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Updated: Jun 17, 2025

Assessment and Communication for People with Disorders of Consciousness
Published on: August 1, 2017
在意识障碍中的认知运动分离
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.).
通过fMRI或EEG检测到的认知运动分离发生在25%的无反应患者中. 这一发现突出了意识障碍中隐藏的认知能力,改善了诊断和护理.
科学领域:
- 神经科学是一个神经科学.
- 临床神经学 临床神经学
背景情况:
- 认知运动解离 (Cognitive Motor Dissociation,简称CMD) 是一种能够执行认知任务,尽管对命令没有反应的能力,可以通过fMRI和EEG检测到.
- 在有意识障碍 (DoC) 的大量患者群体中,CMD尚未得到广泛的研究.
研究的目的:
- 系统地调查CMD的流行率和特征,在一个大队列的成年人DoC.
- 为了比较CMD检测率在有或没有可观察到的响应命令的患者之间.
主要方法:
- 这是一项前性队列研究,涉及6个国际中心的353名成年人.
- 收集了临床,行为和基于任务的fMRI和EEG数据.
- 使用昏迷恢复尺度修订 (CRS-R) 评估反应能力.
主要成果:
- 在25% (60/241) 的参与者中检测到CMD,但没有观察到对命令的反应.
- 慢性脑病与年龄较小,受伤时间较长以及脑部创伤有关.
- 基于任务的fMRI或EEG反应发生在38% (43/112) 的参与者中,有可观察到的反应.
结论:
- 大约四分之一的没有反应的DoC患者表现出CMD,这表明认知功能得到保护.
- 使用fMRI和EEG检测CMD为脑损伤患者的意识提供了宝贵的见解.
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