Differential compromise of prospective and retrospective metamemory monitoring and their dissociable structural brain correlates

Neural Correlates of Metacognition Impairment in Opioid Addiction

BACKGROUND

Individuals with substance use disorder show impaired self-awareness of ongoing behavior. This deficit suggests problems with metacognition, which has been operationalized in the cognitive neuroscience literature as the ability to monitor and evaluate the success of one's own cognition and behavior. However, the neural mechanisms of metacognition have not been characterized in a population with drug addiction.

METHODS

Community samples of participants with opioid use disorder (OUD) (n = 27) and healthy control participants (n = 29) performed a previously validated functional magnetic resonance imaging metacognition task (perceptual decision-making task along with confidence ratings of performance). Measures of recent drug use and addiction severity were also acquired.

RESULTS

Individuals with OUD had lower metacognitive sensitivity (i.e., disconnection between task performance and task-related confidence) than control individuals. Trial-by-trial analyses showed that this overall group difference was driven by (suboptimally) low confidence in participants with OUD during correct trials. In functional magnetic resonance imaging analyses, the task engaged an expected network of brain regions (e.g., rostrolateral prefrontal cortex and dorsal anterior cingulate/supplementary motor area, both previously linked to metacognition); group differences emerged in a large ventral anterior cluster that included the medial and lateral orbitofrontal cortex and striatum (higher activation in OUD). Trial-by-trial functional magnetic resonance imaging analyses showed group differences in rostrolateral prefrontal cortex activation, which further correlated with metacognitive behavior across all participants. Exploratory analyses suggested that the behavioral and neural group differences were exacerbated by recent illicit opioid use and unexplained by general cognition.

CONCLUSIONS

With confirmation and extension of these findings, metacognition and its associated neural circuits could become new, promising therapeutic targets in addiction.

Stability and consistency of metamemory judgments within a session

There has been much interest in assessing individual and group differences in metamemory skills. These endeavors require or would benefit from enhanced knowledge about the stability and consistency of metamemory judgments over successive trials. However, few studies have examined these aspects. Thus, the present study investigated and compared the within-session stability and consistency of three major types of metamemory judgment: judgment of learning (JOL), feeling-of-knowing judgment (FOK), and retrospective confidence judgment (RCJ), using a single-task paradigm. A total of 38 healthy young adults (17 males, 21 females) completed three trials of a face–scene associative learning task designed to assess metamemory. In each trial, participants rated their JOLs while studying a new set of face–scene pairs, and then rated their FOKs and RCJs while their memory was being tested. The stability and consistency of the mean confidence ratings and the relationships between confidence rating and memory performance, indexed by two gamma estimates, were analyzed and compared across types of metamemory judgments. Over trials, there was a significant decrease in the mean rating for JOL but not for FOK or RCJ. Also, the gamma scores of JOL, but not that of FOK or RCJ, significantly improved with practice. Furthermore, for each type of metamemory judgment, the mean confidence rating showed excellent consistency across trials. Depending on the judgment type and gamma estimation method, the consistency of gamma scores ranged from poor to excellent. Thus, the present study clarified the temporal dynamics of various types of metamemory judgments and the consistency of metamemory measures.

Reduced calibration between subjective and objective measures of episodic future thinking in alcohol use disorder

BACKGROUND

A reduced capacity to mentally simulate future scenarios could be of clinical importance in alcohol use disorder (AUD). However, little is known about the mechanisms underlying episodic future thinking (EFT) impairment in AUD.

METHODS

We tested patients with severe AUD using two measures of EFT: the individual's own subjective experience of their imaginings (phenomenology) and the objective number of details included in imagined events, as assessed by an independent observer (examination). The comparison between the two measures allowed us to investigate the extent to which the subjective and objective characteristics of EFT are calibrated in healthy and AUD participants matched for age, education, and gender. The possible impact of cognitive functioning and disturbed mood on EFT measures was also investigated.

RESULTS

In terms of objective details of EFT, patients with AUD (n = 40) generated fewer episodic components and more non-episodic components than control participants (n = 40), even when controlling for cognitive functioning. However, self-ratings of phenomenological characteristics indicated that participants with AUD perceived imagined future events at a similar level of detail as control participants. Additionally, there was a significant correlation between objective and subjective measures in healthy individuals but not in the AUD group. A higher depression score in the AUD group was not associated with the EFT measures.

CONCLUSIONS

These results suggest a distorted self-assessment of the richness of imagined future events in individuals with AUD. We discuss these apparent limitations in metacognitive abilities and verbal descriptions of imagined events among individuals with AUD and their clinical implications.

Retrospective confidence judgments: Meta-analysis of functional magnetic resonance imaging studies

Confidence in our retrieved memories, that is, retrospective confidence, is a metamemory process we perform daily. There is an abundance of applied research focusing on the metamemory judgments and very diverse studies including a wide range of clinical populations. However, the neural correlates that support its functioning are not well defined impeding the implementation of noninvasive neuromodulatory clinical interventions. To address the neural basis of metamemory judgments, we ran a meta‐analysis, where we used the activation likelihood estimation method on the 19 eligible functional magnetic resonance imaging studies. The main analysis of retrospective confidence revealed concordant bilateral activation in the parahippocampal gyrus, left middle frontal gyrus, and right amygdala. We also run an analysis between the two extreme levels of confidence, namely, high and low. This additional analysis was exploratory, since the minimum amount of articles reporting these two levels was not reached. Activations for the exploratory high > low confidence subtraction analysis were the same as observed in the main analysis on retrospective confidence, whereas the exploratory low > high subtraction showed distinctive activations of the right precuneus. The involvement of the right precuneus emphasizes its role in the evaluation of low confidence memories, as suggested by previous studies. Overall, our study contributes to a better understanding of the specific brain structures involved in confidence evaluations. Better understanding of the neural basis of metamemory might eventually lead to designing more precise neuromodulatory interventions, significantly improving treatment of patients suffering from metamemory problems.

Metacognition in Psychology

How has the concept of metacognition been used within basic and applied psychological research? We begin our answer by presenting a broad definition of metacognition, a historical overview of its development and its presence in research databases. To assess which function and facets are most frequently addressed within each of the sub-disciplines, we present results from separate literature searches. We then review how metacognition has been defined and empirically explored within selected sub-disciplines in terms of typical research questions, conceptual definitions, how the concept has been measured, and examples of interesting findings and implications. We identify similarities, inconsistencies, and disagreements across fields and point out areas for future research. Our overall conclusion is that it is useful to consider metacognition as a broad umbrella concept across different domains and across basic and applied research. Nonetheless, we recommend that researchers be more specific and explicit about their approach and assumptions whenever using metacognition in their research.

Emotional processing and social cognition in alcohol use disorder

OBJECTIVE

To review deficits in emotional processing and social cognition potentially contributing to the dysfunctional emotion regulation and difficulties with interpersonal relationships observed in individuals with alcohol use disorder (AUD) and to provide directions for future research.

METHOD

First is presented a review of emotional and social-cognitive impairments in recently detoxified AUD individuals that include alexithymia, difficulties in decoding others' emotions, and reduced theory of mind and empathy skills. Social cognition disorders in AUD pose different issues discussed, such as whether (1) these deficits are consequences of excessive alcohol consumption or premorbid risk factors for addiction, (2) emotional and social impairments impede positive treatment outcome, (3) recovery of social abilities is possible with sustained abstinence, and (4) AUD patients are unaware of their emotional and social dysfunctions. Finally, current knowledge on structural and functional brain correlates of these deficits in AUD are reviewed.

RESULTS

Emotional and social-cognitive functions affected in AUD can potentially compromise efforts to initiate and maintain abstinence by hampering efficacy of clinical treatment. Such dysfunction can obstruct efforts to enable or reinstate higher-order abilities such as emotional self-regulation, motivation to change, success in interpersonal/social interactions, and emotional insight and awareness of social dysfunctions (i.e., accurate metacognition).

CONCLUSIONS

The present review highlights the need to account for emotional processing and social cognition in the evaluation and rehabilitation of alcohol-related neurocognitive disorders and to consider psychotherapeutic treatment involving remediation of emotional and social skills as implemented in psychiatric and neurological disorders. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Brain-behavior relations and effects of aging and common comorbidities in alcohol use disorder: A review

OBJECTIVE

Alcohol use disorder (AUD) is a complex, dynamic condition that waxes and wanes with unhealthy drinking episodes and varies in drinking patterns and effects on brain structure and function with age. Its excessive use renders chronically heavy drinkers vulnerable to direct alcohol toxicity and a variety of comorbidities attributable to nonalcohol drug misuse, viral infections, and accelerated or premature aging. AUD affects widespread brain systems, commonly, frontolimbic, frontostriatal, and frontocerebellar networks.

METHOD AND RESULTS

Multimodal assessment using selective neuropsychological testing and whole-brain neuroimaging provides evidence for AUD-related specific brain structure-function relations established with double dissociations. Longitudinal study using noninvasive imaging provides evidence for brain structural and functional improvement with sustained sobriety and further decline with relapse. Functional imaging suggests the possibility that some alcoholics in recovery can compensate for impairment by invoking brain systems typically not used for a target task but that can enable normal-level performance.

CONCLUSIONS

Evidence for AUD-aging interactions, indicative of accelerated aging, together with increasing alcohol consumption in middle-age and older adults, put aging drinkers at special risk for developing cognitive decline and possibly dementia. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Neurobiological basis of feeling of knowing in episodic memory

Feeling of knowing (FOK) is a metacognitive process which allows individuals to predict the likelihood that they will be able to remember, in the future, information which they currently cannot recall. Although FOK provides evidence for the mechanisms of metacognitive systems, the neurobiological basis of FOK is still unclear. We investigated the neural correlates of FOK induced by an episodic memory task in 77 younger adult participants. Data were gathered using event-related potentials (ERPs). ERP components during high, low, extremely high and extremely low FOK judgments were analyzed. Stimulus-locked ERP analyses indicated that FOK judgment was associated with greater positivity for P200 component at frontal, central, and parietal electrode zones and greater negativity for the N200 component at parietal electrode zones. Furthermore, results revealed that amplitude of the ERP components for FOK judgments were affected by the level of FOK judgment. Results suggest that ERP components of FOK judgment observed within a 200 ms time window support the perceptual fluency-based model.

Everyday memory problems in alcohol abuse and dependence: Frequency, patterns and patient-proxy agreement

Using self-report to assess everyday memory in alcoholics presents challenges given the presence of both memory and metamemory deficits. Accordingly, evaluation of the reliability and validity of proxy ratings as well as the frequency of these memory lapses are of clinical importance. In the present study, 180 patient-proxy dyads completed the Prospective and Retrospective Memory Questionnaire (PRMQ). 31.7% of proxy-rated versus 2.8% of patient-rated prospective memory scores fell in the impaired to below average range. 15% of proxy-rated retrospective memory scores were below average, whereas none of the patients reported problems in this regard. Longer delays between intention formation and action yielded better prospective memory performance, while the opposite was true for retrospective memory. Agreement between patients and proxies was generally poor to fair across severity levels and the magnitude of observed differences was large (standardized response mean > 0.8). For all PRMQ items, exact agreement occurred in 45.3% of the cases. Larger patient-proxy discrepancy was associated with older age, less education and greater disease severity. Proxy ratings were internally consistent, significantly correlated with objective memory performance, and were sensitive to differences in overall PRMQ performance between severity groups. Caution should be used in the interpretations of patients' reports.

Contributions to Understanding the Neuropsychology of Alcoholism: An INS Legacy

Alcohol use disorder (AUD) has been a major cause of family, social, and personal strife for centuries, with current prevalence estimates of 14% for 12-month and 29% lifetime AUD. Neuropsychological testing of selective cognitive, sensory, and motor functions complemented with in vivo brain imaging has enabled tracking the consequences of AUD, which follows a dynamic course of development, maintenance, and recovery or relapse. Controlled studies of alcoholism reviewed herein provide evidence for disruption of selective functions involving executive, visuospatial, mnemonic, emotional, and attentional processes, response inhibition, prosody, and postural stability and brain systems supporting these functions. On a hopeful front, longitudinal study provides convincing evidence for improvement in brain structure and function following sustained sobriety. These discoveries have a strong legacy in the International Neuropsychological Society (INS), starting from its early days when assumptions regarding which brain regions were disrupted relied solely on patterns of functional sparing and impairment deduced from testing. This review is based on the symposium presentation delivered at the 2017 annual North American meeting of the INS in celebration of the 50th anniversary since its institution in 1967. In the spirit of the meeting's theme, "Binding the Past and Present," the lecture and this review recognized the past by focusing on early, rigorous neuropsychological studies of alcoholism and their influence on research currently conducted using imaging methods enabling hypothesis testing of brain substrates of observed functional deficits. (JINS, 2017, 23, 843-859).

When do you know what you know? The emergence of memory monitoring

Recent research on comparative metacognition shows that animals, like humans, can differentiate between what they know and what they do not know. However, not much is known about the metacognitive behaviors of human children during their early years. To explore the emergence of memory-monitoring skills, two experiments were conducted using nonverbal tasks adapted from the work of Kornell, Son, and Terrace (2007) and Hampton (2001). Experiment 1 endeavored to determine when children began to show the ability to monitor their memories retrospectively. Experiment 2 aimed to reveal when young children knew what they knew by assessing their prospective monitoring. The results suggested that 4- to 5-year-olds had the ability to judge retrospectively their accuracy in a serial position task, whereas 3- to 4-year-olds did not. In contrast, 4.5- to 5-year-olds could discern items present in and absent from their memory before recognition, whereas 4- to 4.5-year-olds could not. In conclusion, 4-year-olds began to make accurate confidence judgments retrospectively, and children who are approximately 4.5years old began to demonstrate prospective memory-monitoring skills.

Individual Differences in the Accuracy of Judgments of Learning Are Related to the Gray Matter Volume and Functional Connectivity of the Left Mid-Insula

The judgment of learning (JOL) is an important form of prospective metamemory judgment, and the biological basis of the JOL process is an important topic in metamemory research. Although previous task-related functional magnetic resonance imaging (MRI) studies have examined the brain regions underlying the JOL process, the neural correlates of individual differences in JOL accuracy require further investigation. This study used structural and resting-state functional MRI to investigate whether individual differences in JOL accuracy are related to the gray matter (GM) volume and functional connectivity of the bilateral insula and medial Brodmann area (BA) 11, which are assumed to be related to JOL accuracy. We found that individual differences in JOL accuracy were related to the GM volume of the left mid-insula and to the functional connectivity between the left mid-insula and various other regions, including the left superior parietal lobule/precuneus, bilateral inferior parietal lobule/intraparietal sulcus, right frontal pole and left parahippocampal gyrus/fusiform gyrus/cerebellum. Further analyses indicated that the functional connectivity related to individual differences in JOL accuracy could be divided into two factors and might support information integration and selective attention processes underlying accurate JOLs. In addition, individual differences in JOL accuracy were not related to the GM volume or functional connectivity of the medial BA 11. Our findings provide novel evidence for the role of the left mid-insula and its functional connectivity in the JOL process.

Executive Functions, Memory, and Social Cognitive Deficits and Recovery in Chronic Alcoholism: A Critical Review to Inform Future Research

Alcoholism is a complex and dynamic disease, punctuated by periods of abstinence and relapse, and influenced by a multitude of vulnerability factors. Chronic excessive alcohol consumption is associated with cognitive deficits, ranging from mild to severe, in executive functions, memory, and metacognitive abilities, with associated impairment in emotional processes and social cognition. These deficits can compromise efforts in initiating and sustaining abstinence by hampering efficacy of clinical treatment and can obstruct efforts in enabling good decision making success in interpersonal/social interactions, and awareness of cognitive and behavioral dysfunctions. Despite evidence for differences in recovery levels of selective cognitive processes, certain deficits can persist even with prolonged sobriety. Herein is presented a review of alcohol-related cognitive impairments affecting component processes of executive functioning, memory, and the recently investigated cognitive domains of metamemory, social cognition, and emotional processing; also considered are trajectories of cognitive recovery with abstinence. Finally, in the spirit of critical review, limitations of current knowledge are noted and avenues for new research efforts are proposed that focus on (i) the interaction among emotion-cognition processes and identification of vulnerability factors contributing to the development of emotional and social processing deficits and (ii) the time line of cognitive recovery by tracking alcoholism's dynamic course of sobriety and relapse. Knowledge about the heterochronicity of cognitive recovery in alcoholism has the potential of indicating at which points during recovery intervention may be most beneficial.

Deviant functional activation and connectivity of the right insula are associated with lack of awareness of episodic memory impairment in nonamnesic alcoholism

A disorder of metamemory, expressed as unawareness of mnemonic ability, is typically associated with the profound amnesia of Korsakoff's Syndrome (KS). A similar but less severe type of limited awareness can also occur in non-KS alcoholism and is observed as an impairment in generating Feeling-of-Knowing (FOK) predictions about future recognition performance. We previously found that FOK accuracy was selectively related to volumes of the insula in alcoholics involved in the present study. Unknown, however, are the neural substrates of unawareness of memory impairment in alcoholism. A task-activated fMRI paradigm served to identify neural nodes and networks implicated in inaccurate self-estimation of mnemonic ability in sober alcoholics while they made prospective FOK judgments in an episodic memory paradigm. Lower activation in the right insula correlated with greater overestimations of future memory abilities in alcoholics. Weaker connectivity of the right insula with the left dorsal anterior cingulate cortex, a node of the salience network, and stronger connectivity of the right insula with the right ventromedial prefrontal cortex (vmPFC), a node of the default mode network (DMN), co-occurred in alcoholics relative to the controls. Specifically, alcoholics, who failed to desynchronize insula-vmPFC activity, had greater overestimation of their memory predictions and poorer recognition performance. This study provides novel support that deviant functional activation and connectivity involving the right insula, a hub of the salience network, appears to participate in disrupting metamemory functioning in alcoholics. Compromised FOK performance might result from disturbance of the switching mechanism between brain networks serving self-referential processes (i.e., DMN network) and networks serving externally-driven activities like memory monitoring (i.e., fronto-parietal network). Thus, compromise in insular network coupling could be a neural mechanism underlying anosognosia for subtle mnemonic impairment in nonamnesic alcoholism.

Anosognosia for Memory Impairment in Addiction: Insights from Neuroimaging and Neuropsychological Assessment of Metamemory

In addiction, notably Alcohol Use Disorder (AUD), patients often have a tendency to fail to acknowledge the reality of the disease and to minimize the physical, psychological, and social difficulties attendant to chronic alcohol consumption. This lack of awareness can reduce the chances of initiating and maintaining sobriety. Presented here is a model focusing on compromised awareness in individuals with AUD of mild to moderate cognitive deficits, in particular, for episodic memory impairment-the ability to learn new information, such as recent personal experiences. Early in abstinence, alcoholics can be unaware of their memory deficits and overestimate their mnemonic capacities, which can be investigated with metamemory paradigms. Relevant neuropsychological and neuroimaging results considered suggest that the alcoholics' impairment of awareness of their attenuated memory function can be a clinical manifestation explained mechanistically by neurobiological factors, including compromise of brain systems that result in a mild form of mnemonic anosognosia. Specifically, unawareness of memory impairment in AUD may result from a lack of personal knowledge updating attributable to damage in brain regions or connections supporting conscious recollection in episodic memory. Likely candidates are posterior parietal and medial frontal regions known to be integral part of the Default Mode Network (DMN) and the insula leading to an impaired switching mechanism between the DMN and the Central-Executive Control (i.e., Lateral Prefronto-Parietal) Network. The cognitive concepts and neural substrates noted for addictive disorders may also be relevant for problems in self-identification of functional impairment resulting from injury following war-related blast, sport-related concussion, and insidiously occurring dementia.