Modulation of the default-mode network and the attentional network by self-referential processes in patients with disorder of consciousness

Disorders of consciousness (DOC) are related to an altered capacity of the brain to successfully integrate and segregate information. Alterations in brain functional networks structure have been found in fMRI studies, which could account for the incapability of the brain to efficiently manage internally and externally generated information. Here we assess the modulation of neural activity in areas of the networks related to active introspective or extrospective processing in 9 patients with DOC and 17 controls using fMRI. In addition, we assess the functional connectivity between those areas in resting state. Patients were experimentally studied in an early phase after the event of brain injury (3±1 months after the event) and subsequently in a second session 4±1 months after the first session. The results showed that the concerted modulation of the default mode network (DMN) and attentional network (AN) in response to the active involvement in the task improved with the level of consciousness, reflecting an integral recovery of the brain in its ability to be engaged in cognitive processes. In addition, functional connectivity decreased between the DMN and AN with recovery. Our results help to further understand the neural underpins of the disorders of consciousness.