Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
NeuroRehabilitation. 2020;46(1):65-74. doi: 10.3233/NRE-192860.
Although emergence from the minimally conscious state (eMCS) is associated with symptoms including disorientation, memory and attention impairment, restlessness, and significant functional disability, the neurobehavioral profile of eMCS has not been empirically characterized.
Determine degree of cognitive impairment, presence of clinical symptoms and functional disability at time eMCS in patients with traumatic and non-traumatic brain injury (TBI, nTBI).
Retrospective observational study of 169 adults (median [interquartile range] age: 51 [29, 62] years; male: 116; TBI: 103) who emerged from MCS based on the Coma Recovery Scale-Revised while in an inpatient Disorders of Consciousness program. Outcome measures include the Confusion Assessment Protocol (CAP) and Disability Rating Scale (DRS).
CAP administration was attempted in 54 subjects. Twenty-eight subjects had valid scores on all CAP items, with a median [interquartile range] of 4 [3-5] symptoms of confusion. Scores in 93% of this subsample were consistent with an acute confusional state. The most common symptoms were cognitive impairment (98% of subjects), disorientation (93%), and agitation (69%). The median DRS score upon emergence from MCS was 14.5 [13, 16], indicating severe disability (n = 140).
eMCS is associated with an acute confusional state and severe disability. This finding may inform the lower boundary of confusion as well as approach to treatment and caregiver education.
虽然从最小意识状态（MCS）中苏醒与定向障碍、记忆和注意力损伤、不安和显著的功能障碍等症状相关，但 MCS 的神经行为特征尚未得到实证描述。
确定创伤性和非创伤性脑损伤（TBI、nTBI）患者在进入 MCS 时的认知障碍程度、临床症状和功能障碍。
对 169 名成年人（中位数[四分位间距]年龄：51[29，62]岁；男性：116 人；TBI：103 人）进行回顾性观察研究，这些成年人根据修订后的昏迷恢复量表-R 从 MCS 中苏醒，且在意识障碍住院治疗计划中。结局测量包括意识模糊评估量表（CAP）和残疾评定量表（DRS）。
尝试对 54 名受试者进行 CAP 管理。28 名受试者在所有 CAP 项目上均有有效评分，中位数[四分位间距]为 4[3-5]项混乱症状。该亚样本中 93%的分数与急性意识混乱状态一致。最常见的症状是认知障碍（98%的受试者）、定向障碍（93%）和躁动（69%）。从 MCS 中苏醒时的 DRS 中位数为 14.5[13，16]，表明严重残疾（n=140）。
MCS 与急性意识混乱状态和严重残疾相关。这一发现可能为混淆的下限以及治疗和护理人员教育的方法提供信息。
