Abstract
BackgroundIt is well established that some patients who are diagnosed as being in a vegetative state or a minimally conscious state show reliable signs of volition that may only be detected by measuring neural responses. A pertinent question is whether these patients are capable of higher cognitive processes.MethodsHere, we develop a series of EEG paradigms that probe several core aspects of cognition at the bedside without the need for motor responses and explore the sensitivity of this approach in a group of healthy controls.ResultsUsing analysis of ERPs alone, this method can determine with high reliability whether individual participants are able to attend a stimulus stream, maintain items in working memory, or solve complex grammatical reasoning problems.ConclusionWe suggest that this approach could form the basis of a brain-based battery for assessing higher cognition in patients with severe motor impairments or disorders of consciousness.
Highlights
Improvements in intensive care have resulted in a surge of survivors of severe brain injury (Owen 2008)
vegetative state (VS) patients are conceived as lacking awareness, whereas minimally conscious state (MCS) patients display some signs of awareness in the form of occasional purposeful behaviors
Individual comparisons of accuracy between memory set sizes revealed significant differences, with four item sets recalled significantly better than six items (P < 0.001) and eight items (P < 0.001), and six items sets remembered significantly better than eight items (P = 0.005)
Summary
Improvements in intensive care have resulted in a surge of survivors of severe brain injury (Owen 2008). Neurological disorders that involve a persistent impairment of the patient’s awareness of their self and environment are collectively referred to as disorders of consciousness (DOC) and include coma, vegetative state (VS), and minimally conscious state (MCS) (Owen 2008). These three conditions can be conceptualized as varying within the dimensions of wakefulness and awareness. Conclusion: We suggest that this approach could form the basis of a brainbased battery for assessing higher cognition in patients with severe motor impairments or disorders of consciousness
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