The role of conscious attention in statistical learning: evidence from patients with impaired consciousness

The debate over whether conscious attention is necessary for statistical learning has produced mixed and conflicting results. Testing individuals with impaired consciousness may provide some insight, but very few studies have been conducted due to the difficulties associated with testing such patients. In this study, we examined the ability of patients with varying levels of consciousness disorders (DOC), including coma, unresponsive wakefulness syndrome, minimally conscious patients, and emergence from minimally conscious state patients, to extract statistical regularities from an artificial language composed of four randomly concatenated pseudowords. We used a methodology based on frequency tagging in EEG, which was developed in our previous studies on speech segmentation in sleeping neonates. Our study had two main objectives: firstly, to assess the automaticity of the segmentation process and explore correlations between the level of covert consciousness and the abilities to extract statistical regularities, second, to explore a potential new diagnostic indicator to aid in patient management by examining the correlation between successful statistical learning markers and consciousness level. We observed that segmentation abilities were preserved in some minimally conscious patients, suggesting that statistical learning is an inherently automatic low-level process. Due to significant inter-individual variability, word segmentation may not be a sufficiently robust candidate for clinical use, unlike temporal accuracy of auditory syllable responses, which correlates strongly with coma severity. Therefore, we propose that frequency tagging of an auditory stimulus train, a simple and robust measure, should be further investigated as a possible metric candidate for DOC diagnosis.