Assessing the depth of language processing in patients with disorders of consciousness

Gui, Peng; Jiang, Youen; Zang, Di; Qi, Zengxin; Tan, James S.; Hiromi, Tanigawa; Jiang, Jiansheng; Wen, Yunqing; Xu, Liang; Zhao, Jizong; Mao, Ying; Poo, Mu‐ming; Ding, Nai; Dehaene, Stanislas; Wu, Xuehai; Wang, Liping

doi:10.1038/s41593-020-0639-1

Cited by 88 publications

(106 citation statements)

References 60 publications

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“…The prognostic value of our approach in the acute period postinjury is also consistent with recent evidence that linked higher‐level cortical tracking, combined with nonspecific EEG features, with better outcome in chronic disorders of consciousness 11 . Our results extend and complement that important observation by indicating the prognostic value of this paradigm in the acute period in which significant clinical decisions must be made regarding plans for rehabilitation or palliative care.…”

Section: Discussionsupporting

confidence: 88%

“…An EEG measure of speech comprehension is one such passive approach to identifying covert cognition that has recently shown prognostic value in chronic disorders of consciousness 11 (see also Coleman et al 12 for similar outcomes in a functional magnetic resonance imaging [fMRI] study). Using a similar approach, we investigated the level of covert speech comprehension evident in the EEG of a group of sedation‐free yet unresponsive patients with acute TBI in the intensive care unit.…”

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confidence: 99%

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Covert Speech Comprehension Predicts Recovery From Acute Unresponsive States

Sokoliuk

Degano

Banellis

et al. 2021

Annals of Neurology

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Objective Patients with traumatic brain injury who fail to obey commands after sedation‐washout pose one of the most significant challenges for neurological prognostication. Reducing prognostic uncertainty will lead to more appropriate care decisions and ensure provision of limited rehabilitation resources to those most likely to benefit. Bedside markers of covert residual cognition, including speech comprehension, may reduce this uncertainty. Methods We recruited 28 patients with acute traumatic brain injury who were 2 to 7 days sedation‐free and failed to obey commands. Patients heard streams of isochronous monosyllabic words that built meaningful phrases and sentences while their brain activity via electroencephalography (EEG) was recorded. In healthy individuals, EEG activity only synchronizes with the rhythm of phrases and sentences when listeners consciously comprehend the speech. This approach therefore provides a measure of residual speech comprehension in unresponsive patients. Results Seventeen and 16 patients were available for assessment with the Glasgow Outcome Scale Extended (GOSE) at 3 months and 6 months, respectively. Outcome significantly correlated with the strength of patients’ acute cortical tracking of phrases and sentences (r > 0.6, p < 0.007), quantified by inter‐trial phase coherence. Linear regressions revealed that the strength of this comprehension response (beta = 0.603, p = 0.006) significantly improved the accuracy of prognoses relative to clinical characteristics alone (eg, Glasgow Coma Scale [GCS], computed tomography [CT] grade). Interpretation A simple, passive, auditory EEG protocol improves prognostic accuracy in a critical period of clinical decision making. Unlike other approaches to probing covert cognition for prognostication, this approach is entirely passive and therefore less susceptible to cognitive deficits, increasing the number of patients who may benefit. ANN NEUROL 2021;89:646–656

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Section: Discussionsupporting

confidence: 88%

mentioning

confidence: 99%

Covert Speech Comprehension Predicts Recovery From Acute Unresponsive States

Sokoliuk

Degano

Banellis

et al. 2021

Annals of Neurology

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“…Fourth, Ding and colleagues 20 combined frequency tagging and hierarchical linguistic structures to design the protocol used in the present study. The present results are also strengthened by a recent independent study that reported robust EEG results using a similar approach 21 …”

supporting

confidence: 85%

Unmasking Covert Language Processing in the Intensive Care Unit with Electroencephalography

Edlow

Naccache

2021

Annals of Neurology

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“…Using topographical clustering methods, such as modified k-means and topographic atomize and agglomerate hierarchical clustering (TAAHC), typical maps are taken as the so-called microstates. These maps have been widely used to study the residual consciousness in unresponsive patients [17] and other consciousness-related brain activities, including sleep [18], [19], drowsiness [20], and hypnosis [21]. However, most of these researches focused on microstate analysis in a broad frequency range (1~40Hz).…”

Section: Introductionmentioning

confidence: 99%

Effective Brain State Estimation During Propofol-Induced Sedation Using Advanced EEG Microstate Spectral Analysis

Shi

Liu

et al. 2021

IEEE J. Biomed. Health Inform.

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Li and Shi: Effective brain state estimation during propofol-induced sedation using advanced EEG microstate spectral analysis 9  Abstract-Brain states are patterns of neuronal synchrony, and the electroencephalogram (EEG) microstate provides a promising tool to characterize and analyze the synchronous neural firing. However, the topographical spectral information for each predominate microstate is still unclear during the switch of consciousness, such as sedation, and the practical usage of the EEG microstate is worth probing. Also, the mechanism behind the anesthetic-induced alternations of brain states remains poorly understood. In this study, an advanced EEG microstate spectral analysis was utilized using multivariate empirical mode decomposition in Hilbert-Huang transform. The practicability was further investigated in scalp EEG recordings during the propofol-induced transition of consciousness. The process of transition from the awake baseline to moderate sedation was accompanied by apparent increases in microstate (A, B, and F) energy, especially in the whole-brain delta band, frontal alpha band and beta band. In comparison to other effective EEG-based parameters that commonly used to measure anesthetic depth, using

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Assessing the depth of language processing in patients with disorders of consciousness

Cited by 88 publications

References 60 publications

Covert Speech Comprehension Predicts Recovery From Acute Unresponsive States

Covert Speech Comprehension Predicts Recovery From Acute Unresponsive States

Unmasking Covert Language Processing in the Intensive Care Unit with Electroencephalography

Effective Brain State Estimation During Propofol-Induced Sedation Using Advanced EEG Microstate Spectral Analysis

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