Observational studyThe Lancet. Neurology2022
Cognitive-motor dissociation and time to functional recovery in patients with acute brain injury in the USA: a prospective observational cohort study.
Observational study in The Lancet. Neurology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 83 papers, 4 of them syntheses that pooled it.
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Who cites it
83 citing papers in PubMed, 4 syntheses or guidelines pooled it, 122 citations in OpenAlex.
- Cognitive Motor Dissociation in Disorders of Consciousness: An Individual Participant Data Meta-Analysis.European journal of neurology · 2026Pooled it
- An individual patient data meta-analysis on vagal nerve stimulation for recovery from disorders of consciousness.Scientific reports · 2026Pooled it
- A methodological guideline for consciousness assessment via neural electrophysiological activity.Military Medical Research · 2025Guideline
- Noninvasive neuromodulation for disorders of consciousness: an updated systematic review and meta-analysis.Critical care (London, England) · 2025Pooled it
- Stimulants for disorders of consciousness in the intensive care unit: a randomized, placebo-controlled trial.Brain : a journal of neurology · 2025Trial
- Covert brain complexity in the intensive care unit.Cortex; a journal devoted to the study of the nervous system and behavior · 2026Article
- Cognitive Processing of Novel Auditory Stimuli in Children with Acute Disorders of Consciousness.Neurocritical care · 2026Article
- Accuracy of Electronic Medical Records for Quantifying Rates of Sedative and Analgesic Infusions for Acute Disorders of Consciousness in Big Data Research.Neurocritical care · 2026Article
- Resting-state EEG for continuous prognostic monitoring and prediction of coma recovery after acute brain injury.Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology · 2026Article
- Auditory Stimuli Most Effective in Eliciting Reactivity in Critically Ill Patients with an Impaired Consciousness.Neurocritical care · 2026Article
- Supratentorial Brain Lesions in Unconscious Patients Map to a Common Human Brain Circuit.Annals of neurology · 2026Observational
- Neural Response to Familiar Names Predicts Outcome of Comatose ICU Patients: A Prospective Observational Cohort Study.Nature communications · 2026Observational
- Neurological Outcome Beyond the ICU in Patients with Severe Acute Brain Injury: A Knowledge gap for ICU Teams.Journal of intensive care medicine · 2026Observational
- Short-Term Spinal Cord Stimulation Improves Consciousness Level in Prolonged Disorders of Consciousness.Neurocritical care · 2026Article
- Multisensory integration in peripersonal space indexes consciousness states in sleep and disorders of consciousness.Cell reports. Medicine · 2026Article
- Covert Consciousness: Epistemic Limits of Its Definition and Detection.Neurocritical care · 2026Review
- Outcomes in Traumatic Brain Injury: Can Electroencephalography Predict the Unpredictable?Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2026Article
- Article
- Disorders of consciousness diagnosis, interventions, and prognostication for the intensivist: Report of the 2025 ISICEM roundtable.Intensive care medicine · 2026Review
- Amantadine Reshapes Brain Oscillatory Dynamics in Pediatric Disorders of Consciousness.Neural plasticity · 2026Article
23 more citing papers are in PubMed but not listed here.
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Authors and funding
18 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundRecovery trajectories of clinically unresponsive patients with acute brain injury are largely uncertain. Brain activation in the absence of a behavioural response to spoken motor commands can be detected by EEG, also known as cognitive-motor dissociation. We aimed to explore the role of cognitive-motor dissociation in predicting time to recovery in patients with acute brain injury.
methodsIn this observational cohort study, we prospectively studied two independent cohorts of clinically unresponsive patients (aged ≥18 years) with acute brain injury. Machine learning was applied to EEG recordings to diagnose cognitive-motor dissociation by detecting brain activation in response to verbal commands. Survival statistics and shift analyses were applied to the data to identify an association between cognitive-motor dissociation and time to and magnitude of recovery. The prediction accuracy of the model that was built using the derivation cohort was assessed using the validation cohort. Functional outcomes of all patients were assessed with the Glasgow Outcome Scale-Extended (GOS-E) at hospital discharge and at 3, 6, and 12 months after injury. Patients who underwent withdrawal of life-sustaining therapies were censored, and death was treated as a competing risk.
findingsBetween July 1, 2014, and Sept 30, 2021, we screened 598 patients with acute brain injury and included 193 (32%) patients, of whom 100 were in the derivation cohort and 93 were in the validation cohort. At 12 months, 28 (15%) of 193 unresponsive patients had a GOS-E score of 4 or above. Cognitive-motor dissociation was seen in 27 (14%) patients and was an independent predictor of shorter time to good recovery (hazard ratio 5·6 [95% CI 2·5-12·5]), as was underlying traumatic brain injury or subdural haematoma (4·4 [1·4-14·0]), a Glasgow Coma Scale score on admission of greater than or equal to 8 (2·2 [1·0-4·7]), and younger age (1·0 [1·0-1·1]). Among patients discharged home or to a rehabilitation setting, those diagnosed with cognitive-motor dissociation consistently had higher scores on GOS-E indicating better functional recovery compared with those without cognitive-motor dissociation, which was seen as early as 3 months after the injury (odds ratio 4·5 [95% CI 2·0-33·6]).
interpretationRecovery trajectories of clinically unresponsive patients diagnosed with cognitive-motor dissociation early after brain injury are distinctly different from those without cognitive-motor dissociation. 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.
fundingUS National Institutes of Health.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.