title: A role for the default mode network in the bases of disorders of consciousness.
abstract: OBJECTIVE
  Functional connectivity in the default mode network (DMN) is known to be reduced in patients with disorders of consciousness, to a different extent depending on their clinical severity. Nevertheless, the integrity of the structural architecture supporting this network and its relation with the exhibited functional disconnections are very poorly understood. We investigated the structural connectivity and white matter integrity of the DMN in patients with disorders of consciousness of varying clinical severity.
  
  
  METHODS
  Fifty-two patients--19 in a vegetative state (VS), 27 in a minimally conscious state (MCS), and 6 emerging from a minimally conscious state (EMCS)--and 23 healthy volunteers participated in the study. Structural connectivity was assessed by means of probabilistic tractography, and the integrity of the resulting fibers was characterized by their mean fractional anisotropy values.
  
  
  RESULTS
  Patients showed significant impairments in all of the pathways connecting cortical regions within this network, as well as the pathway connecting the posterior cingulate cortex/precuneus with the thalamus, relative to the healthy volunteers. Moreover, the structural integrity of this pathway, as well as that of those connecting the posterior areas of the network, was correlated with the patients' behavioral signs for awareness, being higher in EMCS patients than those in the upper and lower ranges of the MCS patients, and lowest in VS patients.
  
  
  CONCLUSIONS
  These results provide a possible neural substrate for the functional disconnection previously described in these patients, and reinforce the importance of the DMN in the genesis of awareness and the neural bases of its disorders.
authors.affiliation: Brain and Mind Institute, University of Western Ontario, London, Ontario, Canada. despejo@uwo.ca
authors.forename: Davinia
authors.initials: D
authors.lastname: Fernández-Espejo
authors.forename: Andrea
authors.initials: A
authors.lastname: Soddu
authors.forename: Damian
authors.initials: D
authors.lastname: Cruse
authors.forename: Eva M
authors.initials: EM
authors.lastname: Palacios
authors.forename: Carme
authors.initials: C
authors.lastname: Junque
authors.forename: Audrey
authors.initials: A
authors.lastname: Vanhaudenhuyse
authors.forename: Eva
authors.initials: E
authors.lastname: Rivas
authors.forename: Virginia
authors.initials: V
authors.lastname: Newcombe
authors.forename: David K
authors.initials: DK
authors.lastname: Menon
authors.forename: John D
authors.initials: JD
authors.lastname: Pickard
authors.forename: Steven
authors.initials: S
authors.lastname: Laureys
authors.forename: Adrian M
authors.initials: AM
authors.lastname: Owen
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001921:Brain / Q000473:pathology*; D001931:Brain Mapping; D003244:Consciousness Disorders / Q000473:pathology*; D056324:Diffusion Tensor Imaging; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D008959:Models, Neurological; D009415:Nerve Net / Q000473:pathology; D009434:Neural Pathways / Q000473:pathology*; D012720:Severity of Illness Index; D013223:Statistics as Topic