Identifying patients with cognitive motor dissociation using resting-state temporal stability

• Published in: NeuroImage (Orlando, Fla.) Fla.), 2023-05, Vol.272, p.120050-120050, Article 120050
• Main Authors: Wu, Hang, Xie, Qiuyou, Pan, Jiahui, Liang, Qimei, Lan, Yue, Guo, Yequn, Han, Junrong, Xie, Musi, Liu, Yueyao, Jiang, Liubei, Wu, Xuehai, Li, Yuanqing, Qin, Pengmin
• Format: Article
• Language: English
• Subjects: Alzheimer's disease; Brain; Brain - diagnostic imaging; Brain architecture; Brain mapping; Cognition; Cognitive ability; Cognitive motor dissociation; Computer applications; Consciousness; Consciousness Disorders; Datasets; Disorders of consciousness; Dynamic functional connectivity; Functional magnetic resonance imaging; Functional morphology; Humans; Implants; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Medical imaging; Mental disorders; Neuroimaging; Patients; Resting-state fMRI; Support vector machines; Temporal stability; Traumatic brain injury; Unconsciousness
• ISSN: 1053-8119; 1095-9572
• DOI: 10.1016/j.neuroimage.2023.120050

•We investigated the resting-state temporal stability in disorders of consciousness.•Whole-brain and regional temporal stability was impaired in disorders of consciousness.•A classification model was built that correctly identify cognitive motor dissociation.•Multiple independent datasets were included for validating the classification model. Using task-dependent neuroimaging techniques, recent studies discovered a fraction of patients with disorders of consciousness (DOC) who had no command-following behaviors but showed a clear sign of awareness as healthy controls, which was defined as cognitive motor dissociation (CMD). However, existing task-dependent approaches might fail when CMD patients have cognitive function (e.g., attention, memory) impairments, in which patients with covert awareness cannot perform a specific task accurately and are thus wrongly considered unconscious, which leads to false-negative findings. Recent studies have suggested that sustaining a stable functional organization over time, i.e., high temporal stability, is crucial for supporting consciousness. Thus, temporal stability could be a powerful tool to detect the patient's cognitive functions (e.g., consciousness), while its alteration in the DOC and its capacity for identifying CMD were unclear. The resting-state fMRI (rs-fMRI) study included 119 participants from three independent research sites. A sliding-window approach was used to investigate global and regional temporal stability, which measured how stable the brain's functional architecture was across time. The temporal stability was compared in the first dataset (36/16 DOC/controls), and then a Support Vector Machine (SVM) classifier was built to discriminate DOC from controls. Furthermore, the generalizability of the SVM classifier was tested in the second independent dataset (35/21 DOC/controls). Finally, the SVM classifier was applied to the third independent dataset, where patients underwent rs-fMRI and brain-computer interface assessment (4/7 CMD/potential non-CMD), to test its performance in identifying CMD. Our results showed that global and regional temporal stability was impaired in DOC patients, especially in regions of the cingulo-opercular task control network, default-mode network, fronto-parietal task control network, and salience network. Using temporal stability as the feature, the SVM model not only showed good performance in the first dataset (accuracy = 90%), but also good generalizability in the sec