重建隐性意识:作为一种新型意识评估的神经解码

Reconstructing Covert Consciousness: Neural Decoding as a Novel Consciousness Assessment.

作者信息

Fischer David, Edlow Brian L, Freeman Holly J, Alaiev Daniel, Wu Qichao, Ware Jeffrey B, Detre John A, Aguirre Geoffrey K

机构信息

Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.

Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston.

出版信息

Neurology. 2025 Feb 25;104(4):e210208. doi: 10.1212/WNL.0000000000210208. Epub 2025 Jan 30.

Abstract

Determining the level of consciousness in patients with brain injury-and more fundamentally, establishing what they can experience-is ethically and clinically impactful. Patient behaviors may unreliably reflect their level of consciousness: a subset of unresponsive patients demonstrate covert consciousness by willfully modulating their brain activity to commands through fMRI or EEG. However, current paradigms for assessing covert consciousness remain fundamentally limited because they are insensitive, rely on imperfect assumptions of functional neuroanatomy, and do not reflect the spectrum of conscious experience. Neural decoding, in which stimuli and concepts are reconstructed from brain activity, offers a novel approach to covert consciousness assessment that overcomes many of these limitations. In this article, we discuss the current state of covert consciousness assessments, their shortcomings, the state of the science in neural decoding, the potential application of neural decoding to disorders of consciousness, and future directions that may help realize this potential. To do so, we searched PubMed and Google Scholar databases for pertinent articles published between January 1990 and September 2024, using the search terms "covert consciousness," "cognitive motor dissociation," "neural decoding," and "semantic decoding." Redefining covert consciousness with neural decoding may improve sensitivity, enhance granularity, and more directly address the question of what patients can experience after brain injury.

摘要

确定脑损伤患者的意识水平——更根本的是,明确他们能够感知到什么——在伦理和临床方面都具有重要意义。患者的行为可能无法可靠地反映其意识水平:一部分无反应的患者通过功能磁共振成像(fMRI)或脑电图(EEG)对指令有意识地调节大脑活动,从而表现出隐蔽意识。然而,目前评估隐蔽意识的范式仍存在根本局限性,因为它们不够灵敏,依赖于功能神经解剖学的不完美假设,且无法反映意识体验的范围。神经解码,即从大脑活动中重建刺激和概念,为隐蔽意识评估提供了一种新方法,克服了许多这些局限性。在本文中,我们讨论了隐蔽意识评估的现状、它们的缺点、神经解码的科学现状、神经解码在意识障碍中的潜在应用以及可能有助于实现这一潜力的未来方向。为此,我们在PubMed和谷歌学术数据库中搜索了1990年1月至2024年9月期间发表的相关文章,使用的搜索词为“隐蔽意识”“认知运动分离”“神经解码”和“语义解码”。用神经解码重新定义隐蔽意识可能会提高灵敏度、增强粒度,并更直接地解决脑损伤后患者能够感知到什么的问题。

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