Bodien, Yelena G, Allanson, Judith, Cardone, Paolo, Bonhomme, Arthur, Carmona, Jerina, Chatelle, Camille, Chennu, Srivas, Conte, Mary, Dehaene, Stanislas, Finoia, Paola, and others. (2024) Cognitive Motor Dissociation in Disorders of Consciousness. The New England journal of medicine, 391 (7). pp. 598-608. ISSN 1533-4406. (doi:10.1056/NEJMoa2400645) (KAR id:107010)
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| Official URL: https://doi.org/10.1056/NEJMoa2400645 |
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Abstract
Patients with brain injury who are unresponsive to commands may perform cognitive tasks that are detected on functional magnetic resonance imaging (fMRI) and electroencephalography (EEG). This phenomenon, known as cognitive motor dissociation, has not been systematically studied in a large cohort of persons with disorders of consciousness. In this prospective cohort study conducted at six international centers, we collected clinical, behavioral, and task-based fMRI and EEG data from a convenience sample of 353 adults with disorders of consciousness. We assessed the response to commands on task-based fMRI or EEG in participants without an observable response to verbal commands (i.e., those with a behavioral diagnosis of coma, vegetative state, or minimally conscious state-minus) and in participants with an observable response to verbal commands. The presence or absence of an observable response to commands was assessed with the use of the Coma Recovery Scale-Revised (CRS-R). Data from fMRI only or EEG only were available for 65% of the participants, and data from both fMRI and EEG were available for 35%. The median age of the participants was 37.9 years, the median time between brain injury and assessment with the CRS-R was 7.9 months (25% of the participants were assessed with the CRS-R within 28 days after injury), and brain trauma was an etiologic factor in 50%. We detected cognitive motor dissociation in 60 of the 241 participants (25%) without an observable response to commands, of whom 11 had been assessed with the use of fMRI only, 13 with the use of EEG only, and 36 with the use of both techniques. Cognitive motor dissociation was associated with younger age, longer time since injury, and brain trauma as an etiologic factor. In contrast, responses on task-based fMRI or EEG occurred in 43 of 112 participants (38%) with an observable response to verbal commands. Approximately one in four participants without an observable response to commands performed a cognitive task on fMRI or EEG as compared with one in three participants with an observable response to commands.
| Item Type: | Article |
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| DOI/Identification number: | 10.1056/NEJMoa2400645 |
| Projects: | Collaborative study of recovery of consciousness after severe brain injury |
| Uncontrolled keywords: | Female, Adult, Brain - diagnostic imaging - physiopathology, Consciousness Disorders - diagnostic imaging - etiology - physiopathology, Dissociative Disorders - diagnostic imaging - etiology - physiopathology, Magnetic Resonance Imaging, Humans, Male, Young Adult, Brain Injuries - physiopathology - complications - diagnostic imaging, Cognition - physiology, Prospective Studies, Middle Aged, Electroencephalography, Persistent Vegetative State - diagnostic imaging - etiology - physiopathology |
| Subjects: | Q Science > QA Mathematics (inc Computing science) |
| Divisions: | Divisions > Division of Computing, Engineering and Mathematical Sciences > School of Computing |
| SWORD Depositor: | JISC Publications Router |
| Depositing User: | JISC Publications Router |
| Date Deposited: | 28 Aug 2024 14:55 UTC |
| Last Modified: | 06 Sep 2024 08:11 UTC |
| Resource URI: | https://kar.kent.ac.uk/id/eprint/107010 (The current URI for this page, for reference purposes) |
University of Kent Author Information
Chennu, Srivas.
| Creator's ORCID: |
 https://orcid.org/0000-0002-6840-2941
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