Cited by 740Advanced Neuroimaging Techniques and ApplicationsNeural and Behavioral Psychology StudiesMemory and Neural Mechanisms

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The cingulum bundle: Anatomy, function, and dysfunction

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Bubb, Emma J., Metzler-Baddeley, Claudia, Aggleton, John P.·2018·Neuroscience & Biobehavioral Reviews

Abstract

The cingulum bundle is a prominent white matter tract that interconnects frontal, parietal, and medial temporal sites, while also linking subcortical nuclei to the cingulate gyrus. Despite its apparent continuity, the cingulum's composition continually changes as fibres join and leave the bundle. To help understand its complex structure, this review begins with detailed, comparative descriptions of the multiple connections comprising the cingulum bundle. Next, the impact of cingulum bundle damage in rats, monkeys, and humans is analysed. Despite causing extensive anatomical disconnections, cingulum bundle lesions typically produce only mild deficits, highlighting the importance of parallel pathways and the distributed nature of its various functions. Meanwhile, non-invasive imaging implicates the cingulum bundle in executive control, emotion, pain (dorsal cingulum), and episodic memory (parahippocampal cingulum), while clinical studies reveal cingulum abnormalities in numerous conditions, including schizophrenia, depression, post-traumatic stress disorder, obsessive compulsive disorder, autism spectrum disorder, Mild Cognitive Impairment, and Alzheimer's disease. Understanding the seemingly diverse contributions of the cingulum will require better ways of isolating pathways within this highly complex tract.

Overview

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Written from the paper’s full text.

TL;DR

This review integrates anatomical tracing, lesion, cingulotomy, and diffusion MRI evidence to argue that the cingulum bundle is not a unitary tract: its connections and functions change along its length, with anterior/dorsal portions linked to executive-attentional processes and parahippocampal portions to memory. It finds cingulum abnormalities across many psychiatric and neurological conditions, yet lesion and cingulotomy effects are often surprisingly mild, likely because cingulum functions are distributed and supported by alternate routes.

Key findings

  • The cingulum contains short and long sagittal association fibres plus fibres radiating to cortical and subcortical sites; few, if any, connections extend its entire length. The authors recommend five subdivisions—subgenual, anterior cingulate, midcingulate, retrosplenial, and parahippocampal—based on Heilbronner and Haber (2014) plus the midcingulate area.
  • Dorsal/anterior cingulum microstructure correlates with executive function and attention, while parahippocampal cingulum is more linked to memory. In rats, cingulum bundle lesions most consistently affect allocentric spatial tasks but are far less disruptive than anterior thalamic lesions, and fornix lesions produce more severe spatial memory deficits; crossed unilateral cingulum/fornix lesions had little or no apparent effect on T-maze alternation or radial-arm maze working memory (unpublished data), whereas bilateral fornix lesions severely disrupted both.
  • dMRI studies commonly report reduced FA and increased diffusivity in the cingulum across schizophrenia, ADHD, depression, PTSD, OCD, and ASD, most consistently in OCD, ASD, and PTSD and concentrated in the dorsal cingulum. Cited meta-analytic/review figures include OCD: 22 datasets/537 cases; ASD: 33 studies, though a five-study meta-analysis found no significant cingulum FA difference; PTSD: seven studies with mixed FA increases/decreases.
  • A prospective series of 198 cingulotomy cases reported lasting improvement in approximately half treated for OCD, with slightly better outcomes for anxiety/affective disorders, and over 50% of chronic pain patients had appreciable relief; cognition was often preserved, though attention/executive deficits were reported. The cingulum is one of the last major tracts to mature, with mean age to peak FA reported as 42 years.

Methods

  • Narrative review; no primary data collection. It synthesizes cross-species axonal tracing (rat, macaque), lesion studies in rodents and nonhuman primates, human cingulotomy clinical literature, and human diffusion MRI/DTI studies.
  • Evidence is organized into tables: Table 1 compares cingulum bundle lesion effects with anterior cingulate, retrosplenial, anterior thalamic, and fornix lesions; Table 2 lists dMRI findings in psychiatric conditions; Table 3 maps functions to cingulum subdivisions. Cited samples include 202 community adults, 220 healthy older adults, 257 healthy individuals aged 13–84, and 25 MCI patients vs 20 controls.
  • Main analysis is qualitative synthesis and cross-species comparison, with a recommendation for five cingulum subdivisions and discussion of dMRI methodological limitations.

Limitations

  • Paper-stated: dMRI is correlative, not causal; it cannot determine afferent/efferent direction; fibre crossing and tracking limitations can cause streamlines to jump pathways; CSF partial-volume effects can bias FA/MD; cingulum subdivisions and terminology are inconsistent. Lesion studies often lack verification of disconnection extent; cingulotomy literature often lacks formal post-operative assessments, controls, and blinding; no selective cingulum bundle lesions have been investigated in nonhuman primates, and selective parahippocampal cingulum pathology is lacking.
  • Evident from text: as a narrative review, no systematic search or inclusion criteria are reported, and conclusions draw on heterogeneous studies and methods; some key crossed-lesion data are unpublished.

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Integrity signals

Registry

Crossref · 10.1016/j.neubiorev.2018.05.008

Cites

355 of 355 references verified0 citation errors · 0 not checkable

Statistics

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Figures

Fig. 1 Human brain (medial aspect) after partial dissection (the anterior half of the corpus callosum has been removed), showing major limbic tracts, including parts of the cingulum. Labels: a, cingulum; b, cingulum fibres entering parietal cortex; c, corpus callosum; d, head of caudate nucleus; e, body of the fornix; f, columns of the fornix; g, mammillary body; h, mammillothalamic tract; i, anterior nucleus of the thalamus; j, parahippocampal radiation of the cingulum; k, paraolfactory gyrus; l, paraterminal gyrus. (From Shah et al., 2012, with permission).
Fig. 1 Human brain (medial aspect) after partial dissection (the anterior half of the corpus callosum has been removed), showing major limbic tracts, including parts of the cingulum. Labels: a, cingulum; b, cingulum fibres entering parietal cortex; c, corpus callosum; d, head of caudate nucleus; e, body of the fornix; f, columns of the fornix; g, mammillary body; h, mammillothalamic tract; i, anterior nucleus of the thalamus; j, parahippocampal radiation of the cingulum; k, paraolfactory gyrus; l, paraterminal gyrus. (From Shah et al., 2012, with permission).CC BY · PubMed Central
Fig. 2 Schematic diagram of Papez circuit (Papez, 1937), showing the central position of the cingulum bundle.
Fig. 2 Schematic diagram of Papez circuit (Papez, 1937), showing the central position of the cingulum bundle.CC BY · PubMed Central
Fig. 3 Coronal section from rat brain with anterior thalamic injection of wheat germ agglutin (WGA) in left hemisphere. Labelled anterior thalamic fibres join the external medullary stratum (Domesick, 1970) of the medial cingulum bundle to reach the cingulate cortex. The lack of corresponding fibres in the right hemisphere is because the thalamo-cortical projections remain ipsilateral, although the reciprocal cortico-thalamic projections are bilateral (Mathiasen et al., 2017). For methods, see Amin et al., 2010. Scale bar = 200 μm.
Fig. 3 Coronal section from rat brain with anterior thalamic injection of wheat germ agglutin (WGA) in left hemisphere. Labelled anterior thalamic fibres join the external medullary stratum (Domesick, 1970) of the medial cingulum bundle to reach the cingulate cortex. The lack of corresponding fibres in the right hemisphere is because the thalamo-cortical projections remain ipsilateral, although the reciprocal cortico-thalamic projections are bilateral (Mathiasen et al., 2017). For methods, see Amin et al., 2010. Scale bar = 200 μm.CC BY · PubMed Central
Fig. 4 Schematic of rat brain showing connections that provide sagittal fibres to the cingulum bundle. (Note cingulate projections that cross the bundle, e.g., to the anterior thalamic nuclei, are not depicted). The colours help distinguish the multiple pathways. Abbreviations: ACC, anterior cingulate cortex; ATN, anterior thalamic nuclei; CC, corpus callosum; DB, diagonal band; HPC, hippocampus, including subiculum; LC, locus coeruleus; LD laterodorsal thalamic nucleus; OFC, orbital frontal cortex; PARAHPC, parahippocampal region; PL, prelimbic cortex; RPHN, raphe nucleus; RSC, retrosplenial cortex. Note, that dividing lines do not represent collaterals.
Fig. 4 Schematic of rat brain showing connections that provide sagittal fibres to the cingulum bundle. (Note cingulate projections that cross the bundle, e.g., to the anterior thalamic nuclei, are not depicted). The colours help distinguish the multiple pathways. Abbreviations: ACC, anterior cingulate cortex; ATN, anterior thalamic nuclei; CC, corpus callosum; DB, diagonal band; HPC, hippocampus, including subiculum; LC, locus coeruleus; LD laterodorsal thalamic nucleus; OFC, orbital frontal cortex; PARAHPC, parahippocampal region; PL, prelimbic cortex; RPHN, raphe nucleus; RSC, retrosplenial cortex. Note, that dividing lines do not represent collaterals.CC BY · PubMed Central
Fig. 5 Schematic of macaque monkey brain showing connections that provide sagittal fibres to the cingulum bundle. (Note cingulate projections that cross the bundle, e.g., to the anterior thalamic nuclei, are not depicted). The colours help distinguish the multiple pathways. While it is most likely that additional subcortical projections join the cingulum (see Fig. 4), explicit descriptions are often lacking. Abbreviations: ACC, anterior cingulate cortex; ATN, anterior thalamic nuclei; CC, corpus callosum; HPC, hippocampus, including subiculum; LC, locus coeruleus; LD laterodorsal thalamic nucleus; NBM, nucleus basalis of Meynert; PARAHPC, parahippocampal region; PL, prelimbic cortex; RSC, retrosplenial cortex. Note, that offshoots of lines do not represent actual collaterals.
Fig. 5 Schematic of macaque monkey brain showing connections that provide sagittal fibres to the cingulum bundle. (Note cingulate projections that cross the bundle, e.g., to the anterior thalamic nuclei, are not depicted). The colours help distinguish the multiple pathways. While it is most likely that additional subcortical projections join the cingulum (see Fig. 4), explicit descriptions are often lacking. Abbreviations: ACC, anterior cingulate cortex; ATN, anterior thalamic nuclei; CC, corpus callosum; HPC, hippocampus, including subiculum; LC, locus coeruleus; LD laterodorsal thalamic nucleus; NBM, nucleus basalis of Meynert; PARAHPC, parahippocampal region; PL, prelimbic cortex; RSC, retrosplenial cortex. Note, that offshoots of lines do not represent actual collaterals.CC BY · PubMed Central
Fig. 6 Cingulum bundle reconstructions based on diffusion MRI tractography. Images show the left cingulum for one healthy individual displayed on a T1-weighted image. A) The cingulum reconstructed as a single, continuous bundle (green), B) Dorsal (blue) and ventral (yellow) cingulum subdivisions (e.g., Budisavljevic et al., 2015). C) Subgenual (red), retrosplenial (orange), and parahippocampal (yellow) cingulum subdivisions (Jones et al., 2013). D) Proposed subdivisions along the longitudinal axis, with subgenual (red), anterior cingulate (blue), midcingulate (green), retrosplenial (orange), and parahippocampal (yellow) portions. Note that additional streamlines, e.g., in frontal and parietal areas, have been removed (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article).
Fig. 6 Cingulum bundle reconstructions based on diffusion MRI tractography. Images show the left cingulum for one healthy individual displayed on a T1-weighted image. A) The cingulum reconstructed as a single, continuous bundle (green), B) Dorsal (blue) and ventral (yellow) cingulum subdivisions (e.g., Budisavljevic et al., 2015). C) Subgenual (red), retrosplenial (orange), and parahippocampal (yellow) cingulum subdivisions (Jones et al., 2013). D) Proposed subdivisions along the longitudinal axis, with subgenual (red), anterior cingulate (blue), midcingulate (green), retrosplenial (orange), and parahippocampal (yellow) portions. Note that additional streamlines, e.g., in frontal and parietal areas, have been removed (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article).CC BY · PubMed Central
Fig. 7 Performance of rats with unilateral cingulum bundle and fornix lesions in opposite hemispheres (CB/FX contralateral) on T-maze alternation (chance performance 50%; unpublished findings). Later sessions contained a mixture of 10s (as in training) and 60s retention intervals between sample and choice runs. Comparison performance is shown for rats with bilateral fornix lesions (Fx/Fx), unilateral cingulum bundle and fornix lesions in the same hemisphere (CB/Fx ipsilateral), and surgical controls (Sham).
Fig. 7 Performance of rats with unilateral cingulum bundle and fornix lesions in opposite hemispheres (CB/FX contralateral) on T-maze alternation (chance performance 50%; unpublished findings). Later sessions contained a mixture of 10s (as in training) and 60s retention intervals between sample and choice runs. Comparison performance is shown for rats with bilateral fornix lesions (Fx/Fx), unilateral cingulum bundle and fornix lesions in the same hemisphere (CB/Fx ipsilateral), and surgical controls (Sham).CC BY · PubMed Central

Verification

Claims the paper makes

69 No full text of the sources · 46 Own interpretation · 40 Partly supported · 38 Supported · 38 Sources not found · 17 Supported so far · 17 Not checked yet · 17 No basis given · 6 Own method · 5 Couldn’t confirm · 3 Own result · 1 Not supported · accuracy not yet measured

Show all 207 claims

  • Probably not a substantial claim. 25
  • It may state two separate claims as one. 71
90 of 90
  • The paper relies on this without support.

    Attempts to integrate anatomical and functional knowledge about the cingulum tract remain rare.

    “Nevertheless, attempts to integrate anatomical and functional knowledge about this tract remain rare, yet this integration is needed to understand this highly complex pathway.”
  • The paper relies on this without support.

    The set of subcortical–cortical connections that appear to dominate the rat cingulum bundle are duplicated in the primate brain, including humans.

    “There seems every reason to believe that the set of subcortical – cortical connections, which appear to dominate the rat cingulum bundle, are duplicated in the primate brain, including humans.”
  • The authors state this as an assumption.

    In nonhuman primate studies, surgical lesions in adjacent cingulate areas consistently involved the cingulum bundle unless otherwise stated.

    “It can be assumed that, unless otherwise stated, these surgeries consistently involved the bundle.”
  • The authors state this as an assumption.

    The Papez circuit is vital for normal cognition.

    “which is assumed to be vital for normal cognition (Aggleton and Brown, 1999; Rolls, 2015).”
  • The paper relies on this without support.

    Reductions in FA and increases in diffusivity reflect a loss of white matter integrity.

    “The commonest reported changes are reduced FA and increased diffusivity, both of which are though to reflect a disruption of white matter integrity.”
  • The paper relies on this without support.

    Amnestic MCI is often considered a prodromal condition for AD.

    “Amnestic MCI is often considered a prodromal condition for AD.”
  • The paper relies on this without support.

    Both schizophrenia and autism spectrum disorders are seen as developmental in origin with overlapping features.

    “Both schizophrenia and ASDS are seen as developmental in origin with overlapping features.”
  • The paper relies on this without support.

    In none of the clinical conditions described is pathology restricted to the cingulum bundle.

    “It must also be remembered that in none of the clinical conditions described is pathology restricted to the cingulum bundle.”
8 of 8

Citations

Cites

Show all 353 references

Research works printed but not linked: 2

  1. Reil, 1809, Untersuchungen über den Bau des grossen Gehirns im Menschen, Arch. Physiol., 9, 136
  2. Schmahmann, 2006, Oxford; OUP

Cited by

Sorted by citations

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Metadata

Authors
Bubb, E. J., Metzler-Baddeley, C., & Aggleton, J. P.
Affiliations
Cardiff University (GB)
Corresponding author
Aggleton, John P.
Venue
Neuroscience & Biobehavioral Reviews
Publisher
Elsevier BV
Published
2018-09
Volume
92
Pages
104-127
ISSN
0149-7634 (ISSN-L)
OpenAlex
W2804164821
Cited by
740
References
353
Citations by year
2026: 69 · 2025: 117 · 2024: 106 · 2023: 92 · 2022: 113 · 2021: 99 · 2020: 92 · 2019: 47 · 2018: 4
FWCI
38.04
Type
journal article
Language
en
Open access
Locations
  • Neuroscience & Biobehavioral Reviews (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • ORCA Online Research @Cardiff (Cardiff University) (acceptedVersion)
  • Europe PMC (PubMed Central) (submittedVersion, cc-by)
  • PubMed Central (submittedVersion, cc-by)
Funders
  • Wellcome Trust (103722/Z14/Z)
  • BBSRC (L021005/1)
  • Alzheimer’s Society and BRACE research fellowship (208/506818)
Topics
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advanced Neuroimaging Techniques and Applications
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Memory and Neural Mechanisms
Keywords
cingulum, white matter tracts, cingulate cortex, executive function, emotions, pain, episodic memory, schizophrenia, depression, post-traumatic stress disorder, obsessive-compulsive disorder, autism spectrum disorder, mild cognitive impairment, Alzheimer's disease
MeSH terms
Animals, Brain Injuries, Gyrus Cinguli, Humans, Nerve Fibers, Myelinated, Neuropsychological Tests, White Matter

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