Reading minds with neuroimaging gives coma patients a voice

With a colourful flicker across the screen, the brain image Lorina Naci studied using functional magnetic resonance imaging (fMRI) provided a one-word answer: “Yes.”

The question? “Are you in a hospital?”

The result was part of a groundbreaking study that Naci, a postdoctoral researcher at Western University, led in 2013. Working with Adrian Owen, Canada Excellence Research Chair in Cognitive Neuroscience and Imaging, Naci used a simple test of attention and neuroimaging to read human thought.

By examining brain activity when conveying simple “yes” or “no” answers, the study was a major step toward communicating with patients believed to be in a vegetative state. This provides hope that researchers will be able to determine more quickly and reliably which patients are, in fact, conscious, and allow patients to communicate their wishes more easily.

“For the first time, we showed that a patient clinically diagnosed as ‘vegetative’ can use his attention to show he is conscious, and to communicate with the outside world,” Naci said. “Frequently, after a severe injury to the brain, patients lose their ability to make any physical responses. When we look at or talk to any such patient, we don’t know whether they are still conscious, can understand what is happening around them, or have any thoughts about their condition.”

Naci was one of seven academics who arrived at Western in 2011 to join Owen’s CERC team. Since then, she has sought to understand how the brain’s functional organization supports human cognition and consciousness, and how this organization breaks down in a disordered brain.

Naci develops clinically applicable neuroimaging measures using psychological theory and research of brain-injured and anesthetized patients. Given the emerging complexity of this work, she also explores the medico-ethical and societal implications of such applications, to build ethical guidelines for their translation to clinical settings.

In 2014, Naci led a second pioneering study, demonstrating that a short Alfred Hitchcock movie could be used to detect consciousness in patients in wakeful comas. The study included a Canadian participant who had been entirely unresponsive for 16 years. The patient’s brain response during the film strongly resembled that of healthy participants, suggesting not only that he was consciously aware, but also that he understood the movie.

“We already know that up to one in five of these patients are misdiagnosed as being unconscious. This new technique could help reveal more cases, thus reducing the number of misdiagnoses,” Naci said.

Naci was named Western’s Postdoctoral Scholar of the Year in 2016 for her work. She was also awarded one of two $20,000 L’Oréal-UNESCO For Women in Science fellowships in Canada, which recognize outstanding researchers of exceptional promise.

Following a productive time in a CERC-supported lab that helped move the needle in studies of minimally conscious patients, Naci is preparing to take the next step in her career: she will assume an assistant professor role at Trinity College Dublin, in Ireland, in May 2017.