Dissociable endogenous and exogenous attention in disorders of consciousness.
Dissociable endogenous and exogenous attention in disorders of consciousness.
复制标题
DOI：
10.1016/j.nicl.2013.10.008
复制
发表时间：
2013
影响因子：
4.2
通讯作者：
Bekinschtein, Tristan A.
中科院分区：
文献类型：
--
作者：
Chennu, Srivas;Finoia, Paola;Kamau, Evelyn;Monti, Martin M.;Allanson, Judith;Pickard, John D.;Owen, Adrian M.;Bekinschtein, Tristan A.
最近的研究表明，尽管处于植物人和最低意识状态的患者似乎无法产生一致的行为，但有些人可能具有通过功能性神经成像检测到的隐蔽意识。这些发现激发了对认知机制的进一步研究，这些认知机制可能支持在这些严重神经功能障碍状态下意识的存在。这方面的一个关键问题涉及患者注意力的性质和能力，已知注意力与意识有关，但又与意识不同。先前的脑电图P300注意力标记物的分析已经证明了它的存在和潜在的临床价值。在这里，我们分析了从21例患者和8名健康志愿者收集的数据，在一个实验任务，旨在引起外源性或内源性的注意，索引的P3a和P3b组件，分别响应于一对字的刺激之间的干扰。值得注意的是，我们发现早期的自下而上的P3a和晚期的自上而下的P3b实际上可以在符合植物人状态行为标准的患者中分离。与健康志愿者并列，患者的反应表明存在相对高水平的注意力能力，尽管没有任何行为指示。此外，我们发现了独立的证据，隐蔽命令以下的病人，测量功能性神经成像在网球意象。其他三个最低意识的病人证明了非歧视性的自下而上的定向，但没有自上而下的参与选择性注意力控制。我们的研究结果提出了一个有说服力的情况下，解离注意力处理的行为反应迟钝的患者，增加了我们的理解可能的水平和应用程序的随之而来的有意识的意识。我们分离了意识障碍中的内源性和外源性注意力。21名植物人（VS）和最小意识（MCS）患者进行EEG任务测试，在3名最小意识患者和1名植物人患者中发现了外源性自下而上P3a，在1名进行fMRI网球想象的VS患者中发现了内源性自上而下P3b。
Recent research suggests that despite the seeming inability of patients in vegetative and minimally conscious states to generate consistent behaviour, some might possess covert awareness detectable with functional neuroimaging. These findings motivate further research into the cognitive mechanisms that might support the existence of consciousness in these states of profound neurological dysfunction. One of the key questions in this regard relates to the nature and capabilities of attention in patients, known to be related to but distinct from consciousness. Previous assays of the electroencephalographic P300 marker of attention have demonstrated its presence and potential clinical value. Here we analysed data from 21 patients and 8 healthy volunteers collected during an experimental task designed to engender exogenous or endogenous attention, indexed by the P3a and P3b components, respectively, in response to a pair of word stimuli presented amongst distractors. Remarkably, we found that the early, bottom-up P3a and the late, top-down P3b could in fact be dissociated in a patient who fitted the behavioural criteria for the vegetative state. In juxtaposition with healthy volunteers, the patient's responses suggested the presence of a relatively high level of attentional abilities despite the absence of any behavioural indications thereof. Furthermore, we found independent evidence of covert command following in the patient, as measured by functional neuroimaging during tennis imagery. Three other minimally conscious patients evidenced non-discriminatory bottom-up orienting, but no top-down engagement of selective attentional control. Our findings present a persuasive case for dissociable attentional processing in behaviourally unresponsive patients, adding to our understanding of the possible levels and applications of consequent conscious awareness. We dissociated endogenous and exogenous attention in disorders of consciousness. 21 vegetative (VS) and minimally conscious (MCS) patients tested with EEG task Exogenous bottom-up P3a found in 3 minimally conscious and 1 vegetative patient Endogenous top-down P3b found in one VS patient who performed fMRI tennis imagery Discriminative attention can be preserved in disorders of consciousness.
登录
查看更多内容
DOI：
10.1073/pnas.0809667106
发表时间：
2009-02-03
影响因子：
11.1
作者：
Bekinschtein, Tristan A.;Dehaene, Stanislas;Naccache, Lionel
通讯作者：
Naccache, Lionel
影响因子：
9.9
作者：
Cruse, D.;Chennu, S.;Owen, A. M.
通讯作者：
Owen, A. M.
影响因子：
3
作者：
Cote, KA
通讯作者：
Cote, KA
影响因子：
1
作者：
Boly, M.;Seth, A. K.
通讯作者：
Seth, A. K.
影响因子：
3.7
作者：
Katayama, J;Polich, J
通讯作者：
Polich, J