Yelena G Bodien1,2, Geraldine Martens1,3, Joseph Ostrow1, Kristen Sheau1, Joseph T Giacino1. 1. Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA. 2. Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. 3. Department of Neurology and GIGA-Consciousness, Coma Science Group, GIGA Research, University and University Hospital of Liege, Liege, Belgium.
Abstract
BACKGROUND: Although emergence from the minimally conscious state (eMCS) is associated with symptoms including disorientation, memory and attention impairment, restlessness, and significant functional disability, the neurobehavioral profile of eMCS has not been empirically characterized. OBJECTIVE: Determine degree of cognitive impairment, presence of clinical symptoms and functional disability at time eMCS in patients with traumatic and non-traumatic brain injury (TBI, nTBI). METHODS: Retrospective observational study of 169 adults (median [interquartile range] age: 51 [29, 62] years; male: 116; TBI: 103) who emerged from MCS based on the Coma Recovery Scale-Revised while in an inpatient Disorders of Consciousness program. Outcome measures include the Confusion Assessment Protocol (CAP) and Disability Rating Scale (DRS). RESULTS: CAP administration was attempted in 54 subjects. Twenty-eight subjects had valid scores on all CAP items, with a median [interquartile range] of 4 [3-5] symptoms of confusion. Scores in 93% of this subsample were consistent with an acute confusional state. The most common symptoms were cognitive impairment (98% of subjects), disorientation (93%), and agitation (69%). The median DRS score upon emergence from MCS was 14.5 [13, 16], indicating severe disability (n = 140). CONCLUSIONS: eMCS is associated with an acute confusional state and severe disability. This finding may inform the lower boundary of confusion as well as approach to treatment and caregiver education.
BACKGROUND: Although emergence from the minimally conscious state (eMCS) is associated with symptoms including disorientation, memory and attention impairment, restlessness, and significant functional disability, the neurobehavioral profile of eMCS has not been empirically characterized. OBJECTIVE: Determine degree of cognitive impairment, presence of clinical symptoms and functional disability at time eMCS in patients with traumatic and non-traumatic brain injury (TBI, nTBI). METHODS: Retrospective observational study of 169 adults (median [interquartile range] age: 51 [29, 62] years; male: 116; TBI: 103) who emerged from MCS based on the Coma Recovery Scale-Revised while in an inpatient Disorders of Consciousness program. Outcome measures include the Confusion Assessment Protocol (CAP) and Disability Rating Scale (DRS). RESULTS: CAP administration was attempted in 54 subjects. Twenty-eight subjects had valid scores on all CAP items, with a median [interquartile range] of 4 [3-5] symptoms of confusion. Scores in 93% of this subsample were consistent with an acute confusional state. The most common symptoms were cognitive impairment (98% of subjects), disorientation (93%), and agitation (69%). The median DRS score upon emergence from MCS was 14.5 [13, 16], indicating severe disability (n = 140). CONCLUSIONS: eMCS is associated with an acute confusional state and severe disability. This finding may inform the lower boundary of confusion as well as approach to treatment and caregiver education.
Authors: Katherine Golden; Kimberly S Erler; John Wong; Joseph T Giacino; Yelena G Bodien Journal: Arch Phys Med Rehabil Date: 2022-04-06 Impact factor: 4.060
Authors: Leandro R D Sanz; Aurore Thibaut; Brian L Edlow; Steven Laureys; Olivia Gosseries Journal: Curr Opin Neurol Date: 2021-08-01 Impact factor: 6.283
Authors: Michael J Young; Yelena G Bodien; Joseph T Giacino; Joseph J Fins; Robert D Truog; Leigh R Hochberg; Brian L Edlow Journal: Brain Date: 2021-12-16 Impact factor: 13.501
Authors: John Whyte; Joseph T Giacino; Allen W Heinemann; Yelena Bodien; Tessa Hart; Mark Sherer; Gale G Whiteneck; David Mellick; Flora M Hammond; Patrick Semik; Amy Rosenbaum; Risa Nakase Richardson Journal: Arch Phys Med Rehabil Date: 2020-10-03 Impact factor: 4.060