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van Grinsven EE, Cialdella F, Verhoeff JJC, Philippens MEP, van Zandvoort MJE. Different profiles of neurocognitive functioning in patients with brain metastases prior to brain radiotherapy. Psychooncology 2023; 32:1752-1761. [PMID: 37789598 DOI: 10.1002/pon.6229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVE Patients with brain metastases (BrMs) are a heterogeneous population, with almost 50% experiencing cognitive impairment before brain radiotherapy. Defining pre-radiotherapy cognitive profiles will aid in understanding of the cognitive vulnerabilities and offer valuable insight and guidance for tailoring interventions. METHODS The study population consisted of 58 adult patients with BrMs referred for radiotherapy. A semi-structured interview and comprehensive battery including 10 neuropsychological tests were used to assess subjective and objective cognitive performance prior to radiotherapy. RESULTS A majority (69%) of patients report decline in cognitive performance compared to their premorbid level (i.e. pre-cancer). Objective testing revealed memory (52%), processing speed (33%) and emotion recognition (29%) deficits were most frequent. 21% of patients had no cognitive deficits while 55% had deficits (-1.5SD) in at least two cognitive domains. Hierarchical cluster analysis based on patient deficit profiles identified four clusters: (I) no or limited cognitive deficits selectively restricted to processing speed or executive function, (II) psychomotor speed deficits, (III) memory deficits and (IV) extensive cognitive deficits including memory. No patient or clinical-related (e.g. age, number of BrMs, previous treatment) differences were found between clusters. CONCLUSIONS Patterns of cognitive performance in patients with BrMs are heterogeneous, with most experiencing at least some degree of neurocognitive dysfunction. We identified four meaningful cognitive clusters. Stability of these clusters over time and in different samples should be assessed to advance understanding of the cognitive vulnerability of this patient population.
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Affiliation(s)
- Eva E van Grinsven
- Department of Neurology & Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Fia Cialdella
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joost J C Verhoeff
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marielle E P Philippens
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martine J E van Zandvoort
- Department of Neurology & Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
- Department of Experimental Psychology and Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
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Anticipatory Awareness and Actual Handwriting Performance Measures among Adolescents with Deficient Executive Functions. CHILDREN 2022; 9:children9111628. [DOI: 10.3390/children9111628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/19/2022] [Accepted: 10/21/2022] [Indexed: 11/11/2022]
Abstract
This secondary analysis explores differences and correlations between handwriting anticipatory awareness (time estimation, expected performance, and expected difficulty) before a paragraph copying task and actual performance time and legibility among adolescents with executive function deficits (EFD) versus neurotypical adolescents. Eighty-one adolescents (10–18 years old; 41 with EFD and daily functioning difficulties as per parent reports) estimated their time, expected performance, and expected difficulty before the paragraph copying task using the Self-Awareness of Performance Questionnaire (SAP-Q). Time duration was assessed using the Computerized Penmanship Evaluation Tool (ComPET) software, and legibility was scored using the Handwriting Legibility Scale (HLS). Significant between-group differences were found in actual time duration (ComPET), HLS total score and legibility components, and three SAP-Q questions. Both groups estimated significantly more performance time than their actual performance duration. The adolescents with EFD underestimated their performance before the handwriting task. Significant correlations were found between actual performance, anticipatory awareness, and Executive Function (EF) in both groups. Their performance predictions were significantly correlated with their EF and product’s legibility. The results highlight the potential relationships between anticipatory awareness and actual handwriting performance (time duration and legibility) of adolescents with and without EFD. Further studies may analyze the benefits of focusing on both EF and anticipatory awareness for handwriting improvement among populations with EF deficits.
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Chen W, Wang X, Sun S, Liu Q, Guo Z. The relationship between neuroticism and mobile phone use among college students in love: The masking effect of self-emotional assessment. Front Psychol 2022; 13:942520. [PMID: 36186322 PMCID: PMC9520978 DOI: 10.3389/fpsyg.2022.942520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/26/2022] [Indexed: 11/13/2022] Open
Abstract
The relationship between neuroticism and mobile phone use is a hot research topic in the academic community. The purpose of this study was to investigate the roles of self-emotional assessment and love status in the mechanism through which college students’ neuroticism influences mobile phone use.We construct a moderated mediation model, and taking 869 Chinese college students as the research object and testing the mediating role of self-emotional assessment and the moderating role of love status. The results show that: (1) neuroticism was significantly positively related to mobile phone use and significantly negatively related to self-emotional assessment; self-emotional assessment was significantly positively related to mobile phone use; (2) self-emotional assessment had a masking effect on the relationship between neuroticism and mobile phone use; (3) love status not only moderated the relationship between self-emotional assessment and mobile phone use but also moderated the process through which self-emotional assessment masked the effect of neuroticism on mobile phone use. Our research expands the literature on the mechanisms underlying the effects of neuroticism on mobile phone use, enriches the understanding of the pertinent boundary conditions, and provides a better explanatory basis for the mobile phone use of college students.
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Affiliation(s)
- Weijing Chen
- Business School, Hubei University, Wuhan, China
- Hubei Center for Studies of Human Capital Development Strategy and Policy, Key Research Base of Humanities and Social Science of Hubei Province, Wuhan, China
- *Correspondence: Weijing Chen,
| | | | - Shan Sun
- Department of Psychology, School of Education, Hubei University, Wuhan, China
| | - Qian Liu
- Library, Central China Normal University, Wuhan, China
| | - Zhiwen Guo
- Business School, Hubei University, Wuhan, China
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Hengstschläger A, Sommerlad A, Huntley J. What Are the Neural Correlates of Impaired Awareness of Social Cognition and Function in Dementia? A Systematic Review. Brain Sci 2022; 12:1136. [PMID: 36138872 PMCID: PMC9496823 DOI: 10.3390/brainsci12091136] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/15/2022] [Accepted: 08/17/2022] [Indexed: 11/30/2022] Open
Abstract
Deficits in social cognition and function are characteristic of dementia, commonly accompanied by a loss of awareness of the presence or extent of these deficits. This lack of awareness can impair social relationships, increase patients' and carers' burden, and contribute to increased rates of institutionalization. Despite clinical importance, neural correlates of this complex phenomenon remain unclear. We conducted a systematic search of five electronic databases to identify functional and structural neuroimaging studies investigating the neural correlates of impaired awareness of social cognition and function in any dementia type. We rated study quality and conducted a narrative synthesis of the results of the eight studies that met the predefined eligibility criteria. Across these studies, deficits in awareness of impairments in social cognition and function were associated with structural or functional abnormalities in the frontal pole, orbitofrontal cortex, temporal pole, middle temporal gyrus, inferior temporal gyrus, fusiform gyrus, amygdala, hippocampus, parahippocampal gyrus, and insula. Several identified regions overlap with established neural correlates of social cognition. More research is needed to understand awareness of social cognition and function and how this becomes impaired in dementia to improve neuroscientific understanding, aid the identification of this problematic symptom, and target interventions to reduce burden and improve care.
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Affiliation(s)
| | - Andrew Sommerlad
- Division of Psychiatry, University College London, London W1T 7BN, UK
- Camden and Islington NHS Foundation Trust, London NW1 0PE, UK
| | - Jonathan Huntley
- Division of Psychiatry, University College London, London W1T 7BN, UK
- Camden and Islington NHS Foundation Trust, London NW1 0PE, UK
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5
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Toglia J, Goverover Y. Revisiting the dynamic comprehensive model of self-awareness: a scoping review and thematic analysis of its impact 20 years later. Neuropsychol Rehabil 2022; 32:1676-1725. [PMID: 35583377 DOI: 10.1080/09602011.2022.2075017] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study aimed to (1) describe the scope of research related to the Dynamic Comprehensive Model of Awareness (DCMA) (Toglia & Kirk, 2000); (2) identify themes and support for key model postulates; and (3) suggest future research directions related to this model. Using PRISMA scoping guidelines, 366 articles were reviewed, and 54 articles met our inclusion criteria. Selected studies were clustered into three themes: (1) the relationship between general and online self-awareness (50%); (2) interventions based on the model (41%); and (3) factors contributing to self-awareness (9%). Most studies were conducted with participants with acquired brain injury (BI) and traumatic BI (68%), most used a cross-sectional design (50%), and most intervention studies utilized a single-subject design (18%), followed by an experimental design (9%). This review provides evidence for the wide application of the DCMA across varying ages and populations. The need for a multidimensional assessment approach is recognized; however, stronger evidence that supports a uniform assessment of online self-awareness is needed. The intervention studies frequently described the importance of direct experience in developing self-awareness; however, few studies compared how intervention methods to influence general versus online self-awareness, or how cognitive capacity, self-efficacy, psychological factors, and context, influence the development of self-awareness.
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Affiliation(s)
- Joan Toglia
- School of Health and Natural Sciences, Mercy College, Dobbs Ferry, NY, United States
| | - Yael Goverover
- Department of Occupational Therapy, New York University, New York, NY, United States
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6
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Fogel Y. The Discrepancy between Actual Performance and Self-Awareness among Adolescents with Executive Function Deficits. CHILDREN 2022; 9:children9050684. [PMID: 35626861 PMCID: PMC9139761 DOI: 10.3390/children9050684] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 11/16/2022]
Abstract
Adolescents with executive function deficits (EFD) struggle to perform complex daily activities and have difficulty being self-aware of their performance. This study aimed to compare actual performance with self-awareness of performance among adolescents with EFD before and after a metacognitive intervention. The participants consisted of 41 adolescents aged 10 to 14 years, previously diagnosed with EFD. All performed the Children’s Cooking Task (CCT), and completed the Behavioral Rating Inventory Executive Function—Self-Report (BRIEF-SR) and the Self-Awareness of Performance Questionnaire. Significant positive differences were found in the time duration and the total number of errors from the CCT and three BRIEF-SR subscale scores before and after the intervention. No significant differences were found in self-awareness of performance. After a cognitive intervention, adolescents with EFD improved their performance of a learned skill, but their self-awareness of their performance remained unchanged. These results may imply that EFD inhibits self-awareness development, and that self-awareness may not depend on task performance, but, rather, is influenced by other external factors. The article reports the secondary analysis from the results of the Functional Individualized Therapy for Teenagers with Executive Deficits (FITTED) intervention on human participants.
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Affiliation(s)
- Yael Fogel
- Department of Occupational Therapy, Ariel University, Ariel 4077625, Israel
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7
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Arora C, Frantz C, Toglia J. Awareness of Performance on a Functional Cognitive Performance-Based Assessment Across the Adult Lifespan. Front Psychol 2021; 12:753016. [PMID: 34803834 PMCID: PMC8602564 DOI: 10.3389/fpsyg.2021.753016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/19/2021] [Indexed: 11/15/2022] Open
Abstract
As people age, their cognitive skills and ability to complete complex instrumental activities of daily living often decline in subtle ways. Older adults who are aware of these slight cognitive and functional changes spontaneously adapt and implement strategies to maximize performance. On the other hand, older adults with limited self-awareness are less likely to adjust performance or initiate compensatory strategies as they may not recognize the need to do so. This places them at higher risk of functional decline and loss of independence. Research on awareness of functional performance in healthy adults is, however, limited, and there is a paucity of assessment tools available to address questions of awareness and strategy use in functional tasks. We used the Weekly Calendar Planning Activity (WCPA) - a performance-based assessment of functional cognition including measures of awareness and strategy use - to investigate differences in performance, awareness, and strategy use across the adult lifespan. The WCPA requires examinees to schedule appointments into a weekly calendar while following rules designed to increase task demands. Healthy adults (n=342) from ages 18-92 were observed for strategy use and error recognition, while a post-test interview probed participants' reported strategy use and estimation of accuracy. The discrepancy between participant estimation and actual accuracy provided a measure of online awareness of performance where a larger estimation discrepancy indicated over-estimation of performance. Performance on the WCPA declined across the adult lifespan. Older adults were less likely to use self-monitoring strategies and used less effective strategies overall. Overestimation was associated with use of fewer strategies and lower accuracy in all age groups. Importantly, twice as many older adults overestimated compared to younger adults. Furthermore, the subset of older adults who had good awareness of performance was more likely to use effective strategies, to recognize errors, and achieved accuracy on par with their younger counterparts. Our results emphasize the importance of examining self-awareness of performance and analyzing the strategies used to perform a complex functional task. This information can provide a foundation for early detection of functional decline in aging and for designing interventions to maximize functional independence in aging.
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Affiliation(s)
- Catherine Arora
- Department of Occupational Therapy, School of Health and Natural Sciences, Mercy College, Dobbs Ferry, NY, United States
| | - Carina Frantz
- Department of Occupational Therapy, School of Health and Natural Sciences, Mercy College, Dobbs Ferry, NY, United States
| | - Joan Toglia
- School of Health and Natural Sciences, Mercy College, Dobbs Ferry, NY, United States
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8
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Torres IJ, Hidiroglu C, Mackala SA, Ahn S, Yatham LN, Ozerdem E, Michalak EE. Metacognitive knowledge and experience across multiple cognitive domains in euthymic bipolar disorder. Eur Psychiatry 2021; 64:e36. [PMID: 34082855 PMCID: PMC8204590 DOI: 10.1192/j.eurpsy.2021.31] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Metacognitive knowledge (MK; general awareness of cognitive functioning) and metacognitive experience (ME; awareness of cognitive performance on a specific cognitive task) represent two facets of metacognition that are critical for daily functioning, but are understudied in bipolar disorder. This study was conducted to evaluate MK and ME across multiple cognitive domains in individuals diagnosed with bipolar disorder and unaffected volunteers, and to investigate the association between metacognition and quality of life (QoL). Methods Fifty-seven euthymic participants with bipolar disorder and 55 demographically similar unaffected volunteers provided prediction and postdiction ratings of cognitive task performance across multiple cognitive domains. Self-ratings were compared to objective task performance, and indices of MK and ME accuracy were generated and compared between groups. Participants rated QoL on the Quality of Life in Bipolar Disorder Scale (QoL.BD). Results Metacognitive inaccuracies in both MK and ME were observed in participants with bipolar disorder, but only in select cognitive domains. Furthermore, most metacognitive inaccuracies involved underestimation of cognitive ability. Metacognitive indices were minimally associated with medication variables and mood symptoms, but several indices were related to QoL. Conclusions Individuals with bipolar disorder demonstrate inaccuracies in rating their cognitive functioning and in rating their online cognitive task performance, but only on select cognitive functions. The tendency to underestimate performance may reflect a negative information processing bias characteristic of mood disorders. Metacognitive variables were also predictive of QoL, indicating that further understanding of cognitive self-appraisals in persons with bipolar disorder has significant clinical relevance.
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Affiliation(s)
- Ivan J Torres
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Mental Health and Substance Use Services, Vancouver, British Columbia, Canada
| | - Ceren Hidiroglu
- Department of Psychology, Dokuz Eylul University, Izmir, Turkey
| | - Sylvia A Mackala
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sharon Ahn
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eysegul Ozerdem
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Erin E Michalak
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
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9
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Zimmermann N, Pontes MC, Kochhann R, Prigatano GP, Fonseca RP. Patient Competency Rating Scale-Brazilian Revised Version (PCRS-R-BR): Normative and Psychometric Data in 154 Healthy Individuals. Brain Inj 2020; 35:138-148. [PMID: 33372816 DOI: 10.1080/02699052.2020.1861651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background Patient Competency Rating Scale (PCRS-R-BR) is a clinical tool to evaluate the degree of competence in cognitive skills perceived by patients with brain injuries. However, no studies have investigated the influence of sociodemographic variables on self-report and self-awareness of healthy individuals.Aim This study aimed to (1) present normative data from the PCRS-R-BR in a healthy adult Brazilian sample; and (2) investigate psychometric properties of the scaleMethod One hundred and fifty-four adults that were divided in three age groups and two education groups and their informants completed the PCRS-R-BR.Results Score on the PCRS-R-BR Patient's Form differed as a function of age with younger adults reporting less competency than older individuals. An education effect was found on Attention/Working memory Factor on the Informant's PCRS-R-BR with informants of higher education adults reporting better competency than lower education individuals. A gender effect was observed on the Informant's Form. The Informant's Form scores of informants of women were higher than the scores provided by the informants of men. PCRS-R-BR showed adequate consistency coefficients and six factors.Conclusion PCRS-R-BR scores showed acceptable validity evidence and provides information regarding how age and gender effects may influence ratings in a Brazilian sample.
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Affiliation(s)
- Nicolle Zimmermann
- Neuropsychology Service, Paulo Niemeyer State Brain Institute, Rio De Janeiro, Brazil
| | - Monique Castro Pontes
- Neuropsychology Service, Paulo Niemeyer State Brain Institute, Rio De Janeiro, Brazil
| | - Renata Kochhann
- Department of Psychology, Pontifical Catholic University of Rio Grande Do Sul, Porto Alegre, Brazil
| | - George P Prigatano
- Department of Clinical Neuropsychology, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Rochele P Fonseca
- Department of Psychology, Pontifical Catholic University of Rio Grande Do Sul, Porto Alegre, Brazil
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10
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Quiles C, Prouteau A, Verdoux H. Assessing metacognition during or after basic-level and high-level cognitive tasks? A comparative study in a non-clinical sample. Encephale 2020; 46:3-6. [PMID: 31227210 DOI: 10.1016/j.encep.2019.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/25/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022]
Abstract
This study explored in a non-clinical sample whether metacognitive awareness assessments measured during ("on line") and after ("end line") a neuropsychological task lead to comparable results in tests exploring basic-level or high-level cognitive functions. Short-term memory and working memory tests (forward and backward digit recall of the WAIS-III) were used to measure basic-level cognitive function. A social cognition test, the French adaptation of the Faces Test, was used to assess high-level cognitive function through recognition of facial emotions. For these two tests, we explored "on line" metacognitive awareness using a method based upon Koriat and Goldsmith's protocol. After each answer, participants were asked to rate their level of confidence in the correctness of their response. Persons had also to rate their confidence in their answer only once, at the end of the neuropsychological test, in order to explore "end line" metacognitive awareness. They were then asked "do you feel you have passed this test?" and had to rate their feeling of success on a 4-point Likert-type scale ("no", "rather not", "rather yes", "yes"). No association was found between "on line" and "end line" metacognitive awareness scores on memory tests. Poor "end line" metacognitive awareness was associated with lower "on line" metacognitive awareness score in the social cognition test. It might be of interest to assess both "on line" and "end line" metacognitive awareness in persons with schizophrenia to better take into accounts the multi-faceted structure of metacognition.
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Affiliation(s)
- C Quiles
- Université de Bordeaux, 33000 Bordeaux, France; INSERM, U1219, 33000 Bordeaux, France; Centre hospitalier Charles-Perrens, 33000 Bordeaux, France
| | - A Prouteau
- Université de Bordeaux, 33000 Bordeaux, France; Laboratoire de Psychologie Santé et Qualité de la vie EA 4139, 33000 Bordeaux, France
| | - H Verdoux
- Université de Bordeaux, 33000 Bordeaux, France; INSERM, U1219, 33000 Bordeaux, France; Centre hospitalier Charles-Perrens, 33000 Bordeaux, France.
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11
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Van Camp L, Sabbe BGC, Oldenburg JFE. Metacognitive functioning in bipolar disorder versus controls and its correlations with neurocognitive functioning in a cross-sectional design. Compr Psychiatry 2019; 92:7-12. [PMID: 31202082 DOI: 10.1016/j.comppsych.2019.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 05/08/2019] [Accepted: 06/01/2019] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Metacognition is an important factor in the development and persistence of bipolar disorder. One of the most striking examples of impairment in metacognitive functioning in bipolar disorder is the lack of insight these patients have in their disorder. Despite its importance, research regarding metacognition in bipolar disorder is scarce. Furthermore, the neurocognitive basis of metacognitive functioning is unknown. METHODS The current study included 29 patients with bipolar disorder and 29 age, educational level and gender matched healthy controls. All the participants filled in a metacognition questionnaire that examined their metacognitive beliefs. In addition, it was tested how well they estimated their performance on a neurocognitive test-battery beforehand (metacognitive knowledge) and afterwards (metacognitive experience). RESULTS Bipolar disorder patients showed maladaptive metacognitive beliefs in comparison with the healthy controls. They also showed impaired metacognitive knowledge and experience. That is, they overestimated their own cognitive performance. However, the latter result was also true for the healthy controls. In addition, metacognition had neurocognitive correlates. However, for the bipolar patients, depressive symptomatology had an important effect on this relationship and on metacognition in general. CONCLUSION Maladaptive metacognitive skills are related to depression in bipolar disorder. A more healthy metacognitive thinking should be promoted. An effective training for this could be a therapy that includes various elements, from basic cognitive- to higher order metacognitive training.
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Affiliation(s)
- L Van Camp
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium; Psychiatric Hospital Duffel, University Department, Stationsstraat 22c, 2570 Duffel, Belgium.
| | - B G C Sabbe
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium; Psychiatric Hospital Duffel, University Department, Stationsstraat 22c, 2570 Duffel, Belgium
| | - J F E Oldenburg
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium; Psychiatric Hospital Duffel, University Department, Stationsstraat 22c, 2570 Duffel, Belgium
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Hurst FG, Ownsworth T, Beadle E, Shum DHK, Fleming J. Domain-specific deficits in self-awareness and relationship to psychosocial outcomes after severe traumatic brain injury. Disabil Rehabil 2018; 42:651-659. [DOI: 10.1080/09638288.2018.1504993] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Felicity G. Hurst
- School of Applied Psychology and Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Tamara Ownsworth
- School of Applied Psychology and Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Elizabeth Beadle
- School of Applied Psychology and Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - David H. K. Shum
- School of Applied Psychology and Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Neuropsychology and Applied Cognitive Neuroscience Laboratory CAS Key Laboratory of Mental Health, Institute of Psychology Chinese Academy of Sciences, Griffith University, Beijing, China
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Australia
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Abstract
BACKGROUND Failure to translate best evidence into practice often generates inappropriate, unsafe, and costly healthcare. The continuing professional development (CPD) of physicians and other health professionals represents a widely underutilized strategy to improve both clinician performance and healthcare quality and safety. The evidence: Despite the clear evidence of the potential impact of CPD based in learning theory and science, some CPD providers, health systems, and clinicians themselves implement less-than-effective effective learning strategies. This phenomenon is the product of several factors: within health systems, a lack of recognition of the importance of ongoing, system-linked professional education; among CPD providers, an adherence to old but easy-to-deliver "one-and-done" methods CPD; and even among clinicians themselves, choosing less engaging learning activities, uninformed by objective performance data. RECOMMENDATION Suggestions to improve this lack of translation of best evidence into practice fall into four groups. Academic medical institutions, employers and educators need to embrace principles and practices of self-directed learning; health systems must share responsibility for the physician learning and the performance data and feedback on which such learning is best-based; physician specialty societies and licensing boards must undertake meaningful re-licensure and re-certification processes; and CPD planners must seek out partnerships with health system leadership and quality improvement managers as they create engaging, integrated, and impactful CPD activities.
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Affiliation(s)
- David A Dave Davis
- a Center for Outcomes and Research in Education, Mohammed Bin Rashid University of Medicine and Health Sciences , Dubai , United Arab Emirates
| | - Graham T McMahon
- b Accreditation Council for Continuing Medical Education , Chicago , IL , USA
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14
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Zlotnik S, Toglia J. Measuring Adolescent Self-Awareness and Accuracy Using a Performance-Based Assessment and Parental Report. Front Public Health 2018; 6:15. [PMID: 29456993 PMCID: PMC5801478 DOI: 10.3389/fpubh.2018.00015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/16/2018] [Indexed: 11/25/2022] Open
Abstract
Aim The aim of this study was to assess awareness of performance and performance accuracy for a task that requires executive functions (EF), among healthy adolescents and to compare their performance to their parent’s ratings. Method Participants: 109 healthy adolescents (mean age 15.2 ± 1.86 years) completed the Weekly Calendar Planning Activity (WCPA). The discrepancy between self-estimated and actual performance was used to measure the level of awareness. The participants were divided into high and low accuracy groups according to the WCPA accuracy median score. The participants were also divided into high and low awareness groups. A comparison was conducted between groups using WCPA performance and parent ratings on the Behavior Rating Inventory of Executive Function (BRIEF). Results Higher awareness was associated with better EF performance. Participants with high accuracy scores were more likely to show high awareness of performance as compared to participants with low accuracy scores. The high accuracy group had better parental ratings of EF, higher efficiency, followed more rules, and were more aware of their WCPA performance. Conclusion Our results highlight the important contribution that self-awareness of performance may have on the individual’s function. Assessing the level of awareness and providing metacognitive training techniques for those adolescents who are less aware, could support their performance.
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Affiliation(s)
- Sharon Zlotnik
- Laboratory for Innovation in Rehabilitation Technology Israel Center for Research Excellence: LINKS - Learning in a NetworKed Society, Department of Occupational Therapy, University of Haifa, Haifa, Israel
| | - Joan Toglia
- School of Health and Natural Sciences, Mercy College, Dobbs Ferry, NY, United States
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15
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Fogarty J, Almklov E, Borrie M, Wells J, Roth RM. Subjective rating of executive functions in mild Alzheimer's disease. Aging Ment Health 2017; 21:1184-1191. [PMID: 27454406 DOI: 10.1080/13607863.2016.1207750] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Subjective cognitive decline is considered to be a core feature of pre-Alzheimer's disease (AD) conditions, the vast majority of literature having focused on memory concerns. Neuropsychological studies have implicated executive dysfunction on objective performance measures in AD, but no research has evaluated whether individuals with AD have concerns about their executive functions and whether it differs from their caregiver's concerns. In the present study, we sought to evaluate self- and informant ratings of executive functioning in patients with mild AD. METHOD Participants were 23 patients with mild AD and 32 healthy elderly controls (HC) and their informants who completed the Behavior Rating Inventory of Executive Function - Adult version. RESULTS Patients with AD and their informants reported greater executive dysfunction than the HC group and their informants, respectively, and patients reported greater difficulty than their informants. The largest effect size for both self- and informant ratings was obtained for the Working Memory scale. CONCLUSIONS These findings indicate that subjective cognitive concerns in mild AD extend beyond the memory domain to executive functions. That greater difficulty was endorsed by patients than their informants suggests that at least in the mild stage of AD some awareness of executive dysfunction may be maintained in some patients. Implications for clinical care are discussed.
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Affiliation(s)
- Jennifer Fogarty
- a Department of Psychiatry and Division of Geriatric Medicine , Schulich School of Medicine & Dentistry, Western University , London , Ontario , Canada.,b Specialized Geriatric Services , Parkwood Institute , London , Ontario , Canada
| | - Erin Almklov
- c Neuropsychology Program, Department of Psychiatry , Geisel School of Medicine at Dartmouth , One Medical Center Drive, Lebanon , NH , USA
| | - Michael Borrie
- a Department of Psychiatry and Division of Geriatric Medicine , Schulich School of Medicine & Dentistry, Western University , London , Ontario , Canada.,b Specialized Geriatric Services , Parkwood Institute , London , Ontario , Canada
| | - Jennie Wells
- a Department of Psychiatry and Division of Geriatric Medicine , Schulich School of Medicine & Dentistry, Western University , London , Ontario , Canada.,b Specialized Geriatric Services , Parkwood Institute , London , Ontario , Canada
| | - Robert M Roth
- c Neuropsychology Program, Department of Psychiatry , Geisel School of Medicine at Dartmouth , One Medical Center Drive, Lebanon , NH , USA
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Azar M, Bertrand E, Louis ED, Huey E, Collins K, Rohl B, Cosentino S. Awareness of cognitive impairment in individuals with essential tremor. J Neurol Sci 2017; 377:155-160. [PMID: 28477687 DOI: 10.1016/j.jns.2017.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/05/2017] [Accepted: 04/06/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The extent to which individuals with ET who have clinically significant cognitive impairment are aware of their cognitive changes is unclear. Reduced awareness has important implications for everyday function and decision-making. METHODS 150 individuals with ET (109 Normal Cognition (ET-NC group), and 30 with MCI and 11 dementia (ET-CI group)) completed self-ratings and objective assessments of memory, language, and executive functioning. Discrepancy scores were calculated to assess awareness of cognitive functioning. One sample t-tests evaluated whether mean discrepancy scores in each group were comparable to zero (i.e., accurate). Analyses of covariance (ANCOVA) compared discrepancy scores across two groups controlling for age and education. RESULTS In the ET-NC group, discrepancy scores for language (M=-0.08, SD=1.10) and executive functioning (M=-0.01, SD=0.99) were comparable to zero. Memory discrepancy scores (M=0.32, SD=1.22) were greater than zero. In the ET-CI group, memory, (M=0.78, SD=1.01), language, (M=0.46, SD=0.95), and executive (M=0.39, SD=1.14) discrepancy scores were all greater than zero. Discrepancy scores were larger in ET-CI group than in ET-NC group for memory: F(1,148)=4.02, p=0.047, language: F(1,148)=6.16, p=0.014, and executive: F(1,148)=4.51, p=0.035. CONCLUSIONS Individuals with ET and normal cognition accurately assessed their language and executive abilities, demonstrating mild overconfidence in memory function. Individuals with ET and cognitive impairment overestimated their performance in all domains of functioning. Since ET is linked to increased risk for cognitive impairment, and such impairment may not be accurately perceived, cognitive functioning should be proactively and regularly screened in ET.
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Affiliation(s)
- Martina Azar
- Cognitive Neuroscience Division, Department of Neurology, Gertrude H. Sergievsky Center, NY, USA; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, NY, USA
| | - Elodie Bertrand
- Cognitive Neuroscience Division, Department of Neurology, Gertrude H. Sergievsky Center, NY, USA; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, NY, USA
| | - Elan D Louis
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA; Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA; Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Edward Huey
- Cognitive Neuroscience Division, Department of Neurology, Gertrude H. Sergievsky Center, NY, USA; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, NY, USA
| | - Kathleen Collins
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA; Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA; Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Brittany Rohl
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA; Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA; Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Stephanie Cosentino
- Cognitive Neuroscience Division, Department of Neurology, Gertrude H. Sergievsky Center, NY, USA; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, NY, USA.
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17
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Torres IJ, Mackala SA, Kozicky JM, Yatham LN. Metacognitive knowledge and experience in recently diagnosed patients with bipolar disorder. J Clin Exp Neuropsychol 2016; 38:730-44. [PMID: 27144722 DOI: 10.1080/13803395.2016.1161733] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Metacognition, which refers to an individual's ability to assess their own cognitive ability or performance, is poorly understood in bipolar disorder. This study was conducted to evaluate two aspects of metacognitive ability in recently diagnosed patients with bipolar disorder: (a) metacognitive knowledge, pertaining to awareness of one's own general cognitive functioning; and (b) metacognitive experience, referring to awareness of one's cognitive performance on a specific, online cognitive task. METHOD Participants consisted of 50 clinically euthymic patients recently diagnosed with Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) bipolar I disorder who were within three months of resolution of their first manic episode, and a comparison group of 38 demographically similar healthy volunteers. To assess metacognitive knowledge, participants provided a general rating of their estimated cognitive ability prior to completing a neuropsychological battery, and self-ratings were compared to actual ability based on a composite score of overall cognitive functioning. To assess metacognitive experience, subjects provided a postdiction rating of their perceived memory performance after completing a list learning verbal memory test, and self-ratings were compared to actual memory performance. Measures of both relative and absolute accuracy of ratings were obtained. RESULTS Results indicated that patients showed diminished accuracy in rating their general cognitive ability, implying deficits in metacognitive knowledge. In contrast, patients were accurate in rating their online memory performance, suggesting intact metacognitive experience. CONCLUSIONS Findings suggest that in patients with bipolar disorder, intact task-specific cognitive self-appraisals may fail to generalize to or to modify inaccurate global cognitive self-appraisals. Further research using more comprehensive metacognitive tasks is warranted in bipolar disorder.
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Affiliation(s)
- Ivan J Torres
- a Department of Psychiatry , University of British Columbia , Vancouver , BC , Canada.,b BC Psychosis Program: British Columbia Mental Health and Substance Use Services , Vancouver , BC , Canada
| | - Sylvia A Mackala
- a Department of Psychiatry , University of British Columbia , Vancouver , BC , Canada
| | - Jan-Marie Kozicky
- a Department of Psychiatry , University of British Columbia , Vancouver , BC , Canada
| | - Lakshmi N Yatham
- a Department of Psychiatry , University of British Columbia , Vancouver , BC , Canada
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Quiles C, Prouteau A, Verdoux H. Associations between self-esteem, anxiety and depression and metacognitive awareness or metacognitive knowledge. Psychiatry Res 2015; 230:738-41. [PMID: 26548980 DOI: 10.1016/j.psychres.2015.10.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 09/29/2015] [Accepted: 10/30/2015] [Indexed: 11/17/2022]
Abstract
This study explored in a non-clinical sample the associations between self-esteem, anxiety and depression symptoms and metacognitive awareness or metacognitive knowledge. Higher metacognitive awareness scores measured during the neuropsychological tasks were positively associated with higher depression scores in the social cognition test. Metacognitive knowledge score measured independently of ongoing neuropsychological tasks was positively associated with lower self-esteem, higher anxiety (state or trait) and depression scores.
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Affiliation(s)
- Clélia Quiles
- Université de Bordeaux, F-33000 Bordeaux, France; INSERM, U657, F-33000 Bordeaux, France
| | - Antoinette Prouteau
- Université de Bordeaux, F-33000 Bordeaux, France; Laboratoire de Psychologie Santé et Qualité de la vie, EA 4139, F-33000 Bordeaux, France
| | - Hélène Verdoux
- Université de Bordeaux, F-33000 Bordeaux, France; INSERM, U657, F-33000 Bordeaux, France.
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Assessing metacognition during a cognitive task: impact of "on-line" metacognitive questions on neuropsychological performances in a non-clinical sample. J Int Neuropsychol Soc 2014; 20:547-54. [PMID: 24867441 DOI: 10.1017/s1355617714000290] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Whereas metacognition is of great interest for neuropsychological practice, little is known about the impact of metacognitive questions during a neuropsychological assessment. This study explored the impact of measuring "on-line" metacognitive processes on neuropsychological performances in a non-clinical population. Participants were randomly assigned to a "standard" or a "metacognitive" neuropsychological test procedure. The "standard" procedure assessed executive functions (Modified Card Sorting Test), episodic memory ("Rappel libre Rappel indicé" 16), working memory (digit span test Wechsler Adult Intelligence Scale III) and social cognition (Faces Test). In the "metacognitive" procedure, two questions were added after each item of these tests to evaluate "on-line" metacognitive monitoring and control. Working memory performances were better and episodic memory performances lower in the "metacognitive" versus the "standard" procedure. No significant difference was found concerning executive functioning or social cognition. The assessment of "on-line" metacognition might improve working memory performances by enhancing concentration, and might impair episodic memory performances by acting as a distractor. These findings may have implications for the development of cognitive remediation programs.
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Boosman H, van Heugten CM, Winkens I, Heijnen VA, Visser-Meily JMA. Awareness of memory functioning in patients with stroke who have a good functional outcome. Brain Inj 2014; 28:959-64. [DOI: 10.3109/02699052.2014.888763] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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