Wikipedia

Caudate nucleus

Thecaudate nucleusis one of the structures that make up thecorpus striatum,which is part of thebasal gangliain thehuman brain.[1]Although the caudate nucleus has long been associated with motor processes because of its role inParkinson's disease,[2][clarification needed][3]it also plays important roles in nonmotor functions, such asprocedural learning,[4]associative learning,[5]andinhibitory controlof action.[6]The caudate is also one of the brain structures that compose thereward system,and it functions as part of thecortico-basal ganglia-thalamo-cortical loop.[1]

Caudate nucleus
Caudate nucleus (in red) shown within the brain
Transverse cut of brain (horizontal section),basal gangliais blue
Details
Part ofDorsal striatum
Identifiers
Latinnucleus caudatus
MeSHD002421
NeuroNames226
NeuroLexIDbirnlex_1373
TA98A14.1.09.502
TA25561
FMA61833
Anatomical terms of neuroanatomy

Structure

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Caudate nucleus within the skull

Along with theputamen,the caudate forms thedorsal striatum,which is considered a single functional structure; anatomically, it is separated by a large white-matter tract, theinternal capsule,so it is sometimes also described as two structures—the medial dorsal striatum (the caudate) and the lateral dorsal striatum (the putamen). In this vein, the two are functionally distinct not because of structural differences, but merely because of the topographical distribution of function.

The caudate nuclei are near the center of the brain, sitting astride thethalamus.There is a caudate nucleus in eachhemisphereof the brain. Each nucleus is C-shaped, with a wider "head" (caputin Latin) at the front, tapering to a "body" (corpus) and a "tail" (cauda). Sometimes a part of the caudate nucleus is called the "knee" (genu).[7]The caudate head receives its blood supply from the lenticulostriate artery; the tail of the caudate receives its blood supply from the anterior choroidal artery.[8]

Transverse view of the caudate nucleus from a structuralMR image

The head and body of the caudate nucleus form part of the floor of the anterior horn of thelateral ventricle.The body travels briefly towards the back of the head; the tail then curves back toward the anterior, forming the roof of the inferior horn of the lateral ventricle. This means that a coronal section (on a plane parallel to theface) that cuts through the tail will also cross the body and head of the caudate nucleus.

Neurochemistry

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The caudate is highly innervated bydopaminergic neuronsthat originate from thesubstantia nigra pars compacta(SNc). The SNc is in themidbrainand contains cell projections to the caudate andputamen,using the neurotransmitterdopamine.[9]There are also inputs from variousassociation cortices.

Motor functions

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Spatial mnemonic processing

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The caudate nucleus integrates spatial information with motor behavior formulation. Selective impairment ofspatial working memoryin subjects withParkinson's diseaseand the knowledge of the disease's impact on the amount ofdopaminesupplied to thestriatumhave linked the caudate nucleus to spatial and nonspatial mnemonic processing. Spatially dependent motor preparation has been linked to the caudate nucleus through event-relatedfMRIanalysis techniques. Activity in the caudate nucleus was demonstrated to be greater during tasks featuring spatial and motoric memory demands than those that involved nonspatial tasks.[10] Specifically, spatial working memory activity has been observed, via fMRI studies of delayed recognition, to be greater in the caudate nucleus when the activity immediately preceded a motor response. These results indicate that the caudate nucleus could be involved in coding a motor response. With this in mind, the caudate nucleus could be involved in the recruitment of the motor system to support working memory performance by the mediation of sensory-motor transformations.[11]

Directed movements

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The caudate nucleus contributes importantly to body and limbs posture and the speed and accuracy of directed movements. Deficits in posture and accuracy during paw-usage tasks were observed after the removal of caudate nuclei in cats. A delay in initiating performance and the need to shift body position constantly were both observed in cats after partial removal of the nuclei.[12]

In monkeys, after the application ofcocaineto the caudate nucleus and the resulting lesions produced, there was a "leaping or forward movement". Because of its association with damage to the caudate, this movement demonstrates the inhibitory nature of the caudate nucleus. The "motor release" caused by this procedure indicates that the caudate nucleus inhibits the tendency for an animal to move forward without resistance.[13]

Cognitive functions

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Goal-directed action

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A review of neuroimaging studies, anatomical studies of caudate connectivity, and behavioral studies reveals a role for the caudate in executive functioning. A study of Parkinson's patients (see below) may also contribute to a growing body of evidence.

A two-pronged approach of neuroimaging (includingPETandfMRI) and anatomical studies expose a strong relationship between the caudate and cortical areas associated with executive functioning: "non-invasive measures of anatomical and functional connectivity in humans demonstrate a clear link between the caudate and executive frontal areas."[14]

Meanwhile, behavioral studies provide another layer to the argument: recent studies suggest that the caudate is fundamental to goal-directed action, that is, "the selection of behavior based on the changing values of goals and a knowledge of which actions lead to what outcomes."[14]One such study presented rats with levers that triggered the release of a cinnamon flavored solution. After the rats learned to press the lever, the researchers changed the value of the outcome (the rats were taught to dislike the flavor either by being given too much of the flavor, or by making the rats ill after drinking the solution) and the effects were observed. Normal rats pressed the lever less frequently, while rats with lesions in the caudate did not suppress the behavior as effectively. In this way, the study demonstrates the link between the caudate and goal-directed behavior; rats with damaged caudate nuclei had difficulty assessing the changing value of the outcome.[14]In a 2003-human behavioral study, a similar process was repeated, but the decision this time was whether or not to trust another person when money was at stake.[15]While here the choice was far more complex––the subjects were not simply asked to press a lever, but had to weigh a host of different factors––at the crux of the study was still behavioral selection based on changing values of outcomes.

In short, neuroimagery and anatomical studies support the assertion that the caudate plays a role in executive functioning, while behavioral studies deepen our understanding of the ways in which the caudate guides some of our decision-making processes.

Memory

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The dorsal-prefrontal cortex subcortical loop involving the caudate nucleus has been linked to deficits in working memory, specifically inschizophrenicpatients. Functional imaging has shown activation of this subcortical loop during working memory tasks in primates and healthy human subjects. The caudate may be affiliated with deficits involving working memory from before illness onset as well. Caudate nucleus volume has been found to be inversely associated withperseverativeerrors on spatial working memory tasks.[16][17]

Theamygdalasends direct projections to the caudate nucleus. Both theamygdalaand the caudate nucleus have direct and indirect projections to thehippocampus.The influence of theamygdalaon memory processing in the caudate nucleus has been demonstrated with the finding that lesions involving the connections between these two structures "block the memory-enhancing effects ofoxotremorineinfused into the caudate nucleus ". In a study involving rats given water-maze training, the caudate nucleus was discovered to enhance memory of visually cued training afteramphetaminewas infused post-training into the caudate.[18]

Learning

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In a 2005 study, subjects were asked to learn to categorize visual stimuli by classifying images and receiving feedback on their responses. Activity associated with successful classification learning (correct categorization) was concentrated to the body and tail of the caudate, while activity associated with feedback processing (the result of incorrect categorization) was concentrated to the head of the caudate.[19]

Sleep

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Bilateral lesions in the head of the caudate nucleus in cats were correlated with a decrease in the duration of deepslow wave sleepduring the sleep-wakefulness cycle. With a decrease in total volume of deep slow wave sleep, the transition ofshort-term memorytolong-term memorymay also be affected negatively.[20]

However, the effects of caudate nuclei removal on the sleep–wakefulness pattern of cats have not been permanent. Normalization occurs by three months after caudate nucleiablation.This discovery may be due to the inter-related nature of the roles of the caudate nucleus and thefrontal cortexin controlling levels ofcentral nervous systemactivation. The cats with caudate removal, although permanently hyperactive, had a significant decrease inrapid eye movement sleep(REMS) time, which lasted about two months. However, afrontal cats had a permanent decrease in REMS time and only a temporary period of hyperactivity.[21]

Contrasting with associations between "deep", REM sleep and the caudate nucleus, a study involvingEEGandfMRImeasures during human sleep cycles has indicated that the caudate nucleus demonstrates reduced activity during non-REM sleep across all sleep stages.[22]Additionally, studies of human caudate nuclei volume incongenital central hypoventilation syndrome(CCHS) subjects established a correlation between CCHS and a significant reduction in left and right caudate volume. CCHS is a genetic disorder that affects thesleep cycledue to a reduced drive to breathe. Therefore, the caudate nucleus has been suggested to play a role in human sleep cycles.[23]

Emotion

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The caudate nucleus has been implicated in responses to visual beauty, and has been suggested as one of the "neural correlates of romantic love".[24][25]

Approach-attachment behavior and affect are also controlled by the caudate nucleus. Cats with bilateral removal of the caudate nuclei persistently approached and followed objects, attempting to contact the target, while exhibiting a friendly disposition by the elicitation of treading of the forelimbs and purring. The magnitude of the behavioral responses was correlated to the extent of the removal of the nuclei. Reports of human patients with selective damage to the caudate nucleus show unilateral caudate damage resulting in loss of drive,obsessive-compulsive disorder,stimulus-boundperseverativebehavior, and hyperactivity. Most of these deficits can be classified as relating to approach-attachment behaviors, from approaching a target to romantic love.[12]

Language

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Neuroimaging studies reveal that people who can communicate in multiple languages activate exactly the same brain regions regardless of the language. A 2006 publication studies this phenomenon and identifies the caudate as a center for language control. In perhaps the most illustrative case, a trilingual subject with a lesion to the caudate was observed. The patient maintained language comprehension in her three languages, but when asked to produce language, she involuntarily switched between the three languages. In short, "these and other findings with bilingual patients suggest that the left caudate is required to monitor and control lexical and language alternatives in production tasks."[26][27]

Local shape deformations of the medial surface of the caudate have been correlated with verbal learning capacity for females and the number of perseverance errors on spatial and verbal fluency working memory tasks for males. Specifically, a larger caudate nucleus volume has been linked with better verbal fluency performance.[16]

A neurological study ofglossolaliashowed a significant reduction in activity in the left caudate nucleus during glossolalia compared to singing in English.[28]

Threshold control

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The brain contains large collections of neurons reciprocally connected byexcitatory synapses,thus forming large network of elements withpositive feedback.It is difficult to see how such a system can operate without some mechanism to prevent explosive activation. There is some indirect evidence[29]that the caudate may perform this regulatory role by measuring the general activity ofcerebral cortexand controlling thethreshold potential.

Clinical significance

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See also:Neurobiological effects of physical exercise § Structural growth

Caudate stroke

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Strokes can occur in the caudate nucleus and studies of patients with these kinds of strokes followed the introduction and widespread availability ofcomputed tomography(CT) scanning in the 1970s and early 1980s.[30][31]Major studies of caudate strokes have included Stein et al. (1984),[32]Weisberg et al. (1984),[33]Mendez et al. (1989),[34]Caplan et al. (1990),[35]Caplan & Helgason (1995),[36]Bokura & Robinson (1997),[37]Kumral et al. (1999),[38]Gnanashanmugam (2011),[39]and Kumral et al. (2023).[40][30][31]A number ofliterature reviewson caudate nucleus strokes have been published,[30][31][36][41][39]as well as a 1994meta-analysisofbasal ganglialesions that included analysis of caudate lesions (Bhatia & Marsden, 1994).[42]Caudate strokes are rare, representing only 1% of all strokes in one population of about 3,000 stroke patients.[43][38]Caudate hemorrhages account for about 7% of allintracerebral hemorrhages.[30]Research on caudate strokes has consisted of small clinical series of patients andcase reports.[31][30]A 2002 review described 108 patients with 119 caudate infarcts that had been characterized, with three of the largest series having a total of 64 patients.[31]In the 1994 meta-analysis, there were 43 patients with lesions confined to the caudate nucleus and 129 patients with lesions involving both the caudate and other structures, with 172 patients in total.[42]

Caudate nucleus strokes can be diagnosed with CT ormagnetic resonance imaging(MRI) scanning.[31][36]They are a type ofsubcorticalstroke and are classified asischemic(infarcts) orhemorrhagic.[30][41]In one series of patients, 80% of strokes were ischemic and 20% were hemorrhagic.[39][38]Caudate infarcts can belacunar infarcts,which are small and are due to a single perforating artery occlusion, or can be striatocapsular (caudate–putamen–internal capsule) infarcts, which are larger and are due to multiple perforating artery occlusion.[44][45]Caudate nucleus strokes infrequently affect only the caudate, but usually also involve neighboring areas like the anterior portion of theputamen,adjacentanterior limbof theinternal capsule,adjacentcorona radiatawhite matter,andglobus pallidus.[30][42]About 25 to 30% of lesions are confined exclusively to the caudate.[42][31][30][36]Caudate strokes are usually unilateral, but can also be bilateral, affecting both the left and right caudate nuclei.[31][30]In the 1994 meta-analysis, 90% of isolated caudate infarcts were unilateral and 10% were bilateral.[42]Small vessel diseaseor penetrating-branch disease is a major mechanism of caudate strokes.[30][41]Majorrisk factorsand causes of caudate infarcts includehypertension,hypercholesterolemia,diabetes mellitus,previousmyocardial infarct,cigarette smoking,large artery lesions, rupture ofinternal carotid arteryaneurysms,rupture ofarteriovenous malformations,cardiac embolism,andcarotid artery stenosis and occlusion.[30][41]Less common risk factors may includenon-valvular atrial fibrillation,myocardial dyskinesia,cardiac aneurysmwith amural thrombus,syphilis,Hodgkin's lymphoma,andMoyamoya disease.[30][41]Additionally, a case report of lacunar infarction of the caudate and adjacent structures due to high-dose oralmethylphenidateuse has been published.[46][47]

Caudate nucleus strokes have been associated with a variety of clinical symptoms.[12][31][30]In studies of patients with caudate infarcts, frequently occurring symptoms have includeddysarthriaordysphonia(61–86%),motor weakness(40–100%), and cognitive/behavioral abnormalities (39–78%), includingabulia(26–48%),agitation(29%),restlessness,hyperactivity,disinhibition(9–11%),executive dysfunctionor frontal system abnormalities (26%),memory impairment,minor speech or linguistic deficits (23–50% of left-sided lesions),attentiondifficulties, andmood changesordepression(14–33%).[30][36][42][39]Motor weakness is often absent, minor/slight, or transient, and reportedly does not occur with lesions confined exclusively to the caudate nucleus.[30][31]Abulia is defined as decreased spontaneous verbal and motor activity and slowness, with symptoms includingapathy,disinterest,flattened affect,lethargy,and lack of initiative for usual daily activities.[36]Cognitive and memory impairment includes poorfree recallofepisodicandsemanticitems, verbal amnesia (33% of left-sided lesions), and visual amnesia (right-sided lesions), among other deficits.[30][41][40]Less commonly, there aremotor disorders(20–23%), likechorea(6–7%),ballism,tremor,parkinsonism(2–3%), anddystonia(9–16%), as well as more severe cognitive and behavioral problems, likepsychic akinesia(loss of psychic self-activation) (12%),neglect(10% with right-sided lesions),aphasia(2–5%), andglobal dementia(9%, or 1 of 11 and with bilateral lesions).[30][36][41][39]Among strokes in general, and/or amongbasal gangliastrokes specifically, certain sequelae, including apathy, abulia,fatigue,and depression, have been particularly associated with caudate strokes relative to strokes occurring in other regions.[42][39][48][49][50]Strokes in the caudate nucleus have also been strongly associated with post-strokerestless legs syndrome(RLS).[51][52][53]Other behavioral conditions, likeobsessive–compulsive disorder,perseverations,andmania,have been reported rarely in individuals with caudate strokes as well.[12][31][30][54][55]In one case report of bilateral caudate head damage, severeprospective memoryimpairment was measured, along with other deficits.[12][56]

The sizes, locations, and involvements of neighboring structures define the symptoms of caudate lesions.[41]Damage to the caudate nucleus usually presents with cognitive and behavioral symptoms rather than with neurological signs.[12][30]Cognitive and behavioral symptoms are more common than motor problems (e.g., respective rates of 39% vs. 20% in the 1994 meta-analysis).[42][12][30][39]Due to the predominance of cognitive and behavioral symptoms over neurological symptoms, and frequent absence of classical stroke signs, people with caudate strokes can be misdiagnosed as having primarilypsychogenic illness.[34]This can result in enduring cognitive and behavioral deficits, which can result in significant functional limitations, being overlooked.[34]The symptoms of caudate strokes are usually more severe and persistent when they are bilateral rather than unilateral.[31][30]In addition, they are more severe when other adjacent structures are also involved.[31][30]Mendez et al. (1989) categorized caudate stroke patients into three groups based on stroke location and patterns of clinical symptoms: (1) apathetic or abulic, with difficulties perseverating in tasks (dorsolateral caudate); (2) restless, agitated, hyperactive, disinhibited, inappropriate, impulsive, distractible, and/or inattentive (ventromedial caudate); and (3) affective disturbances (anxiety,depression,bipolar disorder) withpsychoticfeatures (hallucinations,delusions) (dorsolateral caudate, with larger lesions and more often extending into adjacent areas).[31][30][34]Sometimes, abulia can alternate with periods of disinhibition and agitation in people with caudate strokes.[42][30][31]The symptoms of caudate infarcts are assumed to be due to interruption ofneural circuitssuch as cortico–striatal–thalamic–cortical loops.[31][30][36]

Caudate nucleus hemorrhages can mimic the symptoms ofsubarachnoid hemorrhageand can includeheadache,nausea,vomiting,neck stiffness,decreased level of consciousness,hemiparesis,aphasia,neuropsychological disturbances,disorientation,aphasia,mental confusion,and gaze abnormalities, among others.[30][41][42]Caudate hemorrhages are due to rupture of penetrating arteries.[30]Aside from additional acute subarachnoid hemorrhage-like symptoms, symptoms of caudate hemorrhages are similar to those of caudate infarcts, including features like behavioral abnormalities, dysarthria, movement disorders, language disorders, and memory problems.[41]

The prognosis of caudate strokes has been considered good and benign, with majorities of individuals recovering and becoming independent.[41][30]However, patients with caudate strokes can have residual deficits and dependency needs, can worsen clinically with time, or can require institutionalization.[30]Bokura & Robinson (1997) found that some individuals with caudate strokes deteriorated on themini-mental state examination(MMSE), a short clinical test of basic cognitive function and impairment, during follow-up over 1 to 2years, whereas patients with other subcortical lesions tended to improve over 2years.[31][37]People with caudate strokes only rarely die, and generally because of underlying heart disease or other problems rather than the stroke itself.[30]However, although having favorable prognosis in the short-term, and having previously thought to be relatively benign, lacunar strokes in general are associated with greatly increased risk of stroke recurrence, cognitive impairment and dementia, and early death in the mid- to long-term.[57][58][59][60][61]Treatment of caudate strokes may consist ofantiplateletoranticoagulantagents and management of strokerisk factorslike hypertension and diabetes mellitus to reduce the risk of additional strokes.[30]On the basis of case reports and small case series,disorders of diminished motivation,like apathy, abulia, andakinetic mutism,secondary to stroke and other causes, may be treated withdopaminergicagents and otherpro-motivationalmedications, includingpsychostimulants,bupropion,atomoxetine,modafinil,dopamine agonists,levodopa,selegiline,andacetylcholinesterase inhibitors.[62][63][64]

Caudate resection

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The caudate nucleus is sometimessurgically resectedto treatgliomathat has infiltrated the structure.[65]Opinions in this area are mixed about resecting the caudate, with some authors reporting relatively few deficits upon caudate removal, and others recommending against removal due to poor cognitive and behavioral outcomes, for instanceabulia.[65][66][67]

Alzheimer's disease

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A 2013 study has suggested a link betweenAlzheimer'spatients and the caudate nucleus. MRI images were used to estimate the volume of caudate nuclei in patients with Alzheimer's and normal volunteers. The study found a "significant reduction in the caudate volume" in Alzheimer's patients when compared to the normal volunteers. While the correlation does not indicate causation, the finding may have implications for early diagnosis.[68]

Parkinson's disease

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Parkinson's diseaseis likely the most studied basal ganglia disorder. Patients with this progressive neurodegenerative disorder often first experience movement related symptoms (the three most common being tremors at rest, muscular rigidity, andakathisia) which are later combined with various cognitive deficiencies, including dementia.[69]Parkinson's disease depletes dopaminergic neurons in the nigrostriatal tract, a dopamine pathway that is connected to the head of the caudate. As such, many studies have correlated the loss of dopaminergic neurons that send axons to the caudate nucleus and the degree of dementia in Parkinson's patients.[14]And while a relationship has been drawn between the caudate and Parkinson's motor deficiencies, the caudate has also been associated with Parkinson's concomitant cognitive impairments. One review contrasts the performance of patients with Parkinson's and patients that strictly had frontal-lobe damage in theTower of London test.The differences in performance between the two types of patients (in a test that, in short, requires subjects to select appropriate intermediate goals with a larger goal in mind) draws a link between the caudate and goal-directed action. However, the studies are not conclusive. While the caudate has been associated with executive function (see "Goal-Directed Action" ), it remains "entirely unclear whether executive deficits in [Parkinson's patients] reflect pre-dominantly their cortical or subcortical damage."[14]

Huntington's disease

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InHuntington's disease,a genetic mutation occurs in theHTTgene which encodes for Htt protein. The Htt protein interacts with over 100 other proteins, and appears to have multiple biological functions.[70]The behavior of this mutated protein is not completely understood, but it is toxic to certain cell types, particularly in the brain. Early damage is most evident in thestriatum,but as the disease progresses, other areas of the brain are also more conspicuously affected. Early symptoms are attributable to functions of the striatum and its cortical connections—namely control over movement, mood and higher cognitive function.[71]

Attention-deficit hyperactivity disorder

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A 2002 study draws a relationship between caudate asymmetry and symptoms related toADHD.The authors used MR images to compare the relative volumes of the caudate nuclei (as the caudate is a bilateral structure), and drew a connection between any asymmetries and symptoms of ADHD: "The degree of caudate asymmetry significantly predicted cumulative severity ratings of inattentive behaviors." This correlation is congruent with previous associations of the caudate with attentional functioning.[72]A more recent 2018 study replicated these findings, and demonstrated that the caudate asymmetries related to ADHD were more pronounced in the dorsal medial regions of the caudate.[73]

Schizophrenia

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The volume of white matter in the caudate nucleus has been linked with patients diagnosed withschizophrenia.A 2004 study usesmagnetic resonance imagingto compare the relative volume of white matter in the caudate among schizophrenia patients. Those patients with the disorder have "smaller absolute and relative volumes of white matter in the caudate nucleus than healthy subjects."[74]

Bipolar type I

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A 2014 study found Type I Bipolar patients had relatively higher volume of gray and white matter in the caudate nucleus and other areas associated with reward processing and decision making, compared to controls and Bipolar II subjects. Overall the amount of gray and white matter in Bipolar patients was lower than controls.[75][76]

Obsessive-compulsive disorder

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It has been theorized that the caudate nucleus may be dysfunctional in persons withobsessive compulsive disorder(OCD), in that it may perhaps be unable to properly regulate the transmission of information regarding worrying events or ideas between thethalamusand theorbitofrontal cortex.

Aneuroimagingstudy withpositron emission tomographyfound that the right caudate nucleus had the largest change in glucose metabolism after patients had been treated withparoxetine.[77]RecentSDM meta-analysesofvoxel-based morphometrystudies comparing people with OCD and healthy controls have found people with OCD to have increasedgrey mattervolumes in bilaterallenticular nuclei,extending to the caudate nuclei, while decreased grey matter volumes in bilateral dorsalmedial frontal/anterior cingulategyri.[78][79]These findings contrast with those in people with other anxiety disorders, who evince decreased (rather than increased)grey mattervolumes in bilaterallenticular/ caudate nuclei, while also decreased grey matter volumes in bilateral dorsalmedial frontal/anterior cingulategyri.[79]

Additional images

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  • Two views of a model of thestriatum(on the right side of the brain): A,lateralaspect; B,medialaspect.
  • Coronal section through anterior cornua of lateral ventricles.
  • Coronal section of brain through anterior commissure.
  • Superficial dissection of brain-stem. Lateral view. The caudate nucleus can be seen above the optic nerve.
  • Dissection of brain-stem. Lateral view.
  • Deep dissection of brain-stem. Lateral view.
  • Deep dissection of brain-stem. Lateral view.
  • Superficial dissection of brain-stem. Ventral view.
  • Dissection of brain-stem. Dorsal view.
  • Central part and anterior and posterior cornua of lateral ventricles exposed from above.
  • Caudate nucleus
  • Caudate nucleus
  • Ventricles of brain and basal ganglia. Superior view, horizontal section, deep dissection
  • Ventricles of brain and basal ganglia. Close-up of preceding image
  • Caudate nuclei along with other subcortical structures, in glass brain
  • Caudate nucleus highlighted in green on coronal T1 MRI images
  • Caudate nucleus highlighted in green on sagittal T1 MRI images
  • Caudate nucleus highlighted in green on transversal T1 MRI images

References

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