Dopaminergic brainstem disconnection is common to pharmacological and pathological consciousness perturbation
Proceedings of the National Academy of Sciences of the United States of America July 23, 2021 L. R. Spindler, A. Luppi, R. Adapa et al.
A network of brain regions called the default mode network breaks down during anesthesia and after brain damage causing disorders of consciousness. The neurochemical reasons for this breakdown were unclear. Using functional MRI, researchers found that the ventral tegmental area, a dopamine-producing brainstem region, disconnects from key default mode network nodes (precuneus and posterior cingulate) during both propofol sedation and disorders of consciousness. Stronger connectivity between the ventral tegmental area and these nodes was associated with a more awake-like configuration of the default mode network. In patients with disorders of consciousness who later improved behaviorally, this connectivity increased toward healthy levels. In a separate group of traumatic brain injury patients, the drug methylphenidate significantly strengthened this connection. The findings suggest that dopamine modulation may be central to maintaining consciousness.