意识障碍中的认知运动分离。
Cognitive Motor Dissociation in Disorders of Consciousness.
机构信息
From the Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital (Y.G.B., J.T.G.), and the Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital (B.L.E.), Charlestown, and the Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital (Y.G.B., C.C., P.K.L., A.M., W.R.S., B.L.E.), the Department of Physical Medicine and Rehabilitation, Harvard Medical School (Y.G.B., J.T.G.), and the Department of Neurology, Massachusetts General Hospital and Harvard Medical School (Y.G.B., C.C., B.L.E.), Boston - all in Massachusetts; the Department of Neurosciences, Addenbrookes Hospital (J.A.), and the Department of Clinical Neurosciences (J.A., S.C., E.K., V.C.L., J.P., E.A.S.), the Division of Neurosurgery, School of Clinical Medicine (S.C., P.F., E.K., J.P.), the Wolfson Brain Imaging Centre (V.C.L., D.M., J.P.), and the Division of Anaesthesia, Department of Medicine (D.M., E.A.S.), University of Cambridge, Cambridge, and the School of Computing, University of Kent, Canterbury (S.C.) - all in the United Kingdom; the Coma Science Group, GIGA Consciousness, University of Liege (P.C., A.B., C.C., O.G., S.L., A.T.), and Centre du Cerveau, University Hospital of Liege (P.C., A.B., C.C., O.G., A.T.), Liege, and the European Research Council Executive Agency, Brussels (C.C.) - all in Belgium; the Department of Neurology, Columbia University Irving Medical Center, New York-Presbyterian Hospital (J. Carmona, G.H., A. Velazquez, A. Vrosgou, J. Claassen), the Feil Family Brain and Mind Research Institute (M.C., J.E.H., J.D.V., N.D.S.), the Division of Medical Ethics (J.E.H., J.J.F.), and the Departments of Neurology (J.D.V., N.D.S.) and Radiology (H.U.V.), Weill Cornell Medicine, Rockefeller University Hospital (J.J.F., J.D.V., N.D.S.), and the Department of Population Health Science and Policy, Center for Biostatistics, Icahn School of Medicine at Mount Sinai (E.B.) - all in New York; Collège de France, Université Paris Sciences et Lettres (S.D.), Sorbonne Université, Paris Brain Institute-Institut du Cerveau et de la Moelle Épinière, INSERM, Centre National de la Recherche Scientifique (B.R., J.D.S., M.V., L.N.), and Assistance Publique-Hopitaux de Paris, Hôpital Pitié-Salpêtrière, Département Médico-Universitaire Neurosciences (B.R., M.V., L.N.) - all in Paris; the Departments of Physics and Astronomy (A.S.), Physiology and Pharmacology (A.M.O.), and Psychology (A.M.O.), and the Western Institute for Neuroscience (A.S., A.M.O.), University of Western Ontario, London, ON, and the CERVO Brain Research Centre, Quebec, QC (S.L.) - all in Canada; Yale Law School, New Haven, CT (J.J.F.); and the Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China (S.L.).
出版信息
N Engl J Med. 2024 Aug 15;391(7):598-608. doi: 10.1056/NEJMoa2400645.
BACKGROUND
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.
METHODS
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).
RESULTS
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.
CONCLUSIONS
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. (Funded by the James S. McDonnell Foundation and others.).
背景
对指令无反应的脑损伤患者可能会执行在功能磁共振成像（fMRI）和脑电图（EEG）上检测到的认知任务。这种现象称为认知运动分离，尚未在大量意识障碍患者中进行系统研究。
方法
在这项在六个国际中心进行的前瞻性队列研究中，我们从一个方便的意识障碍成年人的 353 例患者中收集了临床、行为和基于任务的 fMRI 和 EEG 数据。我们评估了无口头指令反应的患者（即行为诊断为昏迷、植物状态或最小意识状态-减去）和有口头指令反应的患者基于任务 fMRI 或 EEG 对指令的反应。有无口头指令反应的存在是通过使用昏迷恢复量表修订版（CRS-R）来评估的。
结果
只有 fMRI 或 EEG 的数据可用于 65%的参与者，而 fMRI 和 EEG 的数据都可用于 35%的参与者。参与者的中位年龄为 37.9 岁，从脑损伤到使用 CRS-R 评估的中位时间为 7.9 个月（25%的参与者在损伤后 28 天内接受 CRS-R 评估），脑外伤是 50%的病因。我们在 241 名无口头指令反应的参与者中有 60 名（25%）检测到认知运动分离，其中 11 名仅接受 fMRI 评估，13 名仅接受 EEG 评估，36 名同时接受两种技术评估。认知运动分离与年龄较小、受伤时间较长以及脑外伤作为病因有关。相比之下，在有口头指令反应的 112 名参与者中有 43 名（38%）在基于任务的 fMRI 或 EEG 上出现了反应。
结论
与有口头指令反应的参与者相比，无口头指令反应的参与者中约有四分之一在 fMRI 或 EEG 上执行认知任务，而有口头指令反应的参与者中约有三分之一。（由詹姆斯·麦克唐纳基金会等资助）。
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