Awareness of executive functioning deficits in multiple sclerosis: Self versus informant ratings of impairment

Cognitive Complaints and Their Impact on Daily Life in Patients with Degenerative Cerebellar Disorders

Cognitive and affective sequelae of cerebellar disease are receiving increased attention, but their actual rate of occurrence remains unclear. Complaints may have a significant impact on patients, affecting social behavior and psychological well-being. This study aims to explore the extent of subjective cognitive and affective symptoms in patients with degenerative ataxias in the Netherlands. An explorative study was set up in a heterogeneous group of degenerative ataxia patients. Self-reported cognition was evaluated in terms of executive functioning and affect (Dysexecutive Questionnaire/DEX), and memory/attention (Cognitive Failures Questionnaire/CFQ). The Daily Living Questionnaire (DLQ) was administered to quantify the impact on daily life. Furthermore, informants completed questionnaires to obtain insight into patients' self-awareness and social cognition (Observable Social Cognition Rating Scale/OSCARS). This study shows that subjective complaints in the domains of (1) executive functioning and/or (2) memory and attention were reported by 29% of all patients (n = 24/84). In addition, more difficulties in daily life in terms of language/comprehension and community/participation were reported, and this was more common for patients with cognitive complaints than those without. Discrepancies between patients and informants about executive functioning were present in both directions. Deficits in social cognition were not identified at the group level, but more social-cognitive problems were observed in patients with more executive problems rated by informants. Taken together, our findings indicate that cognitive complaints are common in patients with degenerative cerebellar disorders and have an impact on daily life functioning. These results may help to increase awareness of cognitive symptoms and their impact in patients with cerebellar ataxia, their significant others, and professional caregivers.

Differences in metacognition between multiple sclerosis phenotypes: cognitive impairment and fatigue are key factors

Background

Cognitive impairment is present in 40-65% of patients with multiple sclerosis (pwMS). Objectively measured cognitive performance often does not match patients' subjective perception of their own performance.

Objective

We aimed to compare cognitive performance and subjective perception of cognitive deficits between pwMS and healthy controls (HCs), as well as the accuracy of subjective perception.

Methods

In total, 54 HC and 112 pwMS (relapsing-remitting, RRMS, and progressive PMS) underwent neuropsychological evaluation and completed perceived deficit, fatigue, and anxiety-depression scales. Participants were classified according to their consistency between subjective self-evaluation of cognitive abilities and objective cognitive performance to assess accuracy. Regression models were used to compare cognitive performance between groups and explore factors explaining inaccuracy in the estimation of cognitive performance.

Results

PMS showed greater and more widespread cognitive differences with HC than RRMS. No differences were found between pwMS and HC in the perception of deficit. PMS had higher ratios of overestimators. In explaining inaccuracy, fatigue and cognitive preservation were found to be risk factors for underestimation, whereas physical disability and cognitive impairment were risk factors for overestimation.

Conclusion

PwMS have metacognitive knowledge impairments. This study provides new information about metacognition, data on the prevalence of impairments over a relatively large sample of PwMS, and new insights into factors explaining it. Anosognosia, related to cognitive impairment, may be present in pwMS. Fatigue is a key factor in underestimating cognition.

A Multidimensional Assessment of Metacognition Across Domains in Multiple Sclerosis

OBJECTIVE

In neurological diseases, metacognitive judgements have been widely used in order to assess the degree of disease awareness. However, as yet little research of this type has focused on multiple sclerosis (MS).

METHOD

We here focused on an investigation of item-by-item metacognitive predictions (using feeling-of-knowing judgements) in episodic and semantic memory and global metacognitive predictions in standard neuropsychological tests pertinent to MS (processing speed and verbal fluency). Twenty-seven relapsing-remitting MS (RR-MS) patients and 27 comparison participants took part.

RESULTS

We found that RR-MS patients were as accurate as the group of comparison participants on our episodic and semantic item-by-item judgements. However, for the global predictions, we found that the MS group initially overestimated their performance (ds = .64), but only on a task on which performance was also impaired (ds = .89; processing speed). We suggest that MS patients, under certain conditions, show inaccurate metacognitive knowledge. However, postdictions and item-by-item predictions indicate that online metacognitive processes are no different from participants without MS.

CONCLUSION

We conclude that there is no monitoring deficit in RR-MS and as such these patients should benefit from adaptive strategies and symptom education.

Naturalistic Assessment using a Simulated Environment: Cognitive Correlates and Relationship to Functional Status in Individuals with Neurologic Conditions

Objective

Research has shown that neurologic conditions, such as traumatic brain injury and multiple sclerosis, result in a number of cognitive and functional deficits. However, little is known about the relationship between various cognitive domains and ability to perform everyday activities. The Community Shopping Task (CST), a naturalistic assessment task conducted in a simulated environment, was used to examine functional abilities and cognitive correlates of everyday functioning in individuals with neurologic conditions.

Method

Thirty-four participants with neurologic conditions and 34 healthy controls completed the CST as well as traditional paper-pencil measures of cognition. In addition, all participants completed a questionnaire assessing instrumental activities of daily living (IADLs).

Results

The results indicated that participants with neurologic conditions required significantly more cues and time to complete the CST compared to control participants and that immediate memory and executive functioning were important predictors of CST performance. Furthermore, time to complete the CST accounted for a significant amount of variance in IADL performance, over and beyond the traditional measures of cognition.

Conclusions

These results provide evidence that a naturalistic task completed in an everyday environment can enhance our understanding of how daily functioning is impacted in individuals with neurologic conditions and subsequently inform rehabilitation strategies.

Metacognition and self-awareness in Multiple Sclerosis

Although a large range of literature on awareness and metacognition focuses on different neurological populations, little attention has been paid to Multiple Sclerosis (MS). This paper gathers literatures related to studies of anosognosia and the theoretical construct of metacognition which both offer a means to operationalize and measure awareness in MS. We focused on both a clinical concern, regarding the relationship between subjective and objective evolution of cognitive performance, and the theoretical issue of metacognitive processes implicated in disease awareness. We identified 26 papers with findings related to awareness of cognitive impairment in MS using questionnaire-based or performance-based methods. We found support for the idea that the relationship between subjective evaluation and neuropsychological evaluation depends on disease duration and is strongly modulated by other variables, such as mood state. We propose that the metacognitive deficit for memory tasks in this population arises from memory impairment. Finally, we discuss methodological issues, variability in MS patients, and the domain specificity of metacognitive impairment.

Alteration profile of executive functions in multiple sclerosis

OBJECTIVE

Executive functions (EF) in multiple sclerosis (MS) have been only partially studied, mainly trough the evaluation of subfunctions. The main objective was to analyse the EF alteration profile in a patients with MS sample.

PARTICIPANTS AND METHODS

Case-control study, 100 patients with MS and 30 controls were evaluated by the following tests: Comprehensive Trail Making Test, Stroop Test, Wisconsin Card Sorting Test, picture completion, letter-number sequencing, comprehension and similarities of the WAIS-III scale, phonological and semantic fluency, zoo map test, temporal judgment and behavioural Dysexecutive Questionnaire (DEX-Q) of the Behavioural Assessment of the Dysexecutive Syndrome. Scores below normative values were considered pathological. Factorial analysis was used to simplify the deficits, and multiple regression and ANOVA statistics were used to analyse the relationship between clinical and cognitive variables.

RESULTS

Seventy-four patients had a recurrent-relapsing course, the mean degree of disability by Expanded disability Status Scale (EDSS) was 2.7 and the mean time of evolution was 9.94 years. Eighty-five per cent presented alterations in 3 or more EF tests and 71% in 5 or more. In the factorial analysis, three groups of functions were involved: (i) cognitive flexibility (ii) inhibition and (iii) abstraction ability. Patients with a progressive course and a high EDSS had a significantly worse performance (P < 0.05). The patients showed a low awareness of their deficit in the DEX-Q.

CONCLUSIONS

Cognitive flexibility, inhibition and abstraction ability were the three components of EF most deficient. The patients with the worst performance were those with progressive forms and a high EDSS.

Relationship between subjective and objective cognitive performance in multiple sclerosis

OBJECTIVES

Self- and informant reports of patients' cognitive performance are an important source of information for clinicians to consider in neuropsychological evaluation. The aim of the study was to find out whether the relationship between subjective or informant observations of cognitive deterioration and objective cognitive performance differ in patients with relapsing and progressive multiple sclerosis (MS).

MATERIALS & METHODS

One ninety-six MS patients (relapsing-remitting n = 138; progressive n = 58) underwent neuropsychological assessment with the Brief Repeatable Battery of Neuropsychological Tests. Subjective and informant-reported cognitive symptoms, mood, impact of the disease, and quality of life were evaluated with self-reports. According to consistency of evaluations, patients and informants were classified as accurate estimators (consistent subjective and objective cognitive performance), underestimators (subjectively but not objectively cognitively impaired), or overestimators (objectively but not subjectively cognitively impaired).

RESULTS

Patients' and informants' reports on patients' cognitive performance were approximately equally appropriate, slightly over half being accurate. Mood was associated with patients' subjective cognitive complaints. The relapsing group reported more subjective cognitive symptoms than the progressive group, although the objective cognitive performance did not differ between the groups. Overestimation occurred especially among patients with more severe physical disability, progressive phenotype of the disease, more pronounced cognitive impairment, and less education.

CONCLUSIONS

Slightly over half of patient and informant observations of cognitive deterioration were appropriate. Patients with progressive phenotype were more prone to overestimation than patients with relapsing phenotype.

The Executive Dysfunctions Most Commonly Associated with Multiple Sclerosis and Their Impact on Occupational Performance

Introduction:

The relationship between executive dysfunction and functional status in people with multiple sclerosis (MS) is not fully understood. This study attempts to provide empirical evidence of the executive dysfunctions most commonly associated with MS and to develop an understanding of the impact of this on occupational performance.

Method:

This cross-sectional study explores the relationships between an MS group (n = 69) and a healthy control group (n = 30) using the Behavioural Assessment of Dysexecutive Syndrome and the Dysexecutive Questionnaire.

Results:

More than a third of people with MS experienced some impairment of executive function sufficient to interfere with occupational performance. The most commonly occurring problems included planning, problem solving, behavioural regulation, lack of insight, apathy and lack of motivation. Executive function deficits were evident from the early stages of the disease, although participants with a secondary progressive form of MS appeared to demonstrate greater difficulties.

Conclusion:

While the Behavioural Assessment of Dysexecutive Syndrome may reliably identify the presence of executive dysfunction within this clinical population it does not inform clinicians of the impact on occupational performance. Self-reported executive function demonstrates heightened awareness of occupational performance deficits and may lead to more accurate reporting of executive dysfunction. The impact of depression, fatigue and anxiety, however, requires further investigation.

Self-assessment of cognition in Multiple Sclerosis: the role of personality and anxiety

OBJECTIVE

: To investigate the role of personality and anxiety to self-report measures of cognition in patients with multiple sclerosis (MS).

BACKGROUND

: Self-report measures of cognition have consistently been shown to correlate better with depressed mood than neuropsychological test performance in patients with MS, with few studies focusing on the role of anxiety and personality.

METHOD

: One hundred eight MS patients completed the following: (a) patient and informant report Multiple Sclerosis Neuropsychological Questionnaire (MSNQ); (b) Hospital Anxiety and Depression Scale; (c) cognitive assessment with the Brief Repeatable Battery of Neuropsychological Tests; and (d) personality assessment using the self-report NEO Five-Factor Inventory.

RESULTS

: Higher patient MSNQ (P-MSNQ) scores (greater reported cognitive dysfunction) were significantly correlated with lower scores on the Paced Auditory Serial Addition Test (PASAT; r=-0.20, P<0.05), increased depression (r=0.45, P<0.01) and anxiety (r=0.54, P<0.01), higher neuroticism (r=0.51, P<0.01), and lower conscientiousness (r=-0.35, P<0.01). After controlling for demographic variables, significant predictors of P-MSNQ scores were anxiety (ΔR=0.272, P<0.001), conscientiousness (ΔR=0.067, P=0.002), and performance on the PASAT (ΔR=0.050, P=0.005). Depression and neuroticism did not contribute significant variance in comparison to anxiety.

CONCLUSIONS

: Overall, patient self-reports of cognition did not correspond well to neuropsychological performance. Anxiety and conscientiousness contributed significantly to patients' perceptions of their cognitive failings and thus should be taken into account when addressing these complaints.