{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T02:16:53Z","timestamp":1789957013354,"version":"4.0.1"},"reference-count":27,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2019,3,19]],"date-time":"2019-03-19T00:00:00Z","timestamp":1552953600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002428","name":"Austrian Science Fund","doi-asserted-by":"publisher","award":["W 1223\u2010G16"],"award-info":[{"award-number":["W 1223\u2010G16"]}],"id":[{"id":"10.13039\/501100002428","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002428","name":"Austrian Science Fund","doi-asserted-by":"publisher","award":["Y\u201000777"],"award-info":[{"award-number":["Y\u201000777"]}],"id":[{"id":"10.13039\/501100002428","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004079","name":"Konrad-Adenauer-Stiftung","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004079","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Healthy circadian rhythmicity has been suggested to relate to a better state of brain\u2010injured patients and to support the emergence of consciousness in patient groups characterized by a relative instability thereof such as patients with disorders of consciousness (<jats:styled-content style=\"fixed-case\">DOC<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Going beyond earlier studies, a systems\u2010level perspective was adopted and, using multilevel modelling, the joint predictive value of three indices of circadian rhythm integrity derived from skin temperature variations, melatoninsulfate secretion, and physical activity (wrist actigraphy) patterns was evaluated for the behaviourally assessed state <jats:styled-content style=\"fixed-case\">[Coma Recovery Scale \u2010 Revised (CRS\u2010R) score] of DOC<\/jats:styled-content> patients [13 unresponsive wakefulness syndrome; seven minimally conscious (exit) state]. Additionally, it was assessed in a subset of 16 patients whether patients\u2019 behavioural repertoire (<jats:styled-content style=\"fixed-case\">CRS<\/jats:styled-content>\u2010R score) varied (i) with time of day or (ii) offset from the body temperature maximum (<jats:styled-content style=\"fixed-case\">BT<\/jats:styled-content><jats:sub>max<\/jats:sub>), i.e. when cognitive performance is expected to peak.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The results reveal that better integrity of circadian melatoninsulfate and temperature rhythms relate to a richer behavioural repertoire. Moreover, higher <jats:styled-content style=\"fixed-case\">CRS<\/jats:styled-content>\u2010R scores are, by trend, related to assessments taking place at a later daytime or deviating less from the pre\u2010specified time of occurrence of <jats:styled-content style=\"fixed-case\">BT<\/jats:styled-content><jats:sub>max<\/jats:sub>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In conclusion, the results suggest that therapeutic approaches aimed at improving circadian rhythms in brain\u2010injured patients are promising and should be implemented in hospitals or nursing homes. Beyond this, it might be helpful to schedule diagnostic procedures and therapies around the (pre\u2010assessed) <jats:styled-content style=\"fixed-case\">BT<\/jats:styled-content><jats:sub>max<\/jats:sub> (\u22484\u00a0pm in healthy individuals) as this is when patients should be most responsive.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.13935","type":"journal-article","created":{"date-parts":[[2019,2,16]],"date-time":"2019-02-16T06:23:56Z","timestamp":1550298236000},"page":"1051-1059","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Healthier rhythm, healthier brain? Integrity of circadian melatonin and temperature rhythms relates to the clinical state of brain\u2010injured patients"],"prefix":"10.1111","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2328-9612","authenticated-orcid":false,"given":"C.","family":"Blume","sequence":"first","affiliation":[{"name":"Department of Psychology University of Salzburg Laboratory for Sleep, Cognition, and Consciousness Research Salzburg Austria"},{"name":"University of Salzburg Centre for Cognitive Neuroscience Salzburg Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Angerer","sequence":"additional","affiliation":[{"name":"Department of Psychology University of Salzburg Laboratory for Sleep, Cognition, and Consciousness Research Salzburg Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Raml","sequence":"additional","affiliation":[{"name":"Department of Psychology University of Salzburg Laboratory for Sleep, Cognition, and Consciousness Research Salzburg Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"del Giudice","sequence":"additional","affiliation":[{"name":"Department of Psychology University of Salzburg Laboratory for Sleep, Cognition, and Consciousness Research Salzburg Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Santhi","sequence":"additional","affiliation":[{"name":"Surrey Sleep Research Centre Faculty of Health and Medical Sciences University of Surrey Guildford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Pichler","sequence":"additional","affiliation":[{"name":"Geriatric Health Centres of the City of Graz Albert Schweitzer Clinic Apallic Care Unit Graz Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. 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