Ferraro Stefania, Nigri Anna, D'Incerti Ludovico, Rosazza Cristina, Sattin Davide, Rossi Sebastiano Davide, Visani Elisa, Duran Dunja, Marotta Giorgio, Demichelis Greta, Catricala' Eleonora, Kotz Sonja, Verga Laura, Leonardi Matilde, Cappa Stefano, Bruzzone Maria Grazia
School of Life Science and Technology, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China.
Neuroradiology Department, Fondazione IRCCS Neurologico Carlo Besta, Milan, Italy.
Front Neurol. 2020 Dec 21;11:526465. doi: 10.3389/fneur.2020.526465. eCollection 2020.
The impact of language impairment on the clinical assessment of patients suffering from disorders of consciousness (DOC) is unknown or underestimated and may mask the presence of conscious behavior. In a group of DOC patients ( = 11; time post-injury range: 5-252 months), we investigated the main neural functional and structural underpinnings of linguistic processing, and their relationship with the behavioral measures of the auditory function using the Coma Recovery Scale-Revised (CRS-R). We assessed the integrity of the brainstem auditory pathways, of the left superior temporal gyrus and arcuate fasciculus, the neural activity elicited by passive listening of an auditory language task, and the mean hemispheric glucose metabolism. Our results support the hypothesis of a relationship between the level of preservation of the investigated structures/functions and the CRS-R auditory subscale scores. Moreover, our findings indicate that patients in minimally conscious state minus (MCS-): (1) when presenting the (at the CRS-R auditory subscale) might be aphasic in the receptive domain, being severely impaired in the core language structures/functions; (2) when presenting the might retain language processing, being almost intact or intact in the core language structures/functions. Despite the small group of investigated patients, our findings provide a grounding of the clinical measures of the CRS-R auditory subscale in the integrity of the underlying auditory structures/functions. Future studies are needed to confirm our results that might have important consequences for the clinical practice.
语言障碍对意识障碍（DOC）患者临床评估的影响尚不清楚或被低估，可能会掩盖有意识行为的存在。在一组DOC患者（n = 11；受伤后时间范围：5 - 252个月）中，我们使用昏迷恢复量表修订版（CRS - R）研究了语言处理的主要神经功能和结构基础，以及它们与听觉功能行为测量指标的关系。我们评估了脑干听觉通路、左侧颞上回和弓状束的完整性，被动聆听听觉语言任务引发的神经活动，以及平均半球葡萄糖代谢。我们的结果支持了所研究结构/功能的保留水平与CRS - R听觉子量表得分之间存在关联的假设。此外，我们的研究结果表明，处于最低意识状态减（MCS -）的患者：（1）在CRS - R听觉子量表上表现为[此处原文缺失相关内容]时，在接受域可能存在失语症，核心语言结构/功能严重受损；（2）表现为[此处原文缺失相关内容]时，可能保留语言处理能力，核心语言结构/功能几乎完整或完整。尽管所研究的患者群体较小，但我们的研究结果为CRS - R听觉子量表的临床测量在潜在听觉结构/功能完整性方面提供了依据。需要进一步的研究来证实我们的结果，这些结果可能对临床实践产生重要影响。
