Pitt study probes 'covert consciousness'

Anya Sostek, Tribune News Service

Ricardo Iriart last saw his wife conscious four years ago. Every day since, he has visited Ángeles, often spending hours talking to her in hopes that she could hear him. Over the last year, he's gotten a new understanding of his wife's condition, participating in cutting-edge research into "covert consciousness." It's an emerging field of study that probes what patients with disorders of consciousness can comprehend, even when they can't respond. Earlier this year, the University of Pittsburgh became the first research institution in the US to use an Austrian device called the mindBeagle in a clinical trial of covert consciousness.

"Even though they are not scoring to show that they are aware of their environment, the mindBeagle allows us to tap into whether they are internally following directions," said Katya Hill, a professor who recently moved from Pitt to chair the department of communication science and disorders at Gannon University. "In some cases, they are able to answer yes or no questions when we train them well enough with the paradigms on the mindBeagle."

Over the course of 17 sessions, Iriart took his wife from her skilled nursing facility in Cranberry to UPMC Mercy to be hooked up to electrodes and tested with the mindBeagle. The couple met when they were freshmen in college in their native Argentina. Ángeles was an accounting major and the star of the local club field hockey team, while Ricardo studied business. As a married couple, they moved frequently for Ricardo's work, settling permanently in the United States 25 years ago. As they moved, Ángeles found different jobs, often working with children, and effortlessly excelled in new sports. She won golf trophies in Colombia and Brazil. In Pittsburgh, she picked up tennis, becoming captain of the over-40 team at the Oxford Athletic Club in Pine.

It was there, during a match in September of 2021, that she collapsed on the court. Her doubles partner was a doctor, but even with immediate medical help, Ángeles, then 61, never recovered. She had suffered a brain hemorrhage brought on by an arteriovenous malformation, or AVM, a tangled mass of blood vessels that had likely been present since birth without causing symptoms.

When Iriart saw his wife at the hospital about an hour after she collapsed, she couldn't speak but still seemed awake and conscious enough to recognise him and grab his hand. From there, however, she slipped into a coma after undergoing brain surgery to lessen the pressure from the hemorrhage. About two months later, she opened her eyes, but never showed clinical signs of responsiveness. "All the different people that we had seen, all the professionals, would say that there was nothing else to do and that she was unresponsive," said Iriart. "The prognosis was basically, there is no hope." Even so, Iriart always asked the doctors at his wife's appointments if there were any new opportunities or treatments, or anything at all that could be done to help his wife.

A study to sniff out consciousness: About a year ago, he received a letter inviting him to participate in a clinical trial for the mindBeagle — so named because just as the beagle breed of dogs are used to find people using their sense of smell, the mindBeagle device attempts to sniff out consciousness. Disorders of consciousness run along a spectrum — from a coma, where the patient's eyes remain closed, to unresponsive wakefulness syndrome (previously called a vegetative state), where there is a sleep-wake cycle but patients do not respond to stimuli, to a minimally conscious state, where there are small signs of awareness. There is also a different condition called "locked-in" syndrome where patients are fully conscious but unable to move or speak.

Over the last decade or so, scientists have started to use neuroimaging to detect consciousness in those unable to show signs at the bedside. Studies have shown that 10% to 20% of patients who show no awareness during behavioral examinations do have evidence of conscious awareness through neuroimaging such as MRIs or EEGs. The mindBeagle uses EEGs combined with up to seven vibrating rods placed around the body. Participants are initially told to pay attention to, for example, only the rod vibrating on the right wrist. When the sensation hits that they are looking for, they should register a particular type of brain wave called a P300 — the same feeling that is generated when a grocery store shopper sees an item on the shelf that they are looking for.