Relationship between etiology and covert cognition in the minimally conscious state
Relationship between etiology and covert cognition in the minimally conscious state
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DOI：
10.1212/wnl.0b013e318249f764
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发表时间：
2012-03-01
期刊：
影响因子：
9.9
通讯作者：
Owen, A. M.
中科院分区：
文献类型：
--
作者：
Cruse, D.;Chennu, S.;Owen, A. M.
目的：功能神经成像显示，重型颅脑损伤患者缺乏外部可观察到的意识和认知迹象并不一定意味着这种能力的真正缺乏。然而，与创伤性脑损伤相比，众所周知，非创伤性损伤与恢复明显可测量的意识水平的可能性降低有关。探讨最低意识状态(MCS)患者的病因与外显和内隐认知能力的关系。方法：23例MCS患者(15例创伤性和8例非创伤性)完成了一项运动想象脑电任务，要求他们想象右手和脚趾的运动来指挥。当成功执行时，这些想象的动作看起来像是不同的感觉-运动调制，可以用来确定是否存在可靠的命令跟随。结果：22%的MCS患者(5/23)的脑电对命令有一致和强烈的反应。病因学对成功完成这项任务的能力有显著影响，33%的创伤患者(5/15)脑电结果为阳性，而非创伤患者(0/8)没有。结论：非创伤MCS患者的显性行为意识体征(用昏迷恢复量表-修订版)似乎准确地反映了他们的隐性认知能力。相比之下，MCS中的一组创伤患者中有三分之一拥有一系列高水平的认知能力，这些能力从他们的公开行为中并不明显。神经病学(R)2012；78：816-822
Objectives: Functional neuroimaging has shown that the absence of externally observable signs of consciousness and cognition in severely brain-injured patients does not necessarily indicate the true absence of such abilities. However, relative to traumatic brain injury, nontraumatic injury is known to be associated with a reduced likelihood of regaining overtly measurable levels of consciousness. We investigated the relationships between etiology and both overt and covert cognitive abilities in a group of patients in the minimally conscious state (MCS).Methods: Twenty-three MCS patients (15 traumatic and 8 nontraumatic) completed a motor imagery EEG task in which they were required to imagine movements of their right-hand and toes to command. When successfully performed, these imagined movements appear as distinct sensorimotor modulations, which can be used to determine the presence of reliable command-following. The utility of this task has been demonstrated previously in a group of vegetative state patients.Results: Consistent and robust responses to command were observed in the EEG of 22% of the MCS patients (5 of 23). Etiology had a significant impact on the ability to successfully complete this task, with 33% of traumatic patients (5 of 15) returning positive EEG outcomes compared with none of the nontraumatic patients (0 of 8).Conclusions: The overt behavioral signs of awareness (measured with the Coma Recovery Scale-Revised) exhibited by nontraumatic MCS patients appear to be an accurate reflection of their covert cognitive abilities. In contrast, one-third of a group of traumatically injured patients in the MCS possess a range of high-level cognitive faculties that are not evident from their overt behavior. Neurology (R) 2012;78:816-822