How much do we know?

Consciousness has several distinct dimensions that they can measure. Three of the most important ones are:

• wakefulness or physiological arousal
• awareness or the ability to have conscious mental experiences, including thoughts, feelings, and perceptions
• sensory organization, or how different perceptions and more abstract concepts become woven together to create a seamless conscious experience.

These three dimensions interact to produce our overall state of consciousness from moment to moment. For example, when wide awake, we are in a state of high awareness, but as we drift off to sleep at night, both wakefulness and awareness subside.

Awareness and physiological arousal return during REM (rapid eye movement) sleep, which is when vivid dreams are mostly likely to occur. But these sensory experiences are mostly disconnected from external stimuli and detached from the concepts that anchor us to reality while we are awake.

In a similar way, altered states of consciousness, such as those induced by psychedelic drugs or low oxygen levels, involve normal levels of arousal but disorganized sensory experiences.

These can include hallucinations of sounds, smells, or sights, but also synesthesia, when there is cross-talk between usually discrete senses, such as sounds that evoke visual experiences.

People in a coma, or under anesthesia, can have levels of wakefulness and awareness that are even lower than during non-REM sleep.

Meanwhile, in a strange hybrid state of consciousness known as unresponsive wakefulness syndrome, or a vegetative state, patients undergo daily cycles of sleep and wakefulness, but without showing any sign of awareness.

Despite spending long periods with their eyes open, they do not exhibit behavioral responses to external stimuli.

Some of these patients will recover limited signs of awareness, known as a “minimally conscious state,” such as the ability to respond to instructions or follow a moving object with their eyes.

Patients in different states of consciousness have provided vital clues about the neural correlates of consciousness.

Techniques such as functional magnetic resonance imaging (fMRI) and electroencephalography (EEG) have revealed the neural activity that accompanies these states.

Scientists detect patterns of activity through measures of functional connectivity, using statistical techniques to reveal correlations between the timing of neural events in different parts of the brain.

This reveals the networks of brain regions that are involved in working memory, attention, and mind-wandering, for example.

When they combine data from fMRI and EEG, researchers discover that activity deep inside the brain, in the thalamus, varies during wakefulness in step with activity in the default mode network.

The thalamus operates like a sensory relay station, while the default mode network is a collection of regions within the cortex — the outermost layer of the brain — that are intimately involved in mind-wandering and self-awareness.

By contrast, during non-REM sleep and under anesthetic, functional connectivity breaks down between the thalamus and the default mode network and cortical networks that are involved in attention.

In disorders of consciousness, researchers can see reduced functional connectivity and physical damage that affects the connections between the cortex and deep brain structures.

This demonstrates how important these connections are for maintaining wakefulness and information exchange across the brain.

Despite advances in our understanding of the neural correlates of consciousness, however, doctors still have trouble diagnosing patients who are unable to respond to questions or commands.

They cannot tell whether such a patient is completely unconscious, conscious but disconnected from external stimuli, or conscious and aware of their environment, but unable to respond.

A completely new approach, reported recently in Nature Communications, may provide a way to assess such a patient’s wakefulness, awareness, and sensory organization.

Rather than recording the activity in particular brain regions or networks of regions, the new technique measures gradients of activity across the brain.

This is analogous to recording the steepness of terrain on a map, and how that steepness might change over time, rather than just the locations of roads, towns, and villages.

This innovative way of investigating brain activity, which considers how functional geometry shapes temporal dynamics, takes into account the fact that each region and network has multiple functions and connections.

“Consciousness is complex and studying it is like solving a scrambled Rubik’s cube,” says first author Dr. Zirui Huang, research assistant professor at the University of Michigan Medical School Department of Anesthesiology.

“If you look at just a single surface, you may be confused by the way it is organized. You need to work on the puzzle looking at all dimensions,” he adds.

Dr. Huang and his colleagues looked at how gradients of neural activity — as measured by fMRI — changed with the three main dimensions of consciousness:

• arousability or wakefulness
• awareness
• sensory integration.

The researchers drew on existing fMRI data recorded from the brains of people who were awake, under anesthetic, in a so-called vegetative state — known as “unresponsive wakefulness syndrome” — or who had a psychiatric diagnosis such as schizophrenia.

They discovered an activity gradient that corresponded to changes in arousal levels that stretched from the visual and default mode areas to networks involved in attention.

Another gradient changed in step with awareness and stretched from regions involved in perception and action to regions responsible for the integration of information and formation of abstract concepts.

A third gradient, linked to sensory organization, spanned the visual system and the somatomotor cortex, which helps to control movement.

“We demonstrated that disruptions of human consciousness — due to pharmacological, neuropathological, or psychiatric causes — are associated with a degradation of one or more of the major cortical gradients depending on the state,” notes Dr. Huang.

He told Medical News Today that some patients who are unable to respond in any way may still be conscious. “It is therefore important to develop behavior-independent and task-independent approaches to assessment,” he said.

“According to our work, cortical gradient measurements have the potential to reduce the uncertainty of clinical assessment of consciousness in those patients,” he added.

Scientists like Dr. Huang have discovered a lot about its neural correlates, but their findings do not shed much light on how the brain generates consciousness — the “hard problem”.

Other scientists have argued that to learn more about the causes of consciousness, you have to manipulate brain activity and see what happens.

Transcranial magnetic stimulation, or TMS, is a noninvasive technique that changes brain activity in a tightly controlled way.

The technique involves passing a strong electrical pulse through a conductive coil held close to the participant’s head, creating a brief magnetic pulse that induces electrical activity in the part of the brain closest to the coil.

This boosts the electrical activity of millions of neurons within a region just a few centimeters in diameter.

In an awake participant, a TMS pulse triggers a complex chain of activity across multiple cortical areas, whereas in non-REM sleep, the same pulse has a much briefer, more localized effect.

During REM sleep, however, the pulse evokes a pattern of activity similar to that seen in the brain of a person who is wide awake.

Intriguingly, in patients who are awake but in a vegetative state, TMS induces short-lived, local effects that are similar to those seen during the non-REM sleep of a healthy person.

But in the brain of awake, minimally conscious patients, TMS evokes a similar response to that seen in healthy, awake people.

Researchers have therefore concluded that the complexity and spatial extent of communication between brain regions subsides as levels of wakefulness and awareness fall.

Despite advances in our understanding of the neural correlates of consciousness, the question remains: How does consciousness arise from brain activity?

Scientists have proposed several theories. Two prominent ideas are global neuronal workspace theory (GNWT) and integrated information theory (IIT).

Global neuronal workspace

In brief, GNWT proposes that there is a network of long-range connections that span the brain, called the global workspace.

Neural information becomes conscious when it gains access to this workspace, which allows it to be broadcast throughout the brain, including to specialized hubs for memory, perception, motor output, and attention.

Crucially, it is a case of “winner takes all” for a particular interpretation of sensory data when it gains access to the global workspace.

According to Prof. Michael Graziano, professor of psychology and neuroscience at the Princeton Neuroscience Institute, NJ, and Dr. AaronSchurger, assistant professor in the Crean College of Health and Behavioral Sciences at Chapman University in Irvine, CA, this explains, for example, “bistable” optical illusions.