioning in young alcoholics. Addictive Behaviors, 10(2), 169–176. https://doi.org/10.1016/0306-4603(85)90023-1" | urlize }}</li>
<li id='ref-10'>{{ "Bezrutczyk, D. (2021, October 14). Alcohol-Related Brain Damage. Alcohol Rehab Guide. https://www.alcoholrehabguide.org/resources/medical-conditions/alcohol-related-brain-damage/#" | urlize }}</li>
<li id='ref-11'>{{ "Griffin, M. R. (2017, August 16). What Are the Treatments for Alcohol Use Disorder? WebMD.https://www.webmd.com/mental-health/addiction/alcohol-use-disorder-treatments#2" | urlize }}</li>
<li id='ref-12'>{{ "Klintsova, A. Y., Cowell, R. M., Swain, R. A., Napper, R. M., Goodlett, C. R., & Greenough, W. T. (1998). Therapeutic effects of complex motor training on motor performance deficits induced by neonatal binge-like alcohol exposure in rats. Brain Research, 800(1), 48–61. https://doi.org/10.1016/s0006-8993(98)00495-8" | urlize }}</li>
<li id='ref-13'>{{ "Baillieux, H.; De smet, H. J.; Dobbeleir, A.; Paquier, P. F.; De Deyn, P; Mariën, P. (2010). Cognitive and affective disturbances following focal cerebellar damage in adults: A neuropsychological and SPECT study. CORTEX, 46, 869-897." }}</li>
<li id='ref-14'>{{ "Reeber, Stacey ; Otis, Tom ; Sillitoe, Roy (2013) New roles for the cerebellum in health and disease. Frontiers in Systems Neuroscience, 14, 1662-5137." }}</li>
<li id='ref-15'>{{ "NIH Genetic and Rare Diseases Information Center (2014) Cerebellar Degeneration, Assesed: 05.11.2021" }}</li>
<li id='ref-16'>{{ "Stoodley C. J. (2016). The Cerebellum and Neurodevelopmental Disorders. Cerebellum (London, England), 15(1), 34–37. https://doi.org/10.1007/s12311-015-0715-3" | urlize }}</li>
<li id='ref-17'>{{ "Shanmugarajah, P.D., Hoggard, N., Currie, S. et al. Alcohol-related cerebellar degeneration: not all down to toxicity?. cerebellum ataxias 3, 17 (2016). https://doi.org/10.1186/s40673-016-0055-1" | urlize }}</li>
<li id='ref-18'>{{ "Luo J. (2015). Effects of Ethanol on the Cerebellum: Advances and Prospects. Cerebellum (London, England), 14(4), 383–385. https://doi.org/10.1007/s12311-015-0674-8" | urlize }}</li>
<li id='ref-19'>{{ "Bargiela, David. Cerebellar examination. URL: https://geekymedics.com/cerebellar-examination-osce-guide/. Assessed 05.11.2021" | urlize }}</li>
<li id='ref-20'>{{ "Stanford Medicine 25 (2014) Introduction to the Cerebellar Exam. URL: https://stanfordmedicine25.stanford.edu/the25/cerebellar.html. Assessed 05.11.2021" | urlize }}</li>
<li id='ref-21'>{{ "Arora R. (2015). Imaging spectrum of cerebellar pathologies: a pictorial essay. Polish journal of radiology, 80, 142–150. https://doi.org/10.12659/PJR.892878" | urlize }}</li>
<li id='ref-22'>{{ "Sullivan, E. V., Rosenbloom, M. J., Deshmukh, A., Desmond, J. E., & Pfefferbaum, A. (1995). Alcohol and the Cerebellum: Effects on Balance, Motor Coordination, and Cognition. Alcohol health and research world, 19(2), 138–141." }}</li>
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<h2 id='how-cerebellum-damage-affects-you'>How does damage and dysfunction of Cerebellum affect you?</h2> <h2 id='how-cerebellum-damage-affects-you'>How does damage and dysfunction of Cerebellum affect you?</h2>
<p>Damage to the cerebellum can cause a broad spectrum of motor and cognitive disturbances. It causes impairments in motor coordination and balance which lead to symptoms of clumsiness, irregular walking and feelings of dizziness. [1] Smooth and purposeful movements become difficult for subjects with cerebellar damage. [3]</p> <p>Damage to the cerebellum can cause a broad spectrum of motor and cognitive disturbances. It causes impairments in motor coordination and balance which lead to symptoms of clumsiness, irregular walking and feelings of dizziness. [<a href='#ref-13'>13</a>] Smooth and purposeful movements become difficult for subjects with cerebellar damage. [<a href='#ref-14'>14</a>]</p>
<p>Signs and symptoms can include a wide-based, uncoordinated walk; a back and forth tremor in the trunk of the body; uncoordinated movements of the arms and legs; slow and slurred speech and uncontrolled eye movements. This lack of coordination of motor movements is often referred to as Ataxia. [4] Subjects with left cerebellar damage report attention deficits while right cerebellar damage can lead to disrupted language skills. [1] </p> <p>Signs and symptoms can include a wide-based, uncoordinated walk; a back and forth tremor in the trunk of the body; uncoordinated movements of the arms and legs; slow and slurred speech and uncontrolled eye movements. This lack of coordination of motor movements is often referred to as Ataxia. [<a href='#ref-15'>15</a>] Subjects with left cerebellar damage report attention deficits while right cerebellar damage can lead to disrupted language skills. [<a href='#ref-13'>13</a>]</p>
<p>Since the cerebellum plays a role in cognition and emotion, cerebellar dysfunction also contributes to non-motor conditions such as certain neurodevelopmental disorders e.g. autism spectrum disorders. [3] Cerebellar abnormalities have been found in patients with ADHD, which is characterized by inattention, hyperactivity and impulsivity. Moreover neuroimaging studies show cerebellar differences in subjects with dyslexia. Dyslexic subjects have also shown a poorer performance on a variety of cerebellar motor tasks, which leads to the proposal that cerebellar dysfunction is a core neurobiological underpinning of dyslexia. It was found that early cerebellar damage leads to poorer outcomes than cerebellar damage in adulthood, which suggests that the cerebellum is important during development. [2]</p> <p>Since the cerebellum plays a role in cognition and emotion, cerebellar dysfunction also contributes to non-motor conditions such as certain neurodevelopmental disorders e.g. autism spectrum disorders. [<a href='#ref-14'>14</a>] Cerebellar abnormalities have been found in patients with ADHD, which is characterized by inattention, hyperactivity and impulsivity. Moreover neuroimaging studies show cerebellar differences in subjects with dyslexia. Dyslexic subjects have also shown a poorer performance on a variety of cerebellar motor tasks, which leads to the proposal that cerebellar dysfunction is a core neurobiological underpinning of dyslexia. It was found that early cerebellar damage leads to poorer outcomes than cerebellar damage in adulthood, which suggests that the cerebellum is important during development. [<a href='#ref-16'>16</a>]</p>
<p>Cerebellar damage caused by alcoholism specifically is one of the most common acquired forms of cerebellar ataxia. [5] The developing cerebellum is very sensitive to the toxic effects of alcohol. Children with fetal alcohol spectrum disorder, a group of conditions occurring when the mother consumed alcohol during pregnancy show many symptoms of cerebellar dysfunction. [6]</p> <p>Cerebellar damage caused by alcoholism specifically is one of the most common acquired forms of cerebellar ataxia. [<a href='#ref-17'>17</a>] The developing cerebellum is very sensitive to the toxic effects of alcohol. Children with fetal alcohol spectrum disorder, a group of conditions occurring when the mother consumed alcohol during pregnancy show many symptoms of cerebellar dysfunction. [<a href='#ref-18'>18</a>]</p>
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<h2 id='treatment-and-rehab'>Treatment and Rehabilitation</h2> <h2 id='treatment-and-rehab'>Treatment and Rehabilitation</h2>
<p>Loss of balance, dizziness, ...</p> <p>The best treatments for mitigating the effects of alcohol abuse on your body are abstinence, medication, motor and cognitive training and therapeutic counselling. Abstinence from alcohol is the quickest path to recovery as it frees the body of all toxic residues. Abstinence from alcohol may cause intense withdrawal symptoms that can last a few days. Alcoholics normally experience significant signs of improvement on their cognitive tests once the withdrawal period is over. For instance, verbal processing is one of the first areas of cognitive functioning to be fully resumed compared to others (within the first three weeks). The rate of recovery may vary according to various different factors such as the age of the patient or the type of cognitive function required for fulfilling a task. The recovery time for restoring all cognitive functions to normal may vary between weeks, months or even years. In some cases, patients with alcohol addiction may never fully recover their cognitive functions such as multitasking, attention span, decision making, self-restraint, emotion recognition etc. [<a href='#ref-9'>9</a>]</p>
<p>Recovery may not occur at a regular steady rate, so it is necessary to measure their overall cognitive and motor performance on a regular basis (two times per week for instance). The age of alcohol addicts is a crucial factor for measuring the rate of their recovery processes. In the case of younger alcoholics (40 or under), they will show significant recovery of all cognitive skills except for slight cognitive delays in extremely challenging tasks. Despite showing steady and progressive improvements on their cognitive tests, older alcoholics will nevertheless manifest considerable deficits over a longer time span in problem-solving and visuospatial activities Most research studies suggest that there is no correlation between the alcoholic’s drinking history and the rate of its recovery. Moreover, chronic alcoholics with more than 10 years of heavy drinking are not likely to experience slower recovery processes or more permanent damage to their cognitive systems than those who have no or little drinking history. In this respect, it is important to note how relapse to alcohol addiction after an indefinite period of sobriety is not necessarily contingent on the alcoholic’s drinking history [<a href='#ref-9'>9</a>]</p>
<p>Recovery may not occur at a regular steady rate, so it is necessary to measure their overall cognitive and motor performance on a regular basis (two times per week for instance). The age of alcohol addicts is a crucial factor for measuring the rate of their recovery processes. In the case of younger alcoholics (40 or under), they will show significant recovery of all cognitive skills except for slight cognitive delays in extremely challenging tasks. Despite showing steady and progressive improvements on their cognitive tests, older alcoholics will nevertheless manifest considerable deficits over a longer time span in problem-solving and visuospatial activities Most research studies suggest that there is no correlation between the alcoholic’s drinking history and the rate of its recovery. Moreover, chronic alcoholics with more than 10 years of heavy drinking are not likely to experience slower recovery processes or more permanent damage to their cognitive systems than those who have no or little drinking history. In this respect, it is important to note how relapse to alcohol addiction after an indefinite period of sobriety is not necessarily contingent on the alcoholic’s drinking history [<a href='#ref-9'>9</a>]</p>
<p>There is no actual medicine that can cure alcohol-related disorders completely but they can contribute to making alcohol undesirable. For instance, Acamprosate, Disulfiram and Naltrxone are all types of drugs that help reduce the yearning for alcohol as well as prevent the effects of a fall back. To be clear, the taste or smell of alcohol will make the patient feel nauseous and revolting. [<a href='#ref-10'>10</a>, <a href='#ref-11'>11</a>]</p>
<p>Research conducted from Klintsova and other colleagues measured the ability of rats with alcohol exposure to perform certain motor exercises like rope climbing as part of their motor training program within a period of 6 months. “These results suggest that complex motor skill learning improves some of the motor performance deficits produced by postnatal exposure to alcohol and can potentially serve as a model for rehabilitative intervention” [<a href='#ref-12'>12</a>]. Hence, the effects of motor training on rats could be useful for improving motor skills in patients with cerebellar dysfunction. For example, athletes and musicians with alcohol related cerebellar damage can aim at fully recovering their coordinated movements if they undertake such motor training processes. [<a href='#ref-9'>9</a>]</p>
<p>Research conducted from Klintsova and other colleagues measured the ability of rats with alcohol exposure to perform certain motor exercises like rope climbing as part of their motor training program within a period of 6 months. “These results suggest that complex motor skill learning improves some of the motor performance deficits produced by postnatal exposure to alcohol and can potentially serve as a model for rehabilitative intervention” [<a href='#ref-9'>9</a>]. Hence, the effects of motor training on rats could be useful for improving motor skills in patients with cerebellar dysfunction. For example, athletes and musicians with alcohol related cerebellar damage can aim at fully recovering their coordinated movements if they undertake such motor training processes.</p>
<p>Therapeutic counselling is crucial for regaining the cognitive and motor skills as they were prior to addiction. A counsellor also gives you valuable advice for staying sober in the long run. Alcohol addiction may have a strong impact on your family relations that the patient will need to seek for therapy in a rehab institution. This is why it is important to build a network of close friends that can boost your self-esteem. In this respect, a friendly environment helps the patient face the effects of a possible relapse with greater confidence. There are two types of counselling: in-patient and out-patient. The former is the best form of treatment for the patients that are not able to reduce the levels of alcohol by themselves. They are constantly monitored and guided throughout their rehabilitation. Out-patient rehab is rather meant for those people that have control over their mental health as they show milder symptoms [<a href='#ref-11'>11</a>].</p>
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