Preserved cerebellar functions despite structural degeneration in older adults

Reviewer #1 (Public review):

Summary:

Witte et al. examined whether canonical behavioral functions attributed to the cerebellum decline with age. To test this, they recruited younger, old, and older-old adults in a comprehensive battery of tasks previously identified as cerebellar-dependent in the literature. Remarkably, they found that cerebellar function is largely preserved across the lifespan-and in some cases even enhanced. Structural imaging confirmed that their older adult cohort was representative in terms of both cerebellar gray- and white-matter volume. Overall, this is an important study with strong theoretical implications and convincing evidence supporting the motor reserve hypothesis, demonstrating that cerebellar-dependent measures remain largely intact with aging.

Strengths:

(1) Relatively large sample size.

(2) Most comprehensive behavioral battery to date assessing cerebellar-dependent behavior.

(3) Structural MRI confirmation of age-related decline in cerebellar gray and white matter, ensuring representativeness of the sample.

Weaknesses:

(1) Although the authors note this was outside the study's scope, the absence of a voxel-based morphometry (VBM) analysis limits anatomical and functional specificity. Such an analysis would clarify which functions are cerebellar-dependent rather than solely inferring this from prior neuropsychological literature.

(2) As acknowledged in the Discussion, task classification (cerebellar-dependent vs. general measures) remains somewhat ambiguous. Some "general" measures may still rely on cerebellar processes based on the paper's own criteria - for example, tasks in which individuals with cerebellar degeneration show impairments.

(3) Cerebellar-dependent and general measures may inherently differ in measurement noise, potentially biasing results toward detecting effects in general measures but not in cerebellar-dependent ones.

Reviewer #2 (Public review):

Summary:

The authors are investigating cerebellar-mediated motor behaviors in a large sample of adults, including 30 individuals over the age of 80 (a great strength of this work). They employed a large battery of motor tasks that are tied to cerebellar function, in addition to a cognitive task and motor tasks that are more general. They also evaluated cerebellar structure. Across their behavioral metrics, they found that even with cerebellar degeneration, cerebellar-mediated motor behavior remained intact relative to young adults. However, this was not the case for measures not directly tied to cerebellar function. The authors suggest that these functions are preserved and speak to the resiliency and redundancy of function in the cerebellum. They also speculate that cerebellar circuits may be especially good for preserving function in the face of structural change. The tasks are described very well, and their implementation is also well-done with consideration for rigor in the data collection and processing. The inclusion of Bayesian estimates is also particularly useful, given the theoretically important lack of age differences reported. This work is methodologically rigorous with respect to the behavior, and certainly thought-provoking.

Strengths:

The methodological rigor, inclusion of Bayesian statistics, and the larger sample of individuals over the age of 80 in particular are all great strengths of this work. Further, as noted in the text, the fact that all participants completed the full testing battery is of great benefit.

Weaknesses:

The suggestion of cerebellar reserve, given that at the group level there is a lack of difference for cerebellar-specific behavioral components, could be more robustly tested. That is, the authors suggest that this is a reserve given that the volume of cerebellar gray matter is smaller in the two older groups, though behavior is preserved. This implies volume and behavior are seemingly dissociated. However, there is seemingly a great deal of behavioral variability within each group and likewise with respect to cerebellar volume. Is poorer behavior associated with smaller volume? If so, this would still suggest that volume and behavior are linked, but rather than being age that is critical, it is volume. On the flip side, a lack of associations between behavior and volume would be quite compelling with respect to reserve. More generally, as explicated in the recommendations, there are analyses that could be conducted that, in my opinion, would more robustly support their arguments given the data that they have available. This is a well-executed and thought-provoking investigation, but there is also room for a bit more discussion.