A role for the default mode network in the bases of disorders of consciousness

Authors

  • Davinia Fernández-Espejo PhD,

    Corresponding author
    1. Brain and Mind Institute, University of Western Ontario, London, Ontario, Canada
    2. Department of Psychiatry and Clinical Psychobiology, IDIBAPS, University of Barcelona, Barcelona, Spain
    3. Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
    • Brain and Mind Institute, Natural Sciences Centre, University of Western Ontario, London, Ontario, N6A 5B7, Canada
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  • Andrea Soddu PhD,

    1. Coma Science Group, Cyclotron Research Centre and Neurology Department, University and University Hospital of Liège, Liège, Belgium
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  • Damian Cruse PhD,

    1. Brain and Mind Institute, University of Western Ontario, London, Ontario, Canada
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  • Eva M. Palacios MSc,

    1. Department of Psychiatry and Clinical Psychobiology, IDIBAPS, University of Barcelona, Barcelona, Spain
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  • Carme Junque PhD,

    1. Department of Psychiatry and Clinical Psychobiology, IDIBAPS, University of Barcelona, Barcelona, Spain
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  • Audrey Vanhaudenhuyse PhD,

    1. Coma Science Group, Cyclotron Research Centre and Neurology Department, University and University Hospital of Liège, Liège, Belgium
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  • Eva Rivas MD,

    1. Anesthesiology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain
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  • Virginia Newcombe MD, PhD,

    1. Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
    2. Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge,United Kingdom
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  • David K. Menon MD, PhD,

    1. Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
    2. Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge,United Kingdom
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  • John D. Pickard FMedSci, MChir, FRCS,

    1. Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
    2. Division of Academic Neurosurgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
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  • Steven Laureys MD, PhD,

    1. Coma Science Group, Cyclotron Research Centre and Neurology Department, University and University Hospital of Liège, Liège, Belgium
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  • Adrian M. Owen PhD

    1. Brain and Mind Institute, University of Western Ontario, London, Ontario, Canada
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Abstract

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 patients—19 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;72:335–343.

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