Minimally conscious state “plus”: diagnostic criteria and relation to functional recovery

Background We investigated the relationship between three language-dependent behaviors (i.e., command-following, intelligible verbalization, and intentional communication) and the functional status of patients with disorders of consciousness (DoC). We hypothesized that patients in minimally consciou...

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Bibliographic Details
Published in:Journal of neurology Vol. 267; no. 5; pp. 1245 - 1254
Main Authors: Thibaut, Aurore, Bodien, Yelena G., Laureys, Steven, Giacino, Joseph T.
Format: Journal Article
Language:English
Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.05.2020
Springer Nature B.V
Springer
Subjects:
Adolescent
Adult
Aged
Behavior
Brain Injuries - complications
Brain injury
Brain-injuries
Coma recovery scale-revised
Command-following
Consciousness
Disability rating scale
Disorders of consciousness
Etiology
Female
Humans
Intelligible verbalization
Intentional communication
Language
Male
Medicine
Medicine & Public Health
Middle Aged
Minimally conscious state
Neurology
Neuroradiology
Neurosciences
Neurosciences & behavior
Neurosciences & comportement
Original Communication
Persistent Vegetative State - diagnosis
Persistent Vegetative State - etiology
Persistent Vegetative State - physiopathology
Recovery of function
Recovery of Function - physiology
Rehabilitation
Retrospective Studies
Sciences sociales & comportementales, psychologie
Severity of Illness Index
Sleep and wakefulness
Social & behavioral sciences, psychology
Unconsciousness
Young Adult
Command-following
Disability rating scale
Minimally conscious state
Disorders of consciousness
Brain-injuries
Coma recovery scale-revised
Intelligible verbalization
Intentional communication
ISSN:0340-5354, 1432-1459, 1432-1459
Online Access:Get full text
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Summary:Background We investigated the relationship between three language-dependent behaviors (i.e., command-following, intelligible verbalization, and intentional communication) and the functional status of patients with disorders of consciousness (DoC). We hypothesized that patients in minimally conscious state (MCS) who retain behavioral evidence of preserved language function would have similar levels of functional disability, while patients who lack these behaviors would demonstrate significantly greater disability. We reasoned that these results could then be used to establish empirically-based diagnostic criteria for MCS +. Methods In this retrospective cohort study we included rehabilitation inpatients diagnosed with DoC following severe-acquired brain injury (MCS = 57; vegetative state/unresponsive wakefulness syndrome [VS/UWS] = 63); women: 46; mean age: 47 ± 19 years; traumatic etiology: 68; time post-injury: 40 ± 23 days). We compared the scores of the Disability Rating Scale score (DRS) at time of transition from VS/UWS to MCS or from MCS – to MCS +, and at discharge between groups. Results Level of disability on the DRS was similar in patients with any combination of the three language-related behaviors. MCS patients with no behavioral evidence of language function (i.e., MCS –) were more functionally impaired than patients with MCS + at time of transition and at discharge. Conclusions Command-following, intelligible verbalization, and intentional communication are not associated with different levels of functional disability. Thus, the MCS + syndrome can be diagnosed based on the presence of any one of these language-related behaviors. Patients in MCS + may evidence less functional disability compared to those in MCS who fail to demonstrate language function (i.e., MCS –).
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scopus-id:2-s2.0-85075616654
ISSN:0340-5354
1432-1459
1432-1459
DOI:10.1007/s00415-019-09628-y