Cognitive motor dissociation in patients with chronic disorders of consciousness: a literature review

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Abstract

Chronic disorders of consciousness include several conditions that differ significantly in both clinical and neurophysiological features. As medical technology continues to develop, the differential diagnosis of disorders of consciousness extends beyond purely clinical work. Nevertheless, all types of consciousness disorders are united by varying degrees of dissociation between wakefulness, cognitive and motor activity. The external similarity and minimal differences in clinical symptoms in unresponsive patients may hide different morphofunctional variants of this condition. In particular, use of electroencephalography and functional magnetic re- sonance imaging techniques allows us to detect covert consciousness in some clinically unresponsive patients. Based on various estimates, this phenomenon occurs in 5–15% of all cases. A special instance of covert consciousness is cognitive motor dissociation (CMD), defined as activation of cortical motor centers, recorded using neurophysiological techniques, in response to a corresponding instruction to perform a movement without its visible performance. Some researchers believe that detection of CMD indicates a more favourable prognosis for the subsequent restoration of consciousness, rather than its absence. The aim of this review is to examine CMD and its potential significance for outcomes in patients with chronic disorders of consciousness.

About the authors

Vladimir A. Belkin

Clinical Institute of the Brain

Author for correspondence.
Email: vbelkin@neuro-ural.ru
ORCID iD: 0000-0002-4043-743X

neurologist, Intensive care unit

Russian Federation, 623702, Berezovsky, Sverdlovsk Region, Russia, Shilovsky str., 28. build. 6

Kseniya A. Ilina

Research Center of Neurology

Email: vbelkin@neuro-ural.ru
ORCID iD: 0000-0002-3014-4350

neurologist, Department of anesthesiology and intensive care

Russian Federation, Moscow

Yulia V. Ryabinkina

Research Center of Neurology

Email: vbelkin@neuro-ural.ru
ORCID iD: 0000-0001-8576-9983

D. Sci. (Med.), Head, Department of anesthesiology and intensive care

Russian Federation, Moscow

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Copyright (c) 2021 Belkin V.A., Ilina K.A., Ryabinkina Y.V.

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