Do Patients Thought to Lack Consciousness Retain the Capacity for Internal as Well as External Awareness?
It is well established that some patients, who are deemed to have disorders of consciousness, remain entirely behaviorally non-responsive and are diagnosed as being in a vegetative state, yet can nevertheless demonstrate covert awareness of their external environment by modulating their brain activi...
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doaj-89b29ba724c5424387928c0be19848822020-11-24T23:05:18ZengFrontiers Media S.A.Frontiers in Neurology1664-22952018-06-01910.3389/fneur.2018.00492355527Do Patients Thought to Lack Consciousness Retain the Capacity for Internal as Well as External Awareness?Amelie Haugg0Amelie Haugg1Rhodri Cusack2Laura E. Gonzalez-Lara3Bettina Sorger4Adrian M. Owen5Lorina Naci6Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, SwitzerlandNeuroscience Center Zurich, Swiss Federal Institute of Technology, University of Zurich, Zurich, SwitzerlandSchool of Psychology, Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, IrelandThe Brain and Mind Institute, University of Western Ontario, London, ON, CanadaFaculty of Psychology and Neuroscience, Maastricht University, Maastricht, NetherlandsThe Brain and Mind Institute, University of Western Ontario, London, ON, CanadaSchool of Psychology, Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, IrelandIt is well established that some patients, who are deemed to have disorders of consciousness, remain entirely behaviorally non-responsive and are diagnosed as being in a vegetative state, yet can nevertheless demonstrate covert awareness of their external environment by modulating their brain activity, a phenomenon known as cognitive-motor dissociation. However, the extent to which these patients retain internal awareness remains unknown. To investigate the potential for internal and external awareness in patients with chronic disorders of consciousness (DoC), we asked whether the pattern of juxtaposition between the functional time-courses of the default mode (DMN) and fronto-parietal networks, shown in healthy individuals to mediate the naturally occurring dominance switching between internal and external aspects of consciousness, was present in these patients. We used a highly engaging movie by Alfred Hitchcock to drive the recruitment of the fronto-parietal networks, including the dorsal attention (DAN) and executive control (ECN) networks, and their maximal juxtaposition to the DMN in response to the complex stimulus, relative to rest and a scrambled, meaningless movie baseline condition. We tested a control group of healthy participants (N = 13/12) and two groups of patients with disorders of consciousness, one comprised of patients who demonstrated independent, neuroimaging-based evidence of covert external awareness (N = 8), and the other of those who did not (N = 8). Similarly to the healthy controls, only the group of patients with overt and, critically, covert external awareness showed significantly heightened differentiation between the DMN and the DAN in response to movie viewing relative to their resting state time-courses, which was driven by the movie's narrative. This result suggested the presence of functional integrity in the DMN and fronto-parietal networks and their relationship to one another in patients with covert external awareness. Similar to the effect in healthy controls, these networks became more strongly juxtaposed to one another in response to movie viewing relative to the baseline conditions, suggesting the potential for internal and external awareness during complex stimulus processing. Furthermore, our results suggest that naturalistic paradigms can dissociate between groups of DoC patients with and without covert awareness based on the functional integrity of brain networks.https://www.frontiersin.org/article/10.3389/fneur.2018.00492/fullfunctional Magnetic Resonance Imaging (fMRI)functional connectivitydisorders of consciousnessnaturalistic stimulationmovie watchingconscious information processing |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Amelie Haugg Amelie Haugg Rhodri Cusack Laura E. Gonzalez-Lara Bettina Sorger Adrian M. Owen Lorina Naci |
spellingShingle |
Amelie Haugg Amelie Haugg Rhodri Cusack Laura E. Gonzalez-Lara Bettina Sorger Adrian M. Owen Lorina Naci Do Patients Thought to Lack Consciousness Retain the Capacity for Internal as Well as External Awareness? Frontiers in Neurology functional Magnetic Resonance Imaging (fMRI) functional connectivity disorders of consciousness naturalistic stimulation movie watching conscious information processing |
author_facet |
Amelie Haugg Amelie Haugg Rhodri Cusack Laura E. Gonzalez-Lara Bettina Sorger Adrian M. Owen Lorina Naci |
author_sort |
Amelie Haugg |
title |
Do Patients Thought to Lack Consciousness Retain the Capacity for Internal as Well as External Awareness? |
title_short |
Do Patients Thought to Lack Consciousness Retain the Capacity for Internal as Well as External Awareness? |
title_full |
Do Patients Thought to Lack Consciousness Retain the Capacity for Internal as Well as External Awareness? |
title_fullStr |
Do Patients Thought to Lack Consciousness Retain the Capacity for Internal as Well as External Awareness? |
title_full_unstemmed |
Do Patients Thought to Lack Consciousness Retain the Capacity for Internal as Well as External Awareness? |
title_sort |
do patients thought to lack consciousness retain the capacity for internal as well as external awareness? |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Neurology |
issn |
1664-2295 |
publishDate |
2018-06-01 |
description |
It is well established that some patients, who are deemed to have disorders of consciousness, remain entirely behaviorally non-responsive and are diagnosed as being in a vegetative state, yet can nevertheless demonstrate covert awareness of their external environment by modulating their brain activity, a phenomenon known as cognitive-motor dissociation. However, the extent to which these patients retain internal awareness remains unknown. To investigate the potential for internal and external awareness in patients with chronic disorders of consciousness (DoC), we asked whether the pattern of juxtaposition between the functional time-courses of the default mode (DMN) and fronto-parietal networks, shown in healthy individuals to mediate the naturally occurring dominance switching between internal and external aspects of consciousness, was present in these patients. We used a highly engaging movie by Alfred Hitchcock to drive the recruitment of the fronto-parietal networks, including the dorsal attention (DAN) and executive control (ECN) networks, and their maximal juxtaposition to the DMN in response to the complex stimulus, relative to rest and a scrambled, meaningless movie baseline condition. We tested a control group of healthy participants (N = 13/12) and two groups of patients with disorders of consciousness, one comprised of patients who demonstrated independent, neuroimaging-based evidence of covert external awareness (N = 8), and the other of those who did not (N = 8). Similarly to the healthy controls, only the group of patients with overt and, critically, covert external awareness showed significantly heightened differentiation between the DMN and the DAN in response to movie viewing relative to their resting state time-courses, which was driven by the movie's narrative. This result suggested the presence of functional integrity in the DMN and fronto-parietal networks and their relationship to one another in patients with covert external awareness. Similar to the effect in healthy controls, these networks became more strongly juxtaposed to one another in response to movie viewing relative to the baseline conditions, suggesting the potential for internal and external awareness during complex stimulus processing. Furthermore, our results suggest that naturalistic paradigms can dissociate between groups of DoC patients with and without covert awareness based on the functional integrity of brain networks. |
topic |
functional Magnetic Resonance Imaging (fMRI) functional connectivity disorders of consciousness naturalistic stimulation movie watching conscious information processing |
url |
https://www.frontiersin.org/article/10.3389/fneur.2018.00492/full |
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