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The impact of language impairment on the clinical assessment of patients suffering from disorders of consciousness (DOC) is unknown or underestimated and may mask the presence of conscious behavior. In a group of DOC patients (n = 11; time post-injury range: 5–252 months), we investigated the main neural functional and structural underpinnings of linguistic processing, and their relationship with the behavioral measures of the auditory function using the Coma Recovery Scale-Revised (CRS-R). We assessed the integrity of the brainstem auditory pathways, of the left superior temporal gyrus and arcuate fasciculus, the neural activity elicited by passive listening of an auditory language task, and the mean hemispheric glucose metabolism. Our results support the hypothesis of a relationship between the level of preservation of the investigated structures/functions and the CRS-R auditory subscale scores. Moreover, our findings indicate that patients in minimally conscious state minus (MCS−): (1) when presenting the auditory startle (at the CRS-R auditory subscale) might be aphasic in the receptive domain, being severely impaired in the core language structures/functions; (2) when presenting the localization to sound might retain language processing, being almost intact or intact in the core language structures/functions. Despite the small group of investigated patients, our findings provide a grounding of the clinical measures of the CRS-R auditory subscale in the integrity of the underlying auditory structures/functions. Future studies are needed to confirm our results that might have important consequences for the clinical practice.

Both theoretical proposals and empirical studies suggest that the brain interprets sensory input based on prior expectations to mitigate computational burden. However, as social beings, much of sensory input is affectively loaded – e.g., the smile of a partner, the critical voice of a boss, or the welcoming gesture of a friend. Given that affective information is highly complex and often ambiguous, building up prior expectations of upcoming affective sensory input may greatly contribute to its rapid and efficient processing. This review points to the role of affective information in the context of the ‘predictive brain’. It particularly focuses on repetition suppression (RS) effects that have recently been linked to prediction processes. We interpret the findings as evidence for more pronounced prediction processes with affective material. Importantly, we argue that possible influences from bottom-up attention might inflate the neural RS effect, and thereby particularly overshadow the magnitude of RS for affective information. Finally, anxiety disorders, such as social phobia, are briefly discussed as manifestations of modulations in affective prediction.