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A large-scale study reveals that cognitive motor dissociation, where patients with disorders of consciousness show brain activation on functional MRI or EEG despite being behaviorally unresponsive, is more prevalent than previously thought. This finding has significant implications for the assessment and care of patients with severe brain injuries.
Key Points:
- The study included 353 adults with disorders of consciousness across six international centers, using both fMRI and EEG to detect cognitive responses.
- Cognitive motor dissociation was detected in 25% of participants without observable responses to commands, higher than previous estimates of 10-20%.
- Among participants with observable responses to commands, 38% showed responses on task-based fMRI or EEG.
- Cognitive motor dissociation was associated with younger age, longer time since injury, and traumatic brain injury as an etiologic factor.
- The study found low agreement between behavioral assessments (CRS-R) and neuroimaging techniques (fMRI and EEG), suggesting these methods may capture different aspects of cognitive function.
- Multimodal assessment using both fMRI and EEG appears to be more sensitive in detecting cognitive motor dissociation than using either technique alone.
- The findings highlight the need for standardization and clinical integration of fMRI and EEG methods to improve detection of covert consciousness in patients with brain injuries.
“Identifying that a patient who otherwise appears to be unconscious has the capacity for cognitive processing may mitigate emotional harm when the patient’s clinical team and family recognize that the patient is aware and treats the patient as such.”
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