Covert cognition in disorders of consciousness: A meta-analysis

Caroline Schnakers, Michaela Hirsch, Enrique Noé, Roberto Llorens, Nicolas Lejeune, Vigneswaran Veeramuthu, Sabrina De Marco, Athena Demertzi, Catherine Duclos, Ann Marie Morrissey, Camille Chatelle, Anna Estraneo

Research output: Contribution to journalArticlepeer-review


Covert cognition in patients with disorders of consciousness represents a real diagnostic conundrum for clinicians. In this meta-analysis, our main objective was to identify clinical and demographic variables that are more likely to be associated with responding to an active paradigm. Among 2018 citations found on PubMed, 60 observational studies were found relevant. Based on the QUADAS-2, 49 studies were considered. Data from 25 publications were extracted and included in the meta-analysis. Most of these studies used electrophysiology as well as counting tasks or mental imagery. According to our statistical analysis, patients clinically diagnosed as being in a vegetative state and in a minimally conscious state minus (MCS−) show similar likelihood in responding to active paradigm and responders are most likely suffering from a traumatic brain injury. In the future, multi-centric studies should be performed in order to increase sample size, with similar methodologies and include structural and functional neuroimaging in order to identify cerebral markers related to such a challenging diagnosis.

Original languageEnglish
Article number930
Pages (from-to)1-11
Number of pages11
JournalBrain Sciences
Issue number12
Publication statusPublished - Dec 2020


  • Cognitive motor dissociation
  • Consciousness
  • Covert cognition
  • Minimally conscious state
  • Severe brain injury
  • Vegetative state

ASJC Scopus subject areas

  • Neuroscience(all)


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