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Cognitive function in the locked-in syndrome

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Abstract

Objective

The lockedin syndrome (LIS) originates from a ventro-pontine lesion resulting in a complete quadraplegia and anarthria. Classically, communication remains possible by means of spared vertical eye movements and/or blinking. To allow assessing cognitive functions in LIS patients, we propose here a neuropsychological testing based on eye-coded communication.

Methods

Ten chronic LIS survivors were assessed 1 to 6 years after their brain insult.One patient was evaluated subacutely (at 2 months) and retested at 6 and 16 months.Neuropsychological testing encompassed short- and long-term memory, attention, executive functioning, phonological and semantic processing and verbal intelligence.

Results

None of the patients showed alterations in verbal intelligence. Impairments in one or several tests were found in five patients. In three of these patients, neuropsychological deficits could be related to additional cortical or thalamic structural brain lesions. In the other 2 patients, weakness or signs of fatigue only were observed in one or two cognitive tasks. Repeated measures in a subacute patient with pure brainstem lesion indicate the recovery of good levels of cognition 6 months after injury.

Conclusion

Results indicate that LIS patients can recover intact cognitive levels in cases of pure brainstem lesions, and that additional brain injuries are most likely responsible for associated cognitive deficits in the LIS. Furthermore, a systematic neuropsychological assessment in LIS patients would allow detecting their cognitive deficits,which will contribute to improve their quality of life and of communication with family and medical caretakers.

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Authors and Affiliations

  1. Cyclotron Research Center, University of Liège, Belgium

    Caroline Schnakers* BC, Melanie Boly* MD, Philippe Peigneux PhD & Steven Laureys* MD, PhD

  2. Dept. of Cognitive Sciences, Experimental Psychology and Cognitive, Neuroscience Research Unit-URPENC, University of Liège, Belgium

    Steve Majerus PhD

  3. PET/Biomedical Cyclotron Unit, Hôpital Erasme, Université Libre de Bruxelles, Belgium

    Serge Goldman MD, PhD

  4. Dept. of Speech Therapy, Hôpital de la Pitié-Salpêtrière and “Association du locked-in syndrome”, (ALIS), France

    Philippe Van Eeckhout

  5. Dept. of Neurorehabilitation, Centre Hospitalier Specialisé de l’Arche, Saint-Saturnin-Le Mans, France

    Stephane Gay MD

  6. Dept. of Neurorehabilitation, University Hospital of Nîmes, France

    Frederic Pellas MD

  7. Dept. of Physical Medicine, Centre Hospitalier Universitaire Sart Tilman, University of Liège, Belgium

    Valerie Bartsch MD

  8. Dept. of Neurology, Centre Hospitalier Universitaire Sart Tilman, University of Liège, Belgium

    Melanie Boly* MD, Gustave Moonen MD, PhD & Steven Laureys* MD, PhD

  9. Centre de Recherches du Cyclotron, Sart Tilman, B30, University of Liège, 4000, Liège, Belgium

    Caroline Schnakers* BC

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  1. Caroline Schnakers* BC
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  2. Steve Majerus PhD
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  3. Serge Goldman MD, PhD
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  4. Melanie Boly* MD
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  5. Philippe Van Eeckhout
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  11. Steven Laureys* MD, PhD
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Correspondence to Caroline Schnakers* BC.

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* The Coma Science Group.

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Schnakers*, C., Majerus, S., Goldman, S. et al. Cognitive function in the locked-in syndrome. J Neurol 255, 323–330 (2008). https://doi.org/10.1007/s00415-008-0544-0

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  • DOI: https://doi.org/10.1007/s00415-008-0544-0

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