New research into people in a vegetative state

The New York Times
www.nytimes.com

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Sun, Apr 12 at 7:46 AM

But first, a study found that some people in vegetative states may have more awareness than we thought.

Let’s say something bad happens — a crash, a fall, a stroke, an overdose. Your brain absorbs a violent shock or a period without oxygen. But your heart still beats and your lungs still heave. Now you’re unconscious in the hospital, unable to respond when your spouse calls your name or your doctor prods you with a reflex hammer.

For years, these patients were said to be in a “persistent vegetative state”: bodies without minds. They idle, mostly in care centers and nursing homes, with little attention. But new research shows that many such patients — tens of thousands of Americans — may actually be hearing and thinking. That is the (somewhat horrifying) subject of Katie Engelhart’s new article for The Times Magazine. I asked her about it.

Adam: Now we know that some people declared vegetative can actually perceive and understand things around them. How many people are we talking about?

Katie: Nobody is counting. By some estimates, around 50,000 Americans are in a chronic vegetative state, meaning that they are technically awake, but have no awareness of what is going on around them. Another 200,000 to 400,000 are in a “minimally conscious state,” with fleeting periods of awareness. Research suggests that about a quarter of all these patients are able to follow commands like, “Imagine opening and closing your hand.”

How did researchers figure out that this set of patients was conscious?

Back in 2006, a neuroscientist at Cambridge University put a 23-year-old woman, who had been diagnosed as being in a vegetative state, into an fMRI scanner and asked her to “imagine playing tennis.” And she did! The area that controls motor planning in her brain lit up in just the same way that a healthy person’s brain would. The phenomenon was widely replicated.

The scary thing is that it doesn’t seem like there’s any way for ordinary patients to get tested for this awareness.

Exactly. Researchers have been able to find covertly conscious patients for 20 years, but the testing is almost exclusively done through research trials. I interviewed many people whose loved ones had been diagnosed as being in a vegetative state — and whose doctors never even raised the possibility of covert consciousness. But family members are doing their own research, and they want access to the cutting-edge science.