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Brain, Behavior, and Cognitive Interplay in Disorders of Consciousness: A Multiple Case Study

Patients with prolonged disorders of consciousness (DoC) after severe brain injury may present residual behavioral and cognitive functions. Yet the bedside assessment of these functions is compromised by patients' multiple impairments. Standardized behavioral scales such as the Coma Recovery Sc...

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Autores principales: Aubinet, Charlène, Murphy, Lesley, Bahri, Mohamed A., Larroque, Stephen K., Cassol, Helena, Annen, Jitka, Carrière, Manon, Wannez, Sarah, Thibaut, Aurore, Laureys, Steven, Gosseries, Olivia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6103268/
https://www.ncbi.nlm.nih.gov/pubmed/30154755
http://dx.doi.org/10.3389/fneur.2018.00665
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author Aubinet, Charlène
Murphy, Lesley
Bahri, Mohamed A.
Larroque, Stephen K.
Cassol, Helena
Annen, Jitka
Carrière, Manon
Wannez, Sarah
Thibaut, Aurore
Laureys, Steven
Gosseries, Olivia
author_facet Aubinet, Charlène
Murphy, Lesley
Bahri, Mohamed A.
Larroque, Stephen K.
Cassol, Helena
Annen, Jitka
Carrière, Manon
Wannez, Sarah
Thibaut, Aurore
Laureys, Steven
Gosseries, Olivia
author_sort Aubinet, Charlène
collection PubMed
description Patients with prolonged disorders of consciousness (DoC) after severe brain injury may present residual behavioral and cognitive functions. Yet the bedside assessment of these functions is compromised by patients' multiple impairments. Standardized behavioral scales such as the Coma Recovery Scale-Revised (CRS-R) have been developed to diagnose DoC, but there is also a need for neuropsychological measurement in these patients. The Cognitive Assessment by Visual Election (CAVE) was therefore recently created. In this study, we describe five patients in minimally conscious state (MCS) or emerging from the MCS (EMCS). Their cognitive profiles, derived from the CRS-R and CAVE, are presented alongside their neuroimaging results using structural magnetic resonance imaging (MRI) and fluorodeoxyglucose positron emission tomography (FDG-PET). Scores on the CAVE decreased along with the CRS-R total score, establishing a consistent behavioral/cognitive profile for each patient. Out of these five cases, the one with highest CRS-R and CAVE performance had the least extended cerebral hypometabolism. All patients showed structural and functional brain impairments that were consistent with their behavioral/cognitive profile as based on previous literature. For instance, the presence of visual and motor residual functions was respectively associated with a relative preservation of occipital and motor cortex/cerebellum metabolism. Moreover, residual language comprehension skills were found in the presence of preserved temporal and angular cortex metabolism. Some patients also presented structural impairment of hippocampus, suggesting the presence of memory impairments. Our results suggest that brain-behavior relationships might be observed even in severely brain-injured patients and they highlight the importance of developing new tools to assess residual cognition and language in MCS and EMCS patients. Indeed, a better characterization of their cognitive profile will be helpful in preparation of rehabilitation programs and daily routines.
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spelling pubmed-61032682018-08-28 Brain, Behavior, and Cognitive Interplay in Disorders of Consciousness: A Multiple Case Study Aubinet, Charlène Murphy, Lesley Bahri, Mohamed A. Larroque, Stephen K. Cassol, Helena Annen, Jitka Carrière, Manon Wannez, Sarah Thibaut, Aurore Laureys, Steven Gosseries, Olivia Front Neurol Neurology Patients with prolonged disorders of consciousness (DoC) after severe brain injury may present residual behavioral and cognitive functions. Yet the bedside assessment of these functions is compromised by patients' multiple impairments. Standardized behavioral scales such as the Coma Recovery Scale-Revised (CRS-R) have been developed to diagnose DoC, but there is also a need for neuropsychological measurement in these patients. The Cognitive Assessment by Visual Election (CAVE) was therefore recently created. In this study, we describe five patients in minimally conscious state (MCS) or emerging from the MCS (EMCS). Their cognitive profiles, derived from the CRS-R and CAVE, are presented alongside their neuroimaging results using structural magnetic resonance imaging (MRI) and fluorodeoxyglucose positron emission tomography (FDG-PET). Scores on the CAVE decreased along with the CRS-R total score, establishing a consistent behavioral/cognitive profile for each patient. Out of these five cases, the one with highest CRS-R and CAVE performance had the least extended cerebral hypometabolism. All patients showed structural and functional brain impairments that were consistent with their behavioral/cognitive profile as based on previous literature. For instance, the presence of visual and motor residual functions was respectively associated with a relative preservation of occipital and motor cortex/cerebellum metabolism. Moreover, residual language comprehension skills were found in the presence of preserved temporal and angular cortex metabolism. Some patients also presented structural impairment of hippocampus, suggesting the presence of memory impairments. Our results suggest that brain-behavior relationships might be observed even in severely brain-injured patients and they highlight the importance of developing new tools to assess residual cognition and language in MCS and EMCS patients. Indeed, a better characterization of their cognitive profile will be helpful in preparation of rehabilitation programs and daily routines. Frontiers Media S.A. 2018-08-14 /pmc/articles/PMC6103268/ /pubmed/30154755 http://dx.doi.org/10.3389/fneur.2018.00665 Text en Copyright © 2018 Aubinet, Murphy, Bahri, Larroque, Cassol, Annen, Carrière, Wannez, Thibaut, Laureys and Gosseries. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neurology
Aubinet, Charlène
Murphy, Lesley
Bahri, Mohamed A.
Larroque, Stephen K.
Cassol, Helena
Annen, Jitka
Carrière, Manon
Wannez, Sarah
Thibaut, Aurore
Laureys, Steven
Gosseries, Olivia
Brain, Behavior, and Cognitive Interplay in Disorders of Consciousness: A Multiple Case Study
title Brain, Behavior, and Cognitive Interplay in Disorders of Consciousness: A Multiple Case Study
title_full Brain, Behavior, and Cognitive Interplay in Disorders of Consciousness: A Multiple Case Study
title_fullStr Brain, Behavior, and Cognitive Interplay in Disorders of Consciousness: A Multiple Case Study
title_full_unstemmed Brain, Behavior, and Cognitive Interplay in Disorders of Consciousness: A Multiple Case Study
title_short Brain, Behavior, and Cognitive Interplay in Disorders of Consciousness: A Multiple Case Study
title_sort brain, behavior, and cognitive interplay in disorders of consciousness: a multiple case study
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6103268/
https://www.ncbi.nlm.nih.gov/pubmed/30154755
http://dx.doi.org/10.3389/fneur.2018.00665
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