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A network approach to assessing cognition in disorders of consciousness.
[locked-in syndrome]
Conventional
assessments
of
consciousness
rely
on
motor
responses
to
indicate
awareness
.
However
,
overt
behaviors
may
be
absent
or
ambiguous
in
patients
with
disorders
of
consciousness
(
DOC
)
resulting
in
underrating
capacity
for
cognition
.
fMRI
during
a
silent
picture-naming
task
was
evaluated
as
an
indicator
of
command
following
when
conventional
methods
are
not
sufficient
.
A
total
of
10
patients
with
and
without
conventional
evidence
of
awareness
,
who
met
diagnostic
criteria
for
the
minimally
conscious
state
(
MCS
)
(
n
=
5
)
,
vegetative
state
(
VS
)
(
n
=
3
)
,
emerged
from
MCS
(
EMCS
)
(
n
=
1
)
,
and
locked-
in
syndrome
(
LIS
)
(
n
=
1
)
,
participated
in
this
observational
fMRI
study
.
The
LIS
and
EMCS
patients
engaged
a
complete
network
of
essential
language
-related
regions
during
the
object-naming
task
.
The
MCS
and
2
of
the
VS
patients
demonstrated
both
complete
and
partial
preservation
of
the
object-naming
system
.
Patients
who
engaged
a
complete
network
scored
highest
on
the
Coma
Recovery
Scale-
Revised
.
This
study
supports
the
view
that
fMRI
during
object
naming
can
elicit
brain
activations
in
patients
with
DOC
similar
to
those
observed
in
healthy
subjects
during
command
following
,
and
patients
can
be
stratified
by
completeness
of
the
engaged
neural
system
.
These
results
suggest
that
activity
of
the
language
network
may
serve
as
an
indicator
of
high
-level
cognition
and
possibly
volitional
processes
that
can
not
be
discerned
through
conventional
behavioral
assessment
alone
.
