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Beyond the cerebral cortex: cerebellar language-related subregions contributions to fluency in post-stroke aphasia.

Overview

Authors: Yuqian Zhan1, Xiaohui Xie2, Qiufang Ren1, Xiaomin Pan1, Zhishun Gao1, Jin Li1, Kai Wang1,3,4,5, Tongjian Bai1, Panpan Hu1
  1. Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei 230032, China
  2. Department of Neurology, The Second Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei 230601, China
  3. Anhui Institute of Translational Medicine, Hefei 230032, China
  4. Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei 230032, China
  5. Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei 230032, China
Institutions: Anhui Medical University (China); First Affiliated Hospital of Anhui Medical University (China); Second Affiliated Hospital of Anhui Medical University (China)
Journal: NeuroImage. Clinical, volume 50, article 103999
Dates: received 11 October 2025; accepted 27 April 2026; published online 29 April 2026; in print 2026
Type: Research article · Language: English
License: CC BY
Identifiers: DOI 10.1016/j.nicl.2026.103999 · PMID 42085725 · PMCID PMC13158568 · OpenAlex W7160130681
Open access: gold, a free copy (OpenAlex)
Status: data only
Categories: human (organism), stroke (population)
Methods: Spectral & time-frequency, Statistics, Preprocessing, Connectivity, fMRI & imaging
Keywords: Cerebellum, Fluency, Post-stroke aphasia, Functional connectivity
MeSH: Aphasia*, Cerebellum*, Cerebral Cortex*, Language*, Stroke*, Aged, Brain Mapping, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged (* major topic)
Topic: Neurobiology of Language and Bilingualism (Cognitive Neuroscience, Neuroscience), according to OpenAlex
Funding: National Natural Science Foundation of China (National Science Foundation of China) (82171917, 82471271, U23A20424)
Citations: not cited yet (Europe PMC); 62 references in the paper

Abstract

Although the classical language cortex significantly contributes to post-stroke aphasia (PSA), non-language-specific cortex, such as the cerebellum, is increasingly implicated in language. However, the specific contributions of its subregions to PSA, particularly regarding distinct language dimensions, remain unclear. Given fluency as a core dimension, we investigated the functional and structural integrity of cerebellar language-related subregions to clarify their distinct roles in fluent (FA) versus non-fluent aphasia (nonFA). We enrolled a primary cohort of 81 PSA patients (46 nonFA, 35 FA), and 77 healthy controls (HCs), alongside an independent external validation cohort (Aphasia Recovery Cohort [ARC]; 23 nonFA, 22 FA). Using individualized functional connectivity (FC) and volumetric analyses based on the Multi-Domain Task Battery (MDTB) atlas, we found that nonFA patients exhibited significantly decreased FC between the classical language network (LN) and language-related cerebellar subregions (right MDTB 8 and 9; R_MDTB8/9-LN FC), alongside reduced right Crus II volume. Correlation analysis revealed that these neuroimaging indicators were positively associated with language scores in nonFA, while no such relationships were observed in FA. Furthermore, mediation analysis indicated that right Crus II volume statistically accounted for the observed association between R_MDTB8/9-LN FC and overall Aphasia Quotient (AQ). As the key findings were replicated in the ARC, our results provide compelling evidence that the functional connectivity strength and structural integrity of specific cerebellar subregions contribute to language fluency. Our findings support expanding models of PSA beyond cortical regions and suggest that cerebellar-targeted strategies may improve language rehabilitation outcomes.

Reproduced under the paper's license (CC BY), from the paper cited above.

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Data

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Reproduced under the paper's license (CC BY), from the paper cited above.

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Version 1, 30 September 2026: the first record

Recorded: type, language, journal, volume, pages, dates, 9 authors, 4 keywords, 12 MeSH terms, 1 funder, 59 references.

Cite

This paper

Zhan, Y., Xie, X., Ren, Q., Pan, X., Gao, Z., Li, J., Wang, K., Bai, T., & Hu, P. (2026). Beyond the cerebral cortex: cerebellar language-related subregions contributions to fluency in post-stroke aphasia. NeuroImage. Clinical, 50, 103999. https://doi.org/10.1016/j.nicl.2026.103999

BibTeX

@article{zhan2026beyond,
author = {Zhan, Yuqian and Xie, Xiaohui and Ren, Qiufang and Pan, Xiaomin and Gao, Zhishun and Li, Jin and Wang, Kai and Bai, Tongjian and Hu, Panpan},
title = {{Beyond the cerebral cortex: cerebellar language-related subregions contributions to fluency in post-stroke aphasia}},
journal = {NeuroImage. Clinical},
year = {2026},
month = apr,
volume = {50},
pages = {103999},
publisher = {Elsevier},
issn = {2213-1582},
doi = {10.1016/j.nicl.2026.103999},
url = {https://doi.org/10.1016/j.nicl.2026.103999},
pmid = {42085725},
pmcid = {PMC13158568}
}

RIS

TY - JOUR
AU - Zhan, Yuqian
AU - Xie, Xiaohui
AU - Ren, Qiufang
AU - Pan, Xiaomin
AU - Gao, Zhishun
AU - Li, Jin
AU - Wang, Kai
AU - Bai, Tongjian
AU - Hu, Panpan
TI - Beyond the cerebral cortex: cerebellar language-related subregions contributions to fluency in post-stroke aphasia
T2 - NeuroImage. Clinical
J2 - Neuroimage Clin
PY - 2026
DA - 2026/04/29
VL - 50
SP - 103999
SN - 2213-1582
PB - Elsevier
DO - 10.1016/j.nicl.2026.103999
UR - https://doi.org/10.1016/j.nicl.2026.103999
LA - en
ER -

CSL-JSON

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