A multimodal investigation of altered cortical metabolism in patients with disorders of consciousness
- 1Taipei Medical University
Abstract
Disorders of consciousness (DoC) are characterised by marked reductions in cerebral glucose metabolism, but the specific cellular and neurochemical processes driving this impairment remain unclear. To elucidate these mechanisms, a multimodal imaging approach combining [18F]-fluorodeoxyglucose positron emission tomography (FDG-PET) and magnetic resonance spectroscopy (MRS) was applied to the posterior medial cortex (PMC) in 15 DoC patients and 14 healthy controls. Regional FDG metabolic index (FDG-MI) values and MRS concentration estimates of glutamate plus glutamine (Glx), {gamma}-aminobutyric acid (GABA+), total N-acetylaspartate (tNAA), total creatine (tCr), and total choline (tCho) were compared between groups and evaluated against Coma Recovery Scale-Revised (CRS-R) scores at baseline and follow-up (mean 127 days). Patients demonstrated reductions within the PMC in Glx, tCr, and tNAA concentrations, as well as a reduced Glx/GABA+ ratio. Local FDG-MI was substantially reduced in patients and correlated positively with tNAA and tCr. Furthermore, baseline tCho concentrations positively predicted long-term clinical recovery, as indexed by changes in CRS-R scores at follow-up. These findings suggest that macroscopic glucose hypometabolism in DoC may be linked to disrupted intracellular mitochondrial energy production pathways and a shift towards relative synaptic inhibition in the PMC. Moreover, the association between choline levels and behavioural recovery may point to the relevance of retained structural synthesis capacity for functional outcomes.
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BibTeX
@misc{duncan2026multimodal,
title = {{A multimodal investigation of altered cortical metabolism in patients with disorders of consciousness}},
author = {N. W. Duncan and L. Huang and C. Lee and Y.-C. Wu and C.-M. Yang and D. Y.-T. Chen and T. J. Lane},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.17.26363105},
url = {https://www.medrxiv.org/content/10.64898/2026.09.17.26363105v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - A multimodal investigation of altered cortical metabolism in patients with disorders of consciousness
AU - N. W. Duncan
AU - L. Huang
AU - C. Lee
AU - Y.-C. Wu
AU - C.-M. Yang
AU - D. Y.-T. Chen
AU - T. J. Lane
PY - 2026
DA - 2026/09/17
PB - medRxiv
DO - 10.64898/2026.09.17.26363105
UR - https://www.medrxiv.org/content/10.64898/2026.09.17.26363105v1
AB - Disorders of consciousness (DoC) are characterised by marked reductions in cerebral glucose metabolism, but the specific cellular and neurochemical processes driving this impairment remain unclear. To elucidate these mechanisms, a multimodal imaging approach combining [18F]-fluorodeoxyglucose positron emission tomography (FDG-PET) and magnetic resonance spectroscopy (MRS) was applied to the posterior medial cortex (PMC) in 15 DoC patients and 14 healthy controls. Regional FDG metabolic index (FDG-MI) values and MRS concentration estimates of glutamate plus glutamine (Glx), {gamma}-aminobutyric acid (GABA+), total N-acetylaspartate (tNAA), total creatine (tCr), and total choline (tCho) were compared between groups and evaluated against Coma Recovery Scale-Revised (CRS-R) scores at baseline and follow-up (mean 127 days). Patients demonstrated reductions within the PMC in Glx, tCr, and tNAA concentrations, as well as a reduced Glx/GABA+ ratio. Local FDG-MI was substantially reduced in patients and correlated positively with tNAA and tCr. Furthermore, baseline tCho concentrations positively predicted long-term clinical recovery, as indexed by changes in CRS-R scores at follow-up. These findings suggest that macroscopic glucose hypometabolism in DoC may be linked to disrupted intracellular mitochondrial energy production pathways and a shift towards relative synaptic inhibition in the PMC. Moreover, the association between choline levels and behavioural recovery may point to the relevance of retained structural synthesis capacity for functional outcomes.
ER -