Center for Brain-Computer Interfaces and Brain Information Processing, South China University of Technology, Guangzhou, China.
School of Software, South China Normal University, Guangzhou, China.
Brain. 2020 Apr 1;143(4):1177-1189. doi: 10.1093/brain/awaa026.
Cognitive motor dissociation describes a subset of patients with disorders of consciousness who show neuroimaging evidence of consciousness but no detectable command-following behaviours. Although essential for family counselling, decision-making, and the design of rehabilitation programmes, the prognosis for patients with cognitive motor dissociation remains under-investigated. The current study included 78 patients with disorders of consciousness who showed no detectable command-following behaviours. These patients included 45 patients with unresponsive wakefulness syndrome and 33 patients in a minimally conscious state, as diagnosed using the Coma Recovery Scale-Revised. Each patient underwent an EEG-based brain-computer interface experiment, in which he or she was instructed to perform an item-selection task (i.e. select a photograph or a number from two candidates). Patients who achieved statistically significant brain-computer interface accuracies were identified as cognitive motor dissociation. Two evaluations using the Coma Recovery Scale-Revised, one before the experiment and the other 3 months later, were carried out to measure the patients' behavioural improvements. Among the 78 patients with disorders of consciousness, our results showed that within the unresponsive wakefulness syndrome patient group, 15 of 18 patients with cognitive motor dissociation (83.33%) regained consciousness, while only five of the other 27 unresponsive wakefulness syndrome patients without significant brain-computer interface accuracies (18.52%) regained consciousness. Furthermore, within the minimally conscious state patient group, 14 of 16 patients with cognitive motor dissociation (87.5%) showed improvements in their Coma Recovery Scale-Revised scores, whereas only four of the other 17 minimally conscious state patients without significant brain-computer interface accuracies (23.53%) had improved Coma Recovery Scale-Revised scores. Our results suggest that patients with cognitive motor dissociation have a better outcome than other patients. Our findings extend current knowledge of the prognosis for patients with cognitive motor dissociation and have important implications for brain-computer interface-based clinical diagnosis and prognosis for patients with disorders of consciousness.
认知运动分离描述了意识障碍患者中的一个亚组，他们有神经影像学证据表明有意识，但没有可检测到的指令跟随行为。尽管对于家庭咨询、决策和康复计划的设计至关重要，但认知运动分离患者的预后仍然研究不足。本研究纳入了 78 名表现出无法检测到指令跟随行为的意识障碍患者。这些患者包括 45 名无反应性觉醒综合征患者和 33 名最小意识状态患者，这些患者是根据修订后的昏迷恢复量表诊断的。每位患者都接受了基于脑电图的脑机接口实验，在实验中，他们被要求执行一项项目选择任务（即从两个候选者中选择一张照片或一个数字）。达到统计上显著脑机接口准确性的患者被确定为认知运动分离。使用修订后的昏迷恢复量表进行了两次评估，一次在实验前，另一次在 3 个月后，以测量患者的行为改善情况。在 78 名意识障碍患者中，我们的结果表明，在无反应性觉醒综合征患者组中，18 名认知运动分离患者中有 15 名（83.33%）恢复了意识，而其他 27 名无反应性觉醒综合征患者中没有显著脑机接口准确性的患者只有 5 名（18.52%）恢复了意识。此外，在最小意识状态患者组中，16 名认知运动分离患者中有 14 名（87.5%）的昏迷恢复量表评分有所改善，而其他 17 名最小意识状态患者中没有显著脑机接口准确性的患者只有 4 名（23.53%）的昏迷恢复量表评分有所改善。我们的结果表明，认知运动分离患者的预后比其他患者好。我们的发现扩展了对认知运动分离患者预后的现有认识，对基于脑机接口的意识障碍患者的临床诊断和预后具有重要意义。
