Crone Julia Sophia, Soddu Andrea, Höller Yvonne, Vanhaudenhuyse Audrey, Schurz Matthias, Bergmann Jürgen, Schmid Elisabeth, Trinka Eugen, Laureys Steven, Kronbichler Martin
Neuroscience Institute & Centre for Neurocognitive Research, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria ; Centre for Neurocognitive Research & Department of Psychology, University of Salzburg, Salzburg, Austria ; Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria.
Coma Science Group, Cyclotron Research Centre, University of Liège, Belgium ; Brain and Mind Institute, Physics & Astronomy Department, Western University, London, Ontario, Canada.
Neuroimage Clin. 2013 Dec 26;4:240-8. doi: 10.1016/j.nicl.2013.12.005. eCollection 2014.
Recovery of consciousness has been associated with connectivity in the frontal cortex and parietal regions modulated by the thalamus. To examine this model and to relate alterations to deficits in cognitive functioning and conscious processing, we investigated topological network properties in patients with chronic disorders of consciousness recovered from coma. Resting state fMRI data of 34 patients with unresponsive wakefulness syndrome and 25 in minimally conscious state were compared to 28 healthy controls. We investigated global and local network characteristics. Additionally, behavioral measures were correlated with the local metrics of 28 regions within the fronto-parietal network and the thalamus. In chronic disorders of consciousness, modularity at the global level was reduced suggesting a disturbance in the optimal balance between segregation and integration. Moreover, network properties were altered in several regions which are associated with conscious processing (particularly, in medial parietal, and frontal regions, as well as in the thalamus). Between minimally conscious and unconscious patients the local efficiency of medial parietal regions differed. Alterations in the thalamus were particularly evident in non-conscious patients. Most of the regions affected in patients with impaired consciousness belong to the so-called 'rich club' of highly interconnected central nodes. Disturbances in their topological characteristics have severe impact on information integration and are reflected in deficits in cognitive functioning probably leading to a total breakdown of consciousness.
意识恢复与由丘脑调节的额叶皮质和顶叶区域的连通性有关。为了检验这一模型，并将改变与认知功能和意识加工的缺陷联系起来，我们研究了从昏迷中恢复的慢性意识障碍患者的拓扑网络特性。将34例无反应觉醒综合征患者和25例处于最小意识状态患者的静息态功能磁共振成像数据与28名健康对照者的数据进行比较。我们研究了全局和局部网络特征。此外，行为测量结果与额顶叶网络和丘脑内28个区域的局部指标相关。在慢性意识障碍中，全局水平的模块化降低，表明在分离和整合之间的最佳平衡受到干扰。此外，与意识加工相关的几个区域（特别是内侧顶叶、额叶区域以及丘脑）的网络特性发生了改变。在最小意识和无意识患者之间，内侧顶叶区域的局部效率有所不同。丘脑的改变在无意识患者中尤为明显。意识受损患者中受影响的大多数区域属于高度相互连接的中心节点的所谓“富俱乐部”。它们拓扑特征的紊乱对信息整合有严重影响，并反映在认知功能的缺陷中，可能导致意识完全崩溃。
