CMD Detection Varies by Injury Type, Consciousness

TOPLINECognitive motor dissociation (CMD) was detected in more than 30% of patients with disorders of consciousness, but detection rates varied significantly by brain injury type and clinical state. CMD was less common in anoxic brain injury and cerebrovascular events compared with traumatic brain injury (TBI), and more frequent in patients with minimally conscious state minus than in unresponsive wakefulness syndrome.METHODOLOGYResearchers performed a meta-analysis of 56 studies published between January 2000 and May 2026 that included 1248 patients (mean age 45.5 years; 66.1% men) with disorders of consciousness.Patients were assessed using active neurodiagnostic paradigms including EEG, functional MRI, pupillometry, functional near-infrared spectroscopy, and electromyography to detect CMD.A total of 571 patients were classified as unresponsive wakefulness syndrome, 235 as minimally conscious state minus, and 119 as coma; brain injury etiologies included TBI (346 patients), anoxic brain injury (259 patients), and cerebrovascular events (178 patients).Mixed-effects logistic regression models analyzed associations between CMD detection and clinical factors including etiology, level of consciousness, time since injury, diagnostic modality, and cognitive task paradigm.TAKEAWAYEEG detected CMD in 30.8% of patients. CMD detection was significantly lower in anoxic brain injury (adjusted odds ratio [aOR], 0.35; P < .001) and cerebrovascular events (aOR, 0.51; P = .0007) compared with TBI.Patients with minimally conscious state minus had higher odds of CMD detection compared with those with unresponsive wakefulness syndrome (aOR, 1.50; P = .04). No significant difference in CMD detection was reported between patients with coma vs those with unresponsive wakefulness syndrome.Time since injury, diagnostic modality, and cognitive task paradigm were not associated with CMD detection.IN PRACTICE"CMD detection is primarily determined by patient-related factors rather than the specific diagnostic modality used," the authors wrote. "These findings emphasize the importance of patient selection and clinical context in interpreting CMD assessments and support the use of standardized, multimodal approaches to improve detection of CMD."SOURCEThe study was led by Poul P. Laigaard, Copenhagen University Hospital—Rigshospitalet in Copenhagen, Denmark. It was published online on July 31 in European Journal of Neurology.LIMITATIONSThe analysis included heterogeneous retrospective studies. Important confounders such as sedation status and illness severity were inconsistently reported, many data were cross-sectional, and several eligible studies lacked individual participant data.DISCLOSURESThe study was supported by Rådet for Offerfonden, Ehrenreichfonden, Lundbeck Foundation, and Independent Research Fund Denmark. The authors reported having no relevant conflicts of interest.This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.