Prognosis for patients with cognitive motor dissociation identified by brain-computer interface
Prognosis for patients with cognitive motor dissociation identified by brain-computer interface
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通过脑机接口识别认知运动分离患者的预后
DOI：
10.1093/brain/awaa026
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发表时间：
2020-04-01
期刊：
影响因子：
14.5
通讯作者：
Li, Yuanqing
中科院分区：
文献类型：
--
作者：
Pan, Jiahui;Xie, Qiuyou;Li, Yuanqing
认知运动分离描述了一部分意识障碍患者，他们表现出意识的神经影像学证据，但没有可检测到的命令遵循行为。虽然对于家庭咨询、决策和康复计划的设计至关重要，但认知运动分离患者的预后仍有待研究。目前的研究包括78名意识障碍患者，他们没有表现出可检测的命令行为。这些患者包括45例无反应觉醒综合征患者和33例最低意识状态患者，使用昏迷恢复量表修订版进行诊断。每位患者都接受了基于EEG的脑机接口实验，其中他或她被指示执行项目选择任务（即从两个候选人中选择一张照片或一个数字）。达到统计学显著脑机接口准确性的患者被确定为认知运动分离。使用昏迷恢复量表修订版进行两次评估，一次在实验前，另一次在3个月后，以测量患者的行为改善。在78例意识障碍患者中，我们的研究结果显示，在无反应觉醒综合征患者组中，18例认知运动分离患者中有15例（83.33%）恢复了意识，而其他27例无反应觉醒综合征患者中只有5例（18.52%）恢复了意识。此外，在最低意识状态患者组中，16例认知运动分离患者中有14例（87.5%）的昏迷恢复量表修订评分有所改善，而其他17例无显著脑机接口准确性的最低意识状态患者中只有4例（23.53%）的昏迷恢复量表修订评分有所改善。我们的研究结果表明，认知运动分离的患者比其他患者有更好的结果。我们的研究结果扩展了认知运动分离患者预后的现有知识，并对意识障碍患者基于脑机接口的临床诊断和预后具有重要意义。
Cognitive motor dissociation describes a subset of patients with disorders of consciousness who show neuroimaging evidence of consciousness but no detectable command-following behaviours. Although essential for family counselling, decision-making, and the design of rehabilitation programmes, the prognosis for patients with cognitive motor dissociation remains under-investigated. The current study included 78 patients with disorders of consciousness who showed no detectable command-following behaviours. These patients included 45 patients with unresponsive wakefulness syndrome and 33 patients in a minimally conscious state, as diagnosed using the Coma Recovery Scale-Revised. Each patient underwent an EEG-based brain-computer interface experiment, in which he or she was instructed to perform an item-selection task (i.e. select a photograph or a number from two candidates). Patients who achieved statistically significant brain-computer interface accuracies were identified as cognitive motor dissociation. Two evaluations using the Coma Recovery Scale-Revised, one before the experiment and the other 3 months later, were carried out to measure the patients' behavioural improvements. Among the 78 patients with disorders of consciousness, our results showed that within the unresponsive wakefulness syndrome patient group, 15 of 18 patients with cognitive motor dissociation (83.33%) regained consciousness, while only five of the other 27 unresponsive wakefulness syndrome patients without significant brain-computer interface accuracies (18.52%) regained consciousness. Furthermore, within the minimally conscious state patient group, 14 of 16 patients with cognitive motor dissociation (87.5%) showed improvements in their Coma Recovery Scale-Revised scores, whereas only four of the other 17 minimally conscious state patients without significant brain-computer interface accuracies (23.53%) had improved Coma Recovery Scale-Revised scores. Our results suggest that patients with cognitive motor dissociation have a better outcome than other patients. Our findings extend current knowledge of the prognosis for patients with cognitive motor dissociation and have important implications for brain-computer interface-based clinical diagnosis and prognosis for patients with disorders of consciousness.