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Cognitive-Motor Dissociation and Time to Functional Recovery in Patients with Acute Brain Injury in the USA: A Prospective Observational Cohort Study

By Currents Editor posted 10-28-2022 14:02

  

The Lancet Neurology (08/01/22) Vol. 21, No. 8, P. 704, DOI: 10.1016/S1474-4422(22)00212-5
Egbebike, Jennifer; Shen, Qi; Doyle, Kevin; et al.
https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(22)00212-5/fulltext 

For clinically unresponsive patients with acute brain injury, new research shows that cognitive-motor dissociation is an independent predictor of shorter time to good recovery. Other such factors include underlying traumatic brain injury or subdural hematoma, a Glasgow Coma Scale score on admission of at least 8, and younger age.  The observational cohort study included 193 adults with acute brain injury, with 100 in the derivation cohort and 93 in the validation cohort. The researchers applied machine learning to EEG recordings to diagnose cognitive-motor dissociation, looking for brain activity in response to verbal cues. Using the data, researchers applied survival statistics and shift analyses to identify an association between cognitive-motor dissociation and time to and magnitude of recovery. The Glasgow Outcome Scale–Extended (GOS-E) was used to assess patients' functional outcomes at hospital discharge and at 3, 6, and 12 months post-injury. Overall, 15% of the patients had a GOS-E score of 4 or higher at 12 months. For patients who were discharged home or to a rehabilitation facility, individuals with cognitive-motor dissociation had higher GOS-E scores, suggesting better functional recovery compared with individuals who did not have it. For some patients, cognitive-motor dissociation was detected as early as 3 months following the acute brain injury. Noting the "[r]ecovery trajectories of clinically unresponsive patients diagnosed with cognitive-motor dissociation early after brain injury are distinctly different from those without cognitive-motor dissociation," the researchers write that "[a] diagnosis of cognitive-motor dissociation could inform the counselling of families of clinically unresponsive patients, and it could help clinicians to identify patients who will benefit from rehabilitation."

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