AAN 2026 | Insights into the cerebellum’s compensatory role in Parkinson’s disease
Chi-Ying (Roy) Lin, MD, MPH, Baylor College of Medicine, Houston, TX, discusses the importance of studying the cerebellum in neurodegeneration, particularly in Parkinson’s disease, due to its significant role in modulating supratentorial structure function via the cerebello-cerebral connection. Dr Lin highlights that the cerebellum can potentially provide a compensatory effect in Parkinson’s, as evidenced by its hyperactivation during motor tasks. This interview took place at the 78th American Academy of Neurology (AAN) Annual Meeting in Chicago, IL.
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Transcript
So that’s probably one of the most common questions I got asked, like why the cerebellum? So believe it or not, even though it just accounts for 15% of the brain weight, the cerebellum actually takes up to around 70% of the neurons in the brain. And perhaps most importantly, the small brain and big brain talk to each other via the cerebello-cerebral connection. And there has been an emerging finding that in the past five to 10 years that the cerebellum can modulate the supratentorial structure function via the cerebello-cerebral connection...
So that’s probably one of the most common questions I got asked, like why the cerebellum? So believe it or not, even though it just accounts for 15% of the brain weight, the cerebellum actually takes up to around 70% of the neurons in the brain. And perhaps most importantly, the small brain and big brain talk to each other via the cerebello-cerebral connection. And there has been an emerging finding that in the past five to 10 years that the cerebellum can modulate the supratentorial structure function via the cerebello-cerebral connection. So that’s why studying the cerebellum, the role of the cerebellum in neurodegeneration has become increasingly important. And in terms of the current understanding of how the role of the, like the relationship between the cerebellum and Parkinson, probably around 10-ish years ago, the NIH group proposed that the cerebellum can potentially compensate, provide a compensatory effect in Parkinson’s. For example, during the sequential motor movement task, the cerebellum shows hyperactivation instead of hypo, as opposed to controls, in PD people off medication. So, because theoretically, neurodegeneration should all be on the hypometabolism side, right? But for the cerebellum, during the motor test, it’s a hyperactivation. So that’s how the role of the cerebellum, the compensatory role of the cerebellum has been increasingly identified. And overall, more and more research shows that the involvement of the cerebellum in Parkinson’s has been at the systemic level. Take cerebellar anatomy, for example, the involvement of the cerebellum is in both motor, the anterior lobe, and the non-motor, the posterior lobe. So, with all of this, based on the network degeneration hypothesis, the more preserved brain region, which is the cerebellum in neurodegeneration, especially in Parkinson’s, can potentially provide a compensatory effect to the diseased or disordered brain region, which is the supratentorial region. Overall, the cerebellum is less affected early in the stage of Parkinson’s, so it contains the ability to provide compensation via the cerebello-cerebral connection to the already diseased or disordered brain regions.
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