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Updated: Jun 17, 2025

Assessment and Communication for People with Disorders of Consciousness
Published on: August 1, 2017
Cognitive Motor Dissociation in Disorders of Consciousness
Yelena G Bodien1, Judith Allanson1, Paolo Cardone1
1From 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.).
Cognitive motor dissociation, detected via fMRI or EEG, occurred in 25% of unresponsive patients. This finding highlights hidden cognitive abilities in disorders of consciousness, improving diagnosis and care.
Area of Science:
- Neuroscience
- Clinical Neurology
Background:
- Cognitive motor dissociation (CMD) is the ability to perform cognitive tasks despite unresponsiveness to commands, detectable by fMRI and EEG.
- CMD has not been extensively studied in large cohorts of patients with disorders of consciousness (DoC).
Purpose of the Study:
- To systematically investigate the prevalence and characteristics of CMD in a large cohort of adults with DoC.
- To compare CMD detection rates between patients with and without observable responses to commands.
Main Methods:
- A prospective cohort study involving 353 adults with DoC across six international centers.
- Collected clinical, behavioral, and task-based fMRI and EEG data.
- Assessed responsiveness using the Coma Recovery Scale-Revised (CRS-R).
Main Results:
- CMD was detected in 25% (60/241) of participants without observable responses to commands.
- CMD was associated with younger age, longer time since injury, and brain trauma.
- Task-based fMRI or EEG responses occurred in 38% (43/112) of participants with observable responses.
Conclusions:
- Approximately one in four unresponsive DoC patients exhibit CMD, suggesting preserved cognitive function.
- CMD detection using fMRI and EEG offers valuable insights into consciousness in brain-injured individuals.
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