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Covert Cognition in Disorders of Consciousness: A Meta-Analysis

Schnakers C 1 , Hirsch M 2 , Noé E 3 , Llorens R 3 , Lejeune N 4 , Veeramuthu V 5 Show all authors , De Marco S 6 , Demertzi A 4 , Duclos C 7 , Morrissey AM 8 , Chatelle C 4 , Estraneo A 9

Affiliations 

  • 1 Casa Colina Hospital and Centers for Healthcare, Pomona, CA 917697, USA
  • 2 Department of Psychology, University of California Los Angeles, Los Angeles, CA 90095, USA
  • 3 NEURORHB, Servicio de Neurorrehabilitación de Hospitales Vithas, 46011 València, Spain
  • 4 GIGA-Consciousness, Coma Science Group, University of Liège, 4000 Liège, Belgium
  • 5 ReGen Rehabilitation Hospital, Petaling Jaya 46200, Malaysia
  • 6 Servicio de Terapia Ocupacional, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba, Córdoba X5000 IYG, Argentina
  • 7 School of Physical and Occupational Therapy, McGill University, Montreal, QC H3A 0G4, Canada
  • 8 Ageing Research Centre, Health Research Institute, School of Allied Health, University of Limerick, V94 T9PX Limerick, Ireland
  • 9 IRCCS Fondazione Don Carlo Gnocchi, 50143 Florence, Italy
Brain Sci, 2020 Dec 02;10(12).
PMID: 33276451 DOI: 10.3390/brainsci10120930

Abstract

Covert cognition in patients with disorders of consciousness represents a real diagnostic conundrum for clinicians. In this meta-analysis, our main objective was to identify clinical and demographic variables that are more likely to be associated with responding to an active paradigm. Among 2018 citations found on PubMed, 60 observational studies were found relevant. Based on the QUADAS-2, 49 studies were considered. Data from 25 publications were extracted and included in the meta-analysis. Most of these studies used electrophysiology as well as counting tasks or mental imagery. According to our statistical analysis, patients clinically diagnosed as being in a vegetative state and in a minimally conscious state minus (MCS-) show similar likelihood in responding to active paradigm and responders are most likely suffering from a traumatic brain injury. In the future, multi-centric studies should be performed in order to increase sample size, with similar methodologies and include structural and functional neuroimaging in order to identify cerebral markers related to such a challenging diagnosis.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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