Evaluation of putative signatures of consciousness using specific definitions of responsiveness, connectedness, and consciousness.
Evaluation of putative signatures of consciousness using specific definitions of responsiveness, connectedness, and consciousness.
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DOI：
10.1016/j.bja.2023.09.031
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发表时间：
2023-10
影响因子：
9.8
通讯作者：
Cameron P. Casey;Sean Tanabe;Zahra Farahbakhsh;Margaret Parker;Amber Bo;Marissa White;Tyler Ballweg;Andrew M. McIntosh;William Filbey;M. I. Banks;Y. Saalmann;Robert A. Pearce;Robert D. Sanders
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作者：
Cameron P. Casey;Sean Tanabe;Zahra Farahbakhsh;Margaret Parker;Amber Bo;Marissa White;Tyler Ballweg;Andrew M. McIntosh;William Filbey;M. I. Banks;Y. Saalmann;Robert A. Pearce;Robert D. Sanders
背景了解意识的神经联系对于从理论上理解意识和临床麻醉具有重要的意义。先前研究的一个主要局限性是使用响应性作为意识的指标。我们确定了一组来自无反应受试者的测量，更具体地说，他们与意识(任何主观经验)或连通性(环境刺激的特定经验)的关联。方法使用通过理解意识连通性和术中无反应研究(NCT03284307)产生的公开数据，我们评估了以前发表的10个基于静息状态脑电的测量，这些测量使用无反应作为无意识的替代。对右美托咪定和异丙酚的镇静和自然睡眠进行了测试。这些标记物代表了复杂性、连通性、跨频耦合、图论和功率谱测量。结果虽然许多已提出的标记物都与意识(已报告的主观经验)有关，但没有一个是仅针对意识的；相反，每个标记物都与连通性(即对环境的认识)有关。此外，多个标记与意识无关，只与连通性有关。在测试的标记物中，在所有三种实验条件下，标准化符号传递熵的丧失(从前到后)与连接性有关，而从断开的意识到无意识的转变与排列熵和频谱指数的显著降低有关(P<；0.05，在所有条件下)。结论提出的基于脑电的神经无反应相关性并不只与意识相对应，这突显了在评估无反应的参与者时需要更保守地使用(非)意识一词。临床试验注册NCT03284307。
BackgroundUnderstanding the neural correlates of consciousness has important ramifications for the theoretical understanding of consciousness and for clinical anaesthesia. A major limitation of prior studies is the use of responsiveness as an index of consciousness. We identified a collection of measures derived from unresponsive subjects and more specifically their association with consciousness (any subjective experience) or connectedness (specific experience of environmental stimuli).MethodsUsing published data generated through the UNderstanding Consciousness Connectedness and Intra-Operative Unresponsiveness Study (NCT03284307), we evaluated 10 previously published resting-state EEG-based measures that were derived using unresponsiveness as a proxy for unconsciousness. Measures were tested across dexmedetomidine and propofol sedation and natural sleep. These markers represent the complexity, connectivity, cross-frequency coupling, graph theory, and power spectrum measures.ResultsAlthough many of the proposed markers were associated with consciousnessper se(reported subjective experience), none were specific to consciousness alone; rather, each was also associated with connectedness (i.e. awareness of the environment). In addition, multiple markers showed no association with consciousness and were associated only with connectedness. Of the markers tested, loss of normalised-symbolic transfer entropy (front to back) was associated with connectedness across all three experimental conditions, whereas the transition from disconnected consciousness to unconsciousness was associated with significant decreases in permutation entropy and spectral exponent (P<0.05 for all conditions).ConclusionsNone of the proposed EEG-based neural correlates of unresponsiveness corresponded solely to consciousness, highlighting the need for a more conservative use of the term (un)consciousness when assessing unresponsive participants.Clinical trial registrationNCT03284307.