title: Residual cognitive function in comatose, vegetative and minimally conscious states.
abstract: OBJECTIVE
  The clinical evaluation of cognition in non-communicative severely brain-damaged patients is inherently difficult. In addition to novel behavioural 'consciousness-scales', the role of para-clinical markers of consciousness, such as event related potentials and functional neuroimaging is reviewed.
  
  
  RESULTS
  New behavioural scales for vegetative and minimally conscious patients have been shown to reduce diagnostic error but regrettably remain underused in clinical routine. Electrophysiological studies have confirmed their role in estimating outcome and possibly cognition. Several recent functional neuroimaging studies have shown residual cortical function in undeniably vegetative patients. This cortical activation, however, seems limited to primary 'low-level' areas and does not imply 'higher-order' integration, considered necessary for conscious perception. Minimally conscious patients show large-scale high-order cerebral activation, apparently dependent upon the emotional relevance of the stimulation.
  
  
  CONCLUSIONS
  Careful clinical assessment of putative 'conscious behaviour' in vegetative and minimally conscious patients is the first requirement for their proper diagnosis and management. Complementary functional neuroimaging and electrophysiological studies will have a major impact on future clinical decision making and may guide selective therapeutic options. At present, more experimental evidence and the elucidation of methodological and ethical controversies are awaited prior to their routine clinical use.
authors.affiliation: Cyclotron Research Centre, University of Liège, Belgium. steven.laureys@ulg.ac.be
authors.forename: Steven
authors.initials: S
authors.lastname: Laureys
authors.forename: Fabien
authors.initials: F
authors.lastname: Perrin
authors.forename: Caroline
authors.initials: C
authors.lastname: Schnakers
authors.forename: Melanie
authors.initials: M
authors.lastname: Boly
authors.forename: Steve
authors.initials: S
authors.lastname: Majerus
mesh_terms: D003071:Cognition / Q000502:physiology*; D003128:Coma / Q000503:physiopathology* / Q000523:psychology; D003952:Diagnostic Imaging; D005071:Evoked Potentials / Q000502:physiology; D006801:Humans; D018458:Persistent Vegetative State / Q000503:physiopathology* / Q000523:psychology; D020127:Recovery of Function / Q000502:physiology; D012720:Severity of Illness Index