Cortical Response to the Natural Speech Envelope Correlates with Neuroimaging Evidence of Cognition in Severe Brain Injury
Cortical Response to the Natural Speech Envelope Correlates with Neuroimaging Evidence of Cognition in Severe Brain Injury
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DOI：
10.1016/j.cub.2018.10.057
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发表时间：
2018-12-03
期刊：
影响因子：
9.2
通讯作者：
Schiff, Nicholas D.
中科院分区：
文献类型：
--
作者：
Braiman, Chananel;Fridman, Esteban A.;Schiff, Nicholas D.
最近的研究发现，严重脑损伤患者的行为反应有限或没有，他们成功地执行功能性磁共振成像（fMRI）或脑电图（EEG）心理意象任务[1-5]。这些任务对认知要求很高[1];因此，最近的研究支持脑损伤患者的fMRI命令与保留的脑代谢和保留的睡眠-觉醒EEG相关[5，6]。我们研究了在健康对照组和脑损伤患者（植物人状态到从最低意识状态出现）中使用跟踪口语的自然语音包络（NSE）的EEG反应[7-22]。由于听力通常在脑损伤后保留，因此在寻找隐蔽认知功能时可能首选听觉范例[23-25]。通过将EEG与NSE互相关来获得NSE测量。我们比较了NSE的潜伏期和振幅，并考虑和不考虑功能磁共振成像评估。NSE延迟在诊断类别中显示出显著的进行性延迟。能够进行基于fMRI的心理意象任务的患者与健康对照组相比，NSE潜伏期无统计学显著差异;该亚组包括没有行为命令的患者。NSE可以对患有严重脑损伤的患者进行分层，并识别那些表现出“认知运动分离”（CMD）的患者[26]，这些患者在使用需要高水平认知功能的神经成像或电生理方法后仅显示出隐蔽的命令证据。因此，NSE是一种被动测量，可以提供有用的筛选工具，以改善功能性磁共振成像或其他方法的隐蔽认知检测，并改善研究中意识障碍患者的分层。
Recent studies identify severely brain-injured patients with limited or no behavioral responses who successfully perform functional magnetic resonance imaging (fMRI) or electroencephalogram (EEG) mental imagery tasks [1-5]. Such tasks are cognitively demanding [1]; accordingly, recent studies support that fMRI command following in brain-injured patients associates with preserved cerebral metabolism and preserved sleep-wake EEG [5, 6]. We investigated the use of an EEG response that tracks the natural speech envelope (NSE) of spoken language [7-22] in healthy controls and brain-injured patients (vegetative state to emergence from minimally conscious state). As audition is typically preserved after brain injury, auditory paradigms may be preferred in searching for covert cognitive function [23-25]. NSE measures are obtained by cross-correlating EEG with the NSE. We compared NSE latencies and amplitudes with and without consideration of fMRI assessments. NSE latencies showed significant and progressive delay across diagnostic categories. Patients who could carry out fMRI-based mental imagery tasks showed no statistically significant difference in NSE latencies relative to healthy controls; this subgroup included patients without behavioral command following. The NSE may stratify patients with severe brain injuries and identify those patients demonstrating "cognitive motor dissociation" (CMD) [26] who show only covert evidence of command following utilizing neuroimaging or electrophysiological methods that demand high levels of cognitive function. Thus, the NSE is a passive measure that may provide a useful screening tool to improve detection of covert cognition with fMRI or other methods and improve stratification of patients with disorders of consciousness in research studies.