Background: Disorders of consciousness (DOC) result from focal or extensive brain
lesions. Patients suffering from DOC go through neurobehavioral assessments and are
classified in different categories: coma, unresponsive wakefulness syndrome (UWS)
(also known as vegetative state) and minimally conscious state (MCS). Recently, the
broader use of technologies, such as functional neuroimaging and
electroencephalography, has allowed the highlighting of preserved cognitive capacities
in patients behaviourally categorized as UWS or MCS. Such condition is called cognitive
motor dissociation (CMD).
Objectives: 1) To investigate the consciousness/functional recovery in patients with
disorders of consciousness (DOC) as well as those presenting with cognitive motor
dissociation (CMD), 2) to compare the different functional outcomes to see whether
those with preserved cognitive capacities differ and 3) to evaluate the patients’ clinical
evolution between admission and discharge.
Method: We retrospectively included 141 patients admitted to the Acute Neurorehabilitation
Unit (NRA) of the University Hospital of Lausanne (CHUV, Lausanne,
Switzerland) from November 2011 to August 2018 and investigated their functional
outcomes at admission and discharge using 6 different outcome scales. Univariate
analyses were then performed to compare the different functional outcomes.
Results: Patients presenting with CMD were significantly associated with better
functional outcomes and potential of improvement than the patients suffering from DOC.
Conclusion: Our findings support the fact that CMD patients constitute a separate
category of patients with different potential of improvement and functional outcomes
than patients suffering from DOC. This reinforces the need for them to be recognized as
soon as possible, as it could have a direct impact on patient care and influence life and
death decisions.