How are different neural networks related to consciousness?

Functional connectivity within two brain networks plays distinct roles in disorders of consciousness. Connectivity in the salience network, particularly between the supragenual anterior cingulate cortex and left anterior insula, was reduced in patients with unresponsive wakefulness syndrome compared to those in a minimally conscious state or fully conscious brain-lesioned patients. This connectivity correlated with behavioral signs of consciousness. In contrast, connectivity in the default-mode network, specifically between the posterior cingulate cortex and left lateral parietal cortex, was weaker in patients with unresponsive wakefulness syndrome who did not recover compared to those who later emerged from this state, suggesting this network predicts recovery of consciousness.

Study at a glance

Abstract

OBJECTIVE: We aimed to investigate the roles of different resting-state networks in predicting both the actual level of consciousness and its recovery in brain injury patients. METHODS: We investigated resting-state functional connectivity within different networks in patients with varying levels of consciousness: unresponsive wakefulness syndrome (UWS; n = 56), minimally conscious state (MCS; n = 29), and patients with brain lesions but full consciousness (BL; n = 48). Considering the actual level of consciousness, we compared the strength of network connectivity among the patient groups. We then checked the presence of connections between specific regions in individual patients and calculated the frequency of this in the different patient groups. Considering the recovery of consciousness, we split the UWS group into 2 subgroups according to recovery: those who emerged from UWS (UWS-E) and those who remained in UWS (UWS-R). The above analyses were repeated on these 2 subgroups. RESULTS: Functional connectivity strength in salience network (SN), especially connectivity between the supragenual anterior cingulate cortex (SACC) and left anterior insula (LAI), was reduced in the unconscious state (UWS) compared to the conscious state (MCS and BL). Moreover, at the individual level, SACC-LAI connectivity was more present in MCS than in UWS. Default-mode network (DMN) connectivity strength, especially between the posterior cingulate cortex (PCC) and left lateral parietal cortex (LLPC), was reduced in UWS-R compared with UWS-E. Furthermore, PCC-LLPC connectivity was more present in UWS-E than in UWS-R. INTERPRETATION: Our findings show that SN (SACC-LAI) connectivity correlates with behavioral signs of consciousness, whereas DMN (PCC-LLPC) connectivity instead predicts recovery of consciousness.