Pengmin Qin1,2,3, Xuehai Wu4, Zirui Huang2, Niall W Duncan1,2,3,5, Weijun Tang6, Annemarie Wolff1, Jin Hu4, Liang Gao4, Yi Jin4, Xing Wu4, Jianfeng Zhang5, Lu Lu6, Chunping Wu6, Xiaoying Qu6, Ying Mao4, Xuchu Weng5, Jun Zhang7, Georg Northoff1,2,3,5,8. 1. Graduate Institute of Humanities in Medicine, Taipei Medical University, Taipei, Taiwan. 2. Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada. 3. Brain and Consciousness Research Center, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan. 4. Neurosurgical Department of Huashan Hospital, Fudan University, Shanghai, China. 5. Center for Cognition and Brain Disorders, Hangzhou Normal University, Hangzhou, China. 6. Radiologic Department of Huashan Hospital, Fudan University, Shanghai, China. 7. Department of Anesthesiology, Huashan Hospital, Fudan University, Shanghai, China. 8. National Chengchi University Research Center for Mind, Brain, and Learning, Taipei, Taiwan.
Abstract
OBJECTIVE: We aimed to investigate the roles of different resting-state networks in predicting both the actual level of consciousness and its recovery in brain injury patients. METHODS: We investigated resting-state functional connectivity within different networks in patients with varying levels of consciousness: unresponsive wakefulness syndrome (UWS; n = 56), minimally conscious state (MCS; n = 29), and patients with brain lesions but full consciousness (BL; n = 48). Considering the actual level of consciousness, we compared the strength of network connectivity among the patient groups. We then checked the presence of connections between specific regions in individual patients and calculated the frequency of this in the different patient groups. Considering the recovery of consciousness, we split the UWS group into 2 subgroups according to recovery: those who emerged from UWS (UWS-E) and those who remained in UWS (UWS-R). The above analyses were repeated on these 2 subgroups. RESULTS: Functional connectivity strength in salience network (SN), especially connectivity between the supragenual anterior cingulate cortex (SACC) and left anterior insula (LAI), was reduced in the unconscious state (UWS) compared to the conscious state (MCS and BL). Moreover, at the individual level, SACC-LAI connectivity was more present in MCS than in UWS. Default-mode network (DMN) connectivity strength, especially between the posterior cingulate cortex (PCC) and left lateral parietal cortex (LLPC), was reduced in UWS-R compared with UWS-E. Furthermore, PCC-LLPC connectivity was more present in UWS-E than in UWS-R. INTERPRETATION: Our findings show that SN (SACC-LAI) connectivity correlates with behavioral signs of consciousness, whereas DMN (PCC-LLPC) connectivity instead predicts recovery of consciousness.
OBJECTIVE: We aimed to investigate the roles of different resting-state networks in predicting both the actual level of consciousness and its recovery in brain injurypatients. METHODS: We investigated resting-state functional connectivity within different networks in patients with varying levels of consciousness: unresponsive wakefulness syndrome (UWS; n = 56), minimally conscious state (MCS; n = 29), and patients with brain lesions but full consciousness (BL; n = 48). Considering the actual level of consciousness, we compared the strength of network connectivity among the patient groups. We then checked the presence of connections between specific regions in individual patients and calculated the frequency of this in the different patient groups. Considering the recovery of consciousness, we split the UWS group into 2 subgroups according to recovery: those who emerged from UWS (UWS-E) and those who remained in UWS (UWS-R). The above analyses were repeated on these 2 subgroups. RESULTS: Functional connectivity strength in salience network (SN), especially connectivity between the supragenual anterior cingulate cortex (SACC) and left anterior insula (LAI), was reduced in the unconscious state (UWS) compared to the conscious state (MCS and BL). Moreover, at the individual level, SACC-LAI connectivity was more present in MCS than in UWS. Default-mode network (DMN) connectivity strength, especially between the posterior cingulate cortex (PCC) and left lateral parietal cortex (LLPC), was reduced in UWS-R compared with UWS-E. Furthermore, PCC-LLPC connectivity was more present in UWS-E than in UWS-R. INTERPRETATION: Our findings show that SN (SACC-LAI) connectivity correlates with behavioral signs of consciousness, whereas DMN (PCC-LLPC) connectivity instead predicts recovery of consciousness.
Authors: Zachary D Threlkeld; Yelena G Bodien; Eric S Rosenthal; Joseph T Giacino; Alfonso Nieto-Castanon; Ona Wu; Susan Whitfield-Gabrieli; Brian L Edlow Journal: Cortex Date: 2018-05-12 Impact factor: 4.027