期刊
ANNALS OF NEUROLOGY
卷 72, 期 3, 页码 335-343出版社
WILEY
DOI: 10.1002/ana.23635
关键词
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资金
- Spanish Ministry of Science and Innovation [SAF2007-66077]
- Spanish Ministry of Education [AP2006-00862]
- Medical Research Council [U.1055.01.002.00001.01, G9439390 ID 65883]
- James S. McDonnell Foundation
- Canada Excellence Research Chairs Program
- European Commission
- Fonds de la Recherche Scientifique
- Mind Science Foundation
- Belgian French-Speaking Community Concerted Research Action University Hospital of Liege
- European Space Agency
- Gates Cambridge Trust
- UK National Institute of Health Research Biomedical Research Centre at Cambridge
- UK Department of Health
- University of Liege
- Ministry of Science (Spain)
- ESICM research grant
- GlaxoSmithKline
- Cambridge University
- Medical Research Council [G0001237, G9439390, G0600986] Funding Source: researchfish
- National Institute for Health Research [ACF-2009-14-007] Funding Source: researchfish
- MRC [G9439390, G0001237, G0600986] Funding Source: UKRI
Objective: Functional connectivity in the default mode network (DMN) is known to be reduced in patients with disorders of consciousness, to a different extent depending on their clinical severity. Nevertheless, the integrity of the structural architecture supporting this network and its relation with the exhibited functional disconnections are very poorly understood. We investigated the structural connectivity and white matter integrity of the DMN in patients with disorders of consciousness of varying clinical severity. Methods: Fifty-two patients19 in a vegetative state (VS), 27 in a minimally conscious state (MCS), and 6 emerging from a minimally conscious state (EMCS)and 23 healthy volunteers participated in the study. Structural connectivity was assessed by means of probabilistic tractography, and the integrity of the resulting fibers was characterized by their mean fractional anisotropy values. Results: Patients showed significant impairments in all of the pathways connecting cortical regions within this network, as well as the pathway connecting the posterior cingulate cortex/precuneus with the thalamus, relative to the healthy volunteers. Moreover, the structural integrity of this pathway, as well as that of those connecting the posterior areas of the network, was correlated with the patients' behavioral signs for awareness, being higher in EMCS patients than those in the upper and lower ranges of the MCS patients, and lowest in VS patients. Interpretation: These results provide a possible neural substrate for the functional disconnection previously described in these patients, and reinforce the importance of the DMN in the genesis of awareness and the neural bases of its disorders. Ann Neurol 2012;72:335343.
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