{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:05:05Z","timestamp":1787025905721,"version":"build-2736575974"},"reference-count":59,"publisher":"SAGE Publications","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["NRE"],"published-print":{"date-parts":[[2024,1,23]]},"abstract":"<jats:p>Detecting willful cognition in these patients is known to be challenging due to the patients\u2019 motor disabilities and high vigilance fluctuations but also due to the lack of expertise and use of adequate tools to assess these patients in specific settings. This review will discuss the main disorders of consciousness after severe brain injury, how to assess consciousness and cognition in these patients, as well as the challenges and tools available to overcome these challenges and reach an accurate diagnosis.<\/jats:p>","DOI":"10.3233\/nre-230140","type":"journal-article","created":{"date-parts":[[2024,1,16]],"date-time":"2024-01-16T11:14:45Z","timestamp":1705403685000},"page":"11-21","source":"Crossref","is-referenced-by-count":5,"title":["Assessing consciousness and cognition in disorders of consciousness"],"prefix":"10.1177","volume":"54","author":[{"given":"Caroline","family":"Schnakers","sequence":"first","affiliation":[{"name":"Research Institute, Casa Colina Hospital and Centers for Healthcare, 255 E. Bonita Avenue, Pomona, CA 91769, USA. Tel.: +1 909 596 7733 (ext. 3038); E-mail: cschnakers@casacolina.org"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","reference":[{"key":"10.3233\/NRE-230140_ref1","doi-asserted-by":"crossref","first-page":"116600","DOI":"10.1016\/j.jns.2019.116600","article-title":"The current significance of the FOUR score: A systematic review and critical analysis of the literature","volume":"409","author":"Anestis,","year":"2020","journal-title":"J Neurol Sci"},{"key":"10.3233\/NRE-230140_ref2","doi-asserted-by":"crossref","first-page":"665","DOI":"10.3389\/fneur.2018.00665","article-title":"Brain, Behavior, and Cognitive Interplay in Disorders of Consciousness: A Multiple Case Study","volume":"9","author":"Aubinet,","year":"2018","journal-title":"Front Neurol"},{"issue":"11","key":"10.3233\/NRE-230140_ref3","doi-asserted-by":"crossref","first-page":"4519","DOI":"10.1002\/hbm.24303","article-title":"Clinical subcategorization of minimally conscious state according to resting functional connectivity","volume":"39","author":"Aubinet,","year":"2018","journal-title":"Hum Brain Mapp"},{"issue":"2","key":"10.3233\/NRE-230140_ref4","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1177\/1545968319899914","article-title":"Brain Metabolism but Not Gray Matter Volume Underlies the Presence of Language Function in the Minimally Conscious State (MCS): MCS+ Versus MCS\u2013 Neuroimaging Differences","volume":"34","author":"Aubinet,","year":"2020","journal-title":"Neurorehabil Neural Repair"},{"issue":"5","key":"10.3233\/NRE-230140_ref5","doi-asserted-by":"crossref","first-page":"101432","DOI":"10.1016\/j.rehab.2020.09.001","article-title":"Simplified evaluation of CONsciousness disorders (SECONDs) in individuals with severe Brain Injury: A validation study","volume":"64","author":"Aubinet,","year":"2021","journal-title":"Ann Phys Rehabil Med"},{"issue":"6","key":"10.3233\/NRE-230140_ref6","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1080\/02699052.2021.1894482","article-title":"The Brief Evaluation of Receptive Aphasia test for the detection of language impairment in patients with severe Brain Injury","volume":"35","author":"Aubinet,","year":"2021","journal-title":"Brain Inj"},{"issue":"1","key":"10.3233\/NRE-230140_ref7","doi-asserted-by":"crossref","first-page":"fcz017","DOI":"10.1093\/braincomms\/fcz017","article-title":"Longitudinal assessments highlight long-term behavioural recovery in disorders of consciousness","volume":"1","author":"Bareham,","year":"2019","journal-title":"Brain Commun"},{"issue":"11","key":"10.3233\/NRE-230140_ref8","doi-asserted-by":"crossref","first-page":"2535","DOI":"10.1097\/j.pain.0000000000001637","article-title":"Assessing pain in critically ill brain-injured patients: a psychometric comparison of pain scales and videopupillometry","volume":"160","author":"Bernard,","year":"2019","journal-title":"Pain"},{"issue":"20","key":"10.3233\/NRE-230140_ref9","doi-asserted-by":"crossref","first-page":"1933","DOI":"10.1212\/WNL.0000000000003942","article-title":"Significance of circadian rhythms in severely brain-injured patients: A clue to consciousness?","volume":"88","author":"Blume,","year":"2017","journal-title":"Neurology"},{"issue":"1","key":"10.3233\/NRE-230140_ref10","doi-asserted-by":"crossref","first-page":"65","DOI":"10.3233\/NRE-192860","article-title":"Cognitive impairment, clinical symptoms and functional disability in patients emerging from the minimally conscious state","volume":"46","author":"Bodien,","year":"2020","journal-title":"NeuroRehabilitation"},{"issue":"5-6","key":"10.3233\/NRE-230140_ref11","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1016\/j.jpain.2019.11.004","article-title":"Nociception Coma Scale Revised allows to identify patients with preserved neural basis for pain experience","volume":"21","author":"Bonin,","year":"2020","journal-title":"J Pain"},{"issue":"2","key":"10.3233\/NRE-230140_ref12","doi-asserted-by":"crossref","first-page":"fcaa195","DOI":"10.1093\/braincomms\/fcaa195","article-title":"Auditory localization should be considered as a sign of minimally conscious state based on multimodal findings","volume":"2","author":"Carri\u00e8re,","year":"2020","journal-title":"Brain Commun"},{"issue":"12","key":"10.3233\/NRE-230140_ref13","doi-asserted-by":"crossref","first-page":"1233","DOI":"10.1136\/jnnp-2012-302987","article-title":"A sensitive scale to assess nociceptive pain in patients with disorders of consciousness","volume":"83","author":"Chatelle,","year":"2012","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"4","key":"10.3233\/NRE-230140_ref14","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1097\/AJP.0000000000000259","article-title":"Is the Nociception Coma Scale-Revised a Useful Clinical Tool for Managing Painin Patients With Disorders of Consciousness?","volume":"32","author":"Chatelle,","year":"2016","journal-title":"Clin J Pain"},{"issue":"9","key":"10.3233\/NRE-230140_ref15","doi-asserted-by":"crossref","first-page":"1755","DOI":"10.1016\/j.apmr.2018.03.009","article-title":"Assessment of Nociception and Pain inParticipants in an Unresponsive or Minimally Conscious State AfterAcquired Brain Injury: The Relation Between the Coma RecoveryScale-Revised and the Nociception Coma Scale-Revised","volume":"99","author":"Chatelle,","year":"2018","journal-title":"Arch PhysMed Rehabil"},{"issue":"5","key":"10.3233\/NRE-230140_ref16","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1111\/ane.12550","article-title":"Caregiver\u2019s burden in disorders of consciousness: a longitudinal study","volume":"134","author":"Covelli,","year":"2016","journal-title":"Acta Neurol Scand"},{"issue":"8","key":"10.3233\/NRE-230140_ref17","doi-asserted-by":"crossref","first-page":"1233","DOI":"10.1080\/09602011.2017.1309322","article-title":"Detecting early recovery of consciousness: a comparison of methods","volume":"28","author":"Day,","year":"2018","journal-title":"Neuropsychol Rehabil"},{"issue":"11","key":"10.3233\/NRE-230140_ref19","doi-asserted-by":"crossref","first-page":"e1488","DOI":"10.1212\/WNL.0000000000010254","article-title":"Multicenter prospective study on predictors of short-term outcome indisorders of consciousness","volume":"95","author":"Estraneo,","year":"2020","journal-title":"Neurology"},{"issue":"1","key":"10.3233\/NRE-230140_ref20","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1080\/02699052.2017.1364421","article-title":"Survival and consciousness recovery are better in the minimally conscious state than in the vegetative state","volume":"32","author":"Faugeras,","year":"2018","journal-title":"Brain Inj"},{"issue":"12","key":"10.3233\/NRE-230140_ref21","doi-asserted-by":"crossref","first-page":"1442","DOI":"10.1001\/jamaneurol.2015.2614","article-title":"AThalamocortical Mechanism for the Absence of Overt Motor Behavior inCovertly Aware Patients","volume":"72","author":"Fern\u00e1ndez-Espejo,","year":"2015","journal-title":"JAMA Neurol"},{"issue":"3","key":"10.3233\/NRE-230140_ref22","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1212\/WNL.58.3.349","article-title":"The minimally conscious state:Definition and diagnostic criteria","volume":"58","author":"Giacino,","year":"2002","journal-title":"Neurology"},{"issue":"10","key":"10.3233\/NRE-230140_ref23","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1212\/WNL.0000000000005928","article-title":"Comprehensive systematic review update summary: disorders of consciousness: report of the guideline development, dissemination, and implementation subcommittee of the American Academy of Neurology; the American Congress of Rehabilitation Medicine; and the National Institute on Disability, Independent Living, and Rehabilitation","volume":"91","author":"Giacino,","year":"2018","journal-title":"Neurology"},{"issue":"2","key":"10.3233\/NRE-230140_ref24","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1089\/neu.2019.6429","article-title":"Behavioral Recovery and Early Decision Making in Patients with Prolonged Disturbance in Consciousness after Traumatic Brain Injury","volume":"37","author":"Giacino,","year":"2020","journal-title":"J Neurotrauma"},{"issue":"6","key":"10.3233\/NRE-230140_ref25","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1016\/j.apmr.2020.01.013","article-title":"Minimum Competency Recommendations for Programs That Provide Rehabilitation Services for Persons With Disorders of Consciousness: A Position Statement of the American Congress of Rehabilitation Medicine and the National Institute on Disability, Independent Living and Rehabilitation Research Traumatic Brain Injury Model Systems","volume":"101","author":"Giacino,","year":"2020","journal-title":"Arch Phys Med Rehabil"},{"key":"10.3233\/NRE-230140_ref26","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/bs.pbr.2016.04.003","article-title":"Brain-computer interfaces for patients with disorders of consciousness","volume":"228","author":"Gibson,","year":"2016","journal-title":"Prog Brain Res"},{"issue":"9","key":"10.3233\/NRE-230140_ref27","doi-asserted-by":"crossref","first-page":"1870","DOI":"10.1016\/j.apmr.2022.03.010","article-title":"Should Consistent Command-Following Be Added to the Criteria for Emergence From the Minimally Conscious State?","volume":"103","author":"Golden,","year":"2022","journal-title":"Arch Phys Med Rehabil"},{"issue":"7","key":"10.3233\/NRE-230140_ref28","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1089\/neu.2018.5954","article-title":"Disorders of Consciousness due to Traumatic Brain Injury: Functional Status Ten Years Post-Injury","volume":"36","author":"Hammond,","year":"2019","journal-title":"J Neurotrauma"},{"issue":"10","key":"10.3233\/NRE-230140_ref29","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.1080\/02699052.2017.1306108","article-title":"Effects of preference and sensory modality on behavioural reactionin patients with disorders of consciousness","volume":"31","author":"Heine,","year":"2017","journal-title":"Brain Inj"},{"issue":"5","key":"10.3233\/NRE-230140_ref30","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1136\/jnnp-2015-310958","article-title":"Preserved consciousnessin vegetative and minimal conscious states: systematic review and meta-analysis","volume":"87","author":"Kondziella,","year":"2016","journal-title":"J Neurol NeurosurgPsychiatry"},{"issue":"5","key":"10.3233\/NRE-230140_ref31","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1111\/ene.14151","article-title":"European Academy of Neurology guideline on the diagnosis of coma and other disorders of consciousness","volume":"27","author":"Kondziella,","year":"2020","journal-title":"Eur J Neurol"},{"key":"10.3233\/NRE-230140_ref32","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1186\/1741-7015-8-68","article-title":"Unresponsive wakefulness syndrome: A new name for the vegetative state or apallic syndrome","volume":"8","author":"Laureys,","year":"2010","journal-title":"BMC Medicine"},{"issue":"21","key":"10.3233\/NRE-230140_ref36","doi-asserted-by":"crossref","first-page":"1499","DOI":"10.1056\/NEJM199405263302107","article-title":"Medical aspects of the persistent vegetative state","volume":"330","author":"Multi-Society Task Force on Persistent Vegetative State","year":"1994","journal-title":"New England Journal of Medicine"},{"issue":"8","key":"10.3233\/NRE-230140_ref37","doi-asserted-by":"crossref","first-page":"1275","DOI":"10.1080\/09602011.2018.1454327","article-title":"The Cognitive Assessment by Visual Election (CAVE): A pilot study to develop a cognitive assessment tool for people emerging from disorders of consciousness","volume":"28","author":"Murphy,","year":"2018","journal-title":"Neuropsychol Rehabil"},{"issue":"8","key":"10.3233\/NRE-230140_ref38","doi-asserted-by":"crossref","first-page":"1957","DOI":"10.1007\/s00415-018-8788-9","article-title":"Are visual functions diagnostic signs of the minimally conscious state? an integrative review","volume":"28","author":"Overbeek,","year":"2018","journal-title":"J Neurol"},{"issue":"3","key":"10.3233\/NRE-230140_ref39","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1016\/j.neuron.2019.03.024","article-title":"The Search for Consciousness","volume":"102","author":"Owen,","year":"2019","journal-title":"Neuron"},{"issue":"6","key":"10.3233\/NRE-230140_ref40","doi-asserted-by":"crossref","first-page":"730","DOI":"10.1080\/02699052.2018.1440420","article-title":"Score on Coma Recovery Scale-Revised at admission predicts outcome at discharge in intensive rehabilitation after severe Brain Injury","volume":"32","author":"Portaccio,","year":"2018","journal-title":"Brain Inj"},{"issue":"5","key":"10.3233\/NRE-230140_ref41","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1016\/j.apmr.2018.01.015","article-title":"Improvement on the Coma Recovery Scale-Revised During the First Four Weeks of Hospital Stay Predicts Outcome at Discharge in Intensive Rehabilitation After Severe Brain Injury","volume":"99","author":"Portaccio,","year":"2018","journal-title":"Arch Phys Med Rehabil"},{"issue":"6","key":"10.3233\/NRE-230140_ref43","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1016\/j.pmn.2019.02.003","article-title":"Nociception Coma Scale-Revised: Nurses\u2019 Experience in Clinical Practice","volume":"20","author":"Poulsen,","year":"2019","journal-title":"Pain Manag Nurs"},{"issue":"1","key":"10.3233\/NRE-230140_ref44","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s00134-015-4124-3","article-title":"The reliability of the Glasgow Coma Scale: a systematic review","volume":"42","author":"Reith,","year":"2016","journal-title":"Intensive Care Med"},{"issue":"2","key":"10.3233\/NRE-230140_ref45","doi-asserted-by":"crossref","first-page":"S27","DOI":"10.1007\/s12028-014-0025-5","article-title":"Participants in the International Multi-disciplinary Consensus Conference on Multimodality Monitoring. Clinical monitoring scales in acute Brain Injury: assessment of coma, pain, agitation, and delirium","volume":"21","author":"Riker,","year":"2014","journal-title":"Neurocrit Care"},{"issue":"12","key":"10.3233\/NRE-230140_ref47","doi-asserted-by":"crossref","first-page":"1413","DOI":"10.1001\/jamaneurol.2015.2899","article-title":"Cognitive Motor Dissociation Following Severe Brain Injuries","volume":"72","author":"Schiff,","year":"2015","journal-title":"JAMA Neurol"},{"issue":"2","key":"10.3233\/NRE-230140_ref48","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1016\/j.pain.2009.09.028","article-title":"The Nociception Coma Scale: a new tool to assess nociception in disorders of consciousness","volume":"148","author":"Schnakers,","year":"2010","journal-title":"Pain"},{"issue":"4","key":"10.3233\/NRE-230140_ref49","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1177\/1545968314547767","article-title":"Preserved covertcognition in noncommunicative patients with severe Brain Injury?","volume":"29","author":"Schnakers","year":"2015","journal-title":"Neurorehabil Neural Repair"},{"issue":"11 Suppl","key":"10.3233\/NRE-230140_ref50","first-page":"S270","article-title":"Assessment and Management of Pain in Patients With Disorders of Consciousness","volume":"7","author":"Schnakers","year":"2015","journal-title":"PM R"},{"issue":"1","key":"10.3233\/NRE-230140_ref51","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1177\/1545968314528067","article-title":"Impact of aphasia on consciousness assessment: a cross-sectional study","volume":"29","author":"Schnakers","year":"2015","journal-title":"Neurorehabil Neural Repair"},{"issue":"12","key":"10.3233\/NRE-230140_ref53","doi-asserted-by":"crossref","first-page":"930","DOI":"10.3390\/brainsci10120930","article-title":"Covert Cognition inDisorders of Consciousness: A Meta-Analysis","volume":"10","author":"Schnakers,","year":"2020","journal-title":"Brain Sci"},{"key":"10.3233\/NRE-230140_ref54","first-page":"971315","article-title":"What names for covert awareness? A systematic review","volume":"16","author":"Schnakers,","year":"2022","journal-title":"Front HumNeurosci"},{"issue":"12","key":"10.3233\/NRE-230140_ref55","doi-asserted-by":"crossref","first-page":"1795","DOI":"10.1016\/j.apmr.2010.07.218","article-title":"Assessment scales for disorders of consciousness: evidence-based recommendations for clinical practice and research","volume":"91","author":"Seel,","year":"2010","journal-title":"Arch Phys Med Rehabil"},{"issue":"13-14","key":"10.3233\/NRE-230140_ref56","doi-asserted-by":"crossref","first-page":"1640","DOI":"10.1080\/02699052.2019.1658221","article-title":"Preliminary validation of the coma recovery scale for pediatrics in typically developing young children","volume":"33","author":"Slomine,","year":"2019","journal-title":"Brain Inj"},{"issue":"1","key":"10.3233\/NRE-230140_ref57","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1186\/s12883-018-1040-5","article-title":"Personalized objects can optimize the diagnosis of EMCS in the assessment of functional object use in the CRS-R: a double blind, randomized clinical trial","volume":"18","author":"Sun,","year":"2018","journal-title":"BMC Neurol"},{"issue":"5","key":"10.3233\/NRE-230140_ref58","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1007\/s00415-019-09628-y","article-title":"Minimally conscious state \u201cplus\u201d: diagnostic criteria and relationto functional recovery","volume":"267","author":"Thibaut,","year":"2020","journal-title":"J Neurol"},{"issue":"6","key":"10.3233\/NRE-230140_ref59","doi-asserted-by":"crossref","first-page":"1376","DOI":"10.1007\/s00415-018-8849-0","article-title":"Resistance to eye opening in patients with disorders of consciousness","volume":"265","author":"van Ommen,","year":"2018","journal-title":"J Neurol"},{"issue":"9","key":"10.3233\/NRE-230140_ref60","doi-asserted-by":"crossref","first-page":"1463","DOI":"10.1002\/ejp.1063","article-title":"Clinimetric properties of the Nociception Coma Scale (-Revised): A systematic review","volume":"21","author":"Vink,","year":"2017","journal-title":"Eur J Pain"},{"issue":"4","key":"10.3233\/NRE-230140_ref61","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1111\/ene.13572","article-title":"How often is the diagnosis of the permanent vegetative state incorrect? A review of the evidence","volume":"25","author":"Wade,","year":"2018","journal-title":"Eur J Neurol"},{"issue":"6","key":"10.3233\/NRE-230140_ref62","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1002\/ana.24962","article-title":"The repetition of behavioral assessments in diagnosis of disorders of consciousness","volume":"81","author":"Wannez,","year":"2017","journal-title":"Ann Neurol"},{"issue":"8","key":"10.3233\/NRE-230140_ref63","doi-asserted-by":"crossref","first-page":"1350","DOI":"10.1080\/09602011.2017.1310656","article-title":"Prevalence of coma recovery scale-revised signs of consciousness in patients in minimally conscious state","volume":"28","author":"Wannez,","year":"2018","journal-title":"Neuropsychol Rehabil"},{"key":"10.3233\/NRE-230140_ref64","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S0003-9993(99)90168-5","article-title":"Assessment of command-following in minimally conscious Brain Injured patients","volume":"80","author":"Whyte,","year":"1999","journal-title":"Arch Phys Med Rehabil"},{"issue":"4","key":"10.3233\/NRE-230140_ref65","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1097\/AJP.0000000000000811","article-title":"Development of a Measure of Nociception for Patients With Severe Brain Injury","volume":"36","author":"Whyte,","year":"2020","journal-title":"Clin J Pain"},{"issue":"22","key":"10.3233\/NRE-230140_ref66","doi-asserted-by":"crossref","first-page":"3158","DOI":"10.1089\/neu.2018.6153","article-title":"Favorable Functional Recovery in Severe Traumatic Brain Injury Survivors beyond Six Months","volume":"36","author":"Wilkins,","year":"2019","journal-title":"J Neurotrauma"}],"container-title":["NeuroRehabilitation"],"original-title":[],"link":[{"URL":"https:\/\/content.iospress.com\/download?id=10.3233\/NRE-230140","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T06:08:19Z","timestamp":1777615699000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/full\/10.3233\/NRE-230140"}},"subtitle":[],"editor":[{"given":"Caroline","family":"Schnakers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Nathan D.","family":"Zasler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,1,23]]},"references-count":59,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.3233\/nre-230140","relation":{},"ISSN":["1053-8135","1878-6448"],"issn-type":[{"value":"1053-8135","type":"print"},{"value":"1878-6448","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,23]]}}}