Preface

Advances in neuroimaging and neuroscience hold significant promise for improving understanding of disorders of consciousness arising from severe brain injuries. The 87th Annual Conference of the Association for Research in Nervous and Mental Disease focused on the emerging findings in the field of disorders of consciousness. Held at the historic New York Academy of Medicine in New York City on December 7 and 8, 2007 the Disorders of Consciousness conference brought together a distinguished, small group of basic neuroscientists and clinical investigators engaged in fundamental investigation of arousal and mechanisms underlying large-scale forebrain integration, state-of-the-art neuroimaging studies of patients with disorders of consciousness, and experts in the fields of the neurology of consciousness and ethics who addressed the larger context in which the emerging neuroscience will be received and integrated. The intended goal of the conference was aimed at updating and advancing knowledge of diagnostic and prognostic methods, potential therapeutic strategies, and importantly identifying challenges for professionals engaged in the study of these patient populations. Recent studies have underscored our contention that recovery of consciousness after severe brain injury remains poorly understood. Although public interest is high, the broad needs for systematic research in this emerging area of knowledge are currently unmet. The challenges are surprisingly difficult with a degree of diagnostic uncertainty that may range from the bedside in some patients who are unconscious, to those fully aware, as well as in patients with no evidence of behavioral responsiveness. As measurements of consciousness improve, behaviorally defined states—from “vegetative states” (no evidence of self or environmental awareness) to “minimally conscious states” (at least some evidence of awareness, excepting those patients in “locked-in states” (full consciousness with no motor control))—will reveal subcategories of patients whose level of consciousness we cannot at present identify with confidence. The contributions presented at the Disorders of Consciousness conference are likely to help form the scientific foundations for frameworks to systematically organize information and approaches to future clinical assessments of consciousness. Equally important is that the strategies for measurement and definition of these challenging disorders of consciousness will advance our basic understanding of human consciousness. The current volume reflects contributions from each component of the program, beginning with a review on the relationship between mind and brain and its philosophical, scientific, and practical implications. Athena Demertzi et al., from the Coma Science Group of Liège, and Adam Zeman et al., from Edinburgh University and Peninsula Medical School, present their surveys on scientists’ attitudes toward the mind–brain relationship and its relevance to clinical practice and to the formulation of scientific questions about the nature of consciousness. The next two chapters deal with the fundamental studies of the mechanisms underlying large-scale forebrain integration and arousal in conscious perception. Edward Jones,