A・オウェンらの植物/最小意識状態患者の意識に関する新論文
まだ読んでいないのですが、
メモをかねて速報的に。
メモをかねて速報的に。
Dissociable endogenous and exogenous attention in disorders of consciousness
Srivas Chennu, et.al, NeuroImage: Clinical, Volume 3, pages 450-461
Srivas Chennu, et.al, NeuroImage: Clinical, Volume 3, pages 450-461
ハイライト
・ We dissociated endogenous and exogenous attention in disorders of consciousness.
• 21 vegetative (VS) and minimally conscious (MCS) patients tested with EEG task
• Exogenous bottom-up P3a found in 3 minimally conscious and 1 vegetative patient
• Endogenous top-down P3b found in one VS patient who performed fMRI tennis imagery
• Discriminative attention can be preserved in disorders of consciousness.
• 21 vegetative (VS) and minimally conscious (MCS) patients tested with EEG task
• Exogenous bottom-up P3a found in 3 minimally conscious and 1 vegetative patient
• Endogenous top-down P3b found in one VS patient who performed fMRI tennis imagery
• Discriminative attention can be preserved in disorders of consciousness.
Recent research suggests that despite the seeming inability of patients in vegetative and minimally conscious states to generate consistent behaviour, some might possess covert awareness detectable with functional neuroimaging. These findings motivate further research into the cognitive mechanisms that might support the existence of consciousness in these states of profound neurological dysfunction. One of the key questions in this regard relates to the nature and capabilities of attention in patients, known to be related to but distinct from consciousness. Previous assays of the electroencephalographic P300 marker of attention have demonstrated its presence and potential clinical value. Here we analysed data from 21 patients and 8 healthy volunteers collected during an experimental task designed to engender exogenous or endogenous attention, indexed by the P3a and P3b components, respectively, in response to a pair of word stimuli presented amongst distractors. Remarkably, we found that the early, bottom-up P3a and the late, top-down P3b could in fact be dissociated in a patient who fitted the behavioural criteria for the vegetative state. In juxtaposition with healthy volunteers, the patient's responses suggested the presence of a relatively high level of attentional abilities despite the absence of any behavioural indications thereof. Furthermore, we found independent evidence of covert command following in the patient, as measured by functional neuroimaging during tennis imagery. Three other minimally conscious patients evidenced non-discriminatory bottom-up orienting, but no top-down engagement of selective attentional control. Our findings present a persuasive case for dissociable attentional processing in behaviourally unresponsive patients, adding to our understanding of the possible levels and applications of consequent conscious awareness.
Thaddeus Popeがブログに引用している箇所は以下。
In order to try and assess the true level of brain function and awareness that survives in the vegetative and minimally conscious states, we are progressively building up a fuller picture of the sensory, perceptual and cognitive abilities in patients. This study has added a key piece to that puzzle, and provided a tremendous amount of insight into the ability of these patients to pay attention.
オウェン教授らの研究については ↓
「植物状態」５例に２例は誤診？(2008/9/15)
植物状態の人と脳スキャンでコミュニケーションが可能になった……けど？(2010/2/4)）
Hassan Rasouliさん、「植物状態」から「最少意識状態」へ診断変わる(2012/4/26)
Owen教授の研究で、12年以上「植物状態」だった患者に意識があることが判明(2012/11/13)
カナダの“無益な治療”訴訟で「Owen教授のアセスメントを」(2012/12/8)
Owen教授らの植物状態患者の意識検知に、ベッドサイド簡易法も(2013/3/29)
A・Owen教授らが論文を発表：「植物状態」の40％に誤診の可能性(2013/8/25)
「植物状態」５例に２例は誤診？(2008/9/15)
植物状態の人と脳スキャンでコミュニケーションが可能になった……けど？(2010/2/4)）
Hassan Rasouliさん、「植物状態」から「最少意識状態」へ診断変わる(2012/4/26)
Owen教授の研究で、12年以上「植物状態」だった患者に意識があることが判明(2012/11/13)
カナダの“無益な治療”訴訟で「Owen教授のアセスメントを」(2012/12/8)
Owen教授らの植物状態患者の意識検知に、ベッドサイド簡易法も(2013/3/29)
A・Owen教授らが論文を発表：「植物状態」の40％に誤診の可能性(2013/8/25)
