The role of the cerebellum in multiple sclerosis: structural damage and disconnecting networks

Multiple sclerosis (MS) is a neuroinflammatory and neurodegenerative disease of the central nervous system. Patterns of tissue damage in MS are not random, and some regions are more commonly and more severely affected than others. Gray matter changes in MS are highly clinically relevant and include neurodegeneration in the form of atrophy but also altered functional communication between brain areas. One important structure heavily affected by MS yet still understudied is the cerebellum. This structure has a complex cytoarchitecture and remains difficult to scan in vivo due to its heavily folded cortex and placement in the posterior fossa. Recent insights have shown that the cerebellum is not only involved in motor functioning but also has a clear role in cognitive performance, driven by its network connections to cognitive networks. This review outlines recent insights into cerebellar damage and cerebellar network changes in MS and focuses on their relevance for cognition.