Know thyself: real-world behavioral correlates of self-appraisal accuracy

Metacognition, cortical thickness, and tauopathy in aging

We investigated self-rating of cognitive task performance (self-appraisal) and the difference between self-rating and actual task performance (appraisal discrepancy) in cognitively healthy older adults and their relationship with cortical thickness and Alzheimer's disease (AD) biomarkers, amyloid and tau. All participants (N = 151) underwent neuropsychological testing and 1.5T structural magnetic resonance imaging. A subset (N = 66) received amyloid-PET with [11C] PiB and tau-PET with [18F] Flortaucipir. We found that worse performers had lower self-appraisal ratings, but still overestimated their performance, consistent with the Dunning-Kruger effect. Self-appraisal rating and appraisal discrepancy revealed distinct relationships with cortical thickness and AD pathology. Greater appraisal discrepancy, indicating overestimation, was related to thinning of inferior-lateral temporal, fusiform, and rostral anterior cingulate cortices. Lower self-appraisal was associated with higher entorhinal and inferior temporal tau. These results suggest that overestimation could implicate structural atrophy beyond AD pathology, while lower self-appraisal could indicate early behavioral alteration due to AD pathology, supporting the notion of subjective cognitive decline prior to objective deficits.

Metacognition, psychopathology and daily functioning in adult ADHD

OBJECTIVE

Previous research indicated that adults with ADHD may have deficits in metacognition, yet the evidence base is scarce. This study aims to explore the existence and nature of metacognitive deficits in adults with ADHD, how psychopathology (such as inattention and depression) may affect metacognition and whether metacognition may impact daily functioning in adults with ADHD.

METHOD

Forty-six adult patients with ADHD and 46 controls completed questionnaires for metacognition, psychopathology and daily functioning (subjective assessment; self- and informant report). Participants performed two attention tests in a neuropsychological assessment. After test completion, participants were asked to evaluate their performance with the help of a visual aid and this self-evaluation of test performance was compared with their actual test performance (objective assessment).

RESULTS

Patients with ADHD reported large deficits in knowledge of cognition and medium deficits in regulation of cognition compared to controls. Self-evaluation of cognitive test performance revealed no significant deficits. Regression analyses revealed that psychopathology may explain a part of the variation in metacognition. Further regressions indicated that metacognition may account for a significant and meaningful proportion of variance in daily functioning, both self-rated and informant-rated.

CONCLUSIONS

Current findings of compromised metacognitive functioning of adults with ADHD suggest that clinicians may not want to rely on patients' self-reports in the clinical assessment. Inattention predicted impairments in metacognition, pointing toward the importance of attention for awareness and metacognition. Finally, we recommend that metacognition is addressed in the treatment trajectory of patients with ADHD, given that aspects of metacognition were directly linked to impairments in daily functioning as rated by participants and their relatives.

Metacognition in adult ADHD: subjective and objective perspectives on self-awareness of cognitive functioning

Although attention deficit hyperactivity disorder (ADHD) in adulthood is associated with marked cognitive impairment, research on metacognition in adult ADHD is scarce. Deficits in metacognition may have a negative impact on treatment adherence, functional outcomes, and everyday life. This study explores metacognition, specifically self-awareness of cognitive performance, in adults with ADHD by combining objective and subjective assessments. Forty-seven patients with ADHD and 47 control individuals completed a neuropsychological assessment battery including tests for attention, executive functions and memory (objective assessment), as well as questionnaires for cognitive functioning and symptom severity (subjective assessment; self- and informant-report). Participants evaluated their test performance of the objective assessment after test completion by selecting a percentile rank which was subtracted from their normed test result, yielding a discrepancy score. Compared to controls, adults with ADHD showed impairments in attention (medium effects) and memory (small and medium effects), but not in executive functions. The discrepancy scores between self-evaluation and cognitive performance revealed deficits in self-awareness of attentional functions (small effects), but not in executive functions and memory in patients with ADHD compared to controls. Discrepancy scores between self- and informant-reports of cognitive functioning revealed no significant differences. Adults with ADHD show impairments in metacognition in attentional functions, but may have intact metacognitive abilities in other domains. Patients with ADHD tend to overestimate their abilities, especially in attentional functions. Subjective and objective measures of metacognition may not correspond, highlighting the need for clinicians to not solely rely on patients' self-report in their assessment.

A Pilot randomized clinical trial of adapted tango to improve cognition and psychosocial function in African American women with family history of Alzheimer's disease (ACT trial)

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the adapted tango intervention was very well received as demonstrated by minimal participant attrition, satisfaction questionnaires that indicated high satisfaction, and anecdotal reports.

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Adapted tango intervention may be helpful in controlling or reducing markers of inflammation in AA women with a parental history of AD.

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Participants in tango demonstrated improvements in whole-body spatial cognition and short-term and working memory, and reduced deterioration of executive function.

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Although our tango group did not show large positive effect in cumulative caregiver burden post intervention, the large positive effect in role Captivity, caregiver confidence, and deprivation of intimate exchange displays some of the positive effects of this dance intervention for the caregivers.

Alzheimer's disease (AD) is a devastating, progressive neurodegenerative disease resulting in memory loss and a severe reduction in the ability to perform activities of daily living. Ethnicity-related genetic factors promoting the development of dementias among African Americans (AA) and increased risk among women for developing AD indicates that AA women with a parental history of AD are at great risk for developing AD. This phase I study assessed the impact of a 12 week, 20-lesson adapted Argentine Tango intervention (n = 24) to a no-contact control group (n = 10) on measures of plasma inflammatory markers, cognition, and motor and psychosocial performance in middle-aged AA woman at increased risk for AD by virtue of parental history. Some woman (n = 16) were also caregivers; thus, the impact of the intervention on caregiving burden was examined in this subset. Preliminary analysis of efficacy was conducted with significance tests on biomarkers and key measures of cognition, including visuospatial and executive function, balance, and strength. After 12 weeks, Tango participants had significantly decreased inflammatory cytokine, including reductions in IL-7 (p = 0.003), IFN-γ (p = 0.011), TNFα (p = 0.011), and MCP-1 (p = 0.042) compared to controls. Large effects were noted for the Tango group on tests of executive functioning (d = 0.89), and inhibition (p = 0.031). Participants in Tango improved in dynamic and static balance (p = 0.018) and functional lower body strength (p = 0.023). Secondary assessment revealed trends favoring the intervention group were noted in spatial cognition and executive function. Moderate effects were noted in caregiving burden measures among the subset of caregivers. These data demonstrate substantial reductions in inflammatory biomarkers along with cognitive and motor improvements through a non-pharmacologic, affordable intervention among a small, well-characterized cohort of AA women with a parental history of AD.

Rationale and Design of a Clinical Trial of Adapted Tango to Improve Negative Health Impacts in Middle Aged African-American Female Caregivers of Persons with Alzheimer's Disease (ACT Trial)

Alzheimer's disease (AD) is a devastating progressive neurodegenerative disease resulting in memory loss and a severe reduction in ability to perform activities of daily living. The role of caring for someone with AD frequently falls to female family members, often daughters. The burden of caregiving can increase stress and anxiety and cause health decline in the caregiver. The combination of ethnicity-related genetic factors promoting the development of dementias among African-Americans (AA) and the increased risk among women for developing AD means that AA women who are caregivers of a parent with AD are at great risk for developing dementias including AD. The proposed study would compare the cognitive, motor, and psychosocial benefits of a well-established 12 week, 20-lesson adapted Argentine Tango intervention (N = 30) to a no-contact control group (N = 10) in middle-aged (45-65 years) AA women who are caregivers of a parent with AD in the metro Atlanta area.

Rationale and Design of the Mechanistic Potential of Antihypertensives in Preclinical Alzheimer's (HEART) Trial

Research indicates that certain antihypertensive medications alter Alzheimer's disease (AD) biomarkers in Caucasians. The renin angiotensin system (RAS) regulates blood pressure (BP) in the body and the brain and may directly influence AD biomarkers, including amyloid-β (Aβ) neuropathology, cerebral blood flow (CBF), and inflammatory markers. This hypothesis is supported by studies, including ours, showing that antihypertensives targeting the RAS reduce the risk and slow the progression of AD in Caucasians. While mounting evidence supports a protective role of RAS medications in Caucasians, this mechanism has not been explored in African Americans. To assess the mechanism by which RAS medications modify the brain RAS, cerebrospinal fluid (CSF) Aβ, CBF, and inflammatory markers in African Americans, we are conducting an eight month, Phase Ib randomized, placebo controlled trial, enrolling 60 middle-aged (45-70 years), non-demented individuals, at risk for AD by virtue of a parental history. Participants include normotensive and treated hypertensives that have never been exposed to a RAS medication. Participants are randomized (1 : 1:1) by gender and BP medication use (yes/no) to one of three groups: placebo, or 20 mg, or 40 mg telmisartan (Micardis), to determine the dose required to penetrate the CNS. Our overarching hypothesis is that, compared to placebo, both doses of telmisartan will penetrate the CNS and produce salutary, dose dependent effects on the brain RAS as well as CSF Aβ, CBF, and CSF inflammatory markers in African Americans, over eight months. This manuscript describes the trial rationale and design.

Here's How I Write-Hebrew: Psychometric Properties and Handwriting Self-Awareness Among Schoolchildren With and Without Dysgraphia

OBJECTIVE

This study investigated the psychometric properties of the Here's How I Write-Hebrew (HHIW-HE) and compared handwriting self-awareness between children with and without dysgraphia.

METHOD

Fifty-eight children (29 with and 29 without dysgraphia) completed the HHIW-HE. Occupational therapists provided corresponding ratings that were based on objective handwriting assessments. Self-awareness was measured through child-therapist consensus.

RESULTS

The HHIW-HE has an internal consistency of α = .884. Children with dysgraphia rated themselves as significantly more impaired than controls on 6 of 24 HHIW-HE items and on the total score, with medium to large effect sizes (0.37-0.61). Mean child-therapist agreement was significantly higher for the controls than for the research group, t(56) = 4.268, p = .000.

CONCLUSION

Results support the HHIW-HE's validity. Children with dysgraphia reported more handwriting difficulties than did controls; however, they tended to overestimate their handwriting abilities.

Comparison of Children With and Without ADHD on a New Pictorial Self-Assessment of Executive Functions

OBJECTIVE

We examined the Pictorial Interview of Children's Metacognition and Executive Functions' (PIC-ME's) reliability and validity, targeting children's appraisal of their executive function (EF) in daily life.

METHOD

One hundred children with attention deficit hyperactivity disorder (ADHD) and 44 typically developing children (ages 5-10 yr) completed the PIC-ME. Parents completed the PIC-ME and Behavior Rating Inventory of Executive Function (BRIEF).

RESULTS

Cronbach's α for the child PIC-ME was .914. A high correlation was found between the parent PIC-ME total and the BRIEF (r = .724). Comparisons between groups revealed significant differences on the parent PIC-ME (p < .0001) but none on the child PIC-ME. Children with ADHD identified a median of eight EF challenges they wanted to set as treatment goals.

CONCLUSION

Results support the PIC-ME's initial reliability and validity among children with ADHD. Children were able to identify several EF challenges and engage in goal setting.

Assessment of Self-Awareness of Cognitive Function: Correlations of Self-Ratings with Actual Performance Ranks for Tests of Processing Speed, Memory and Executive Function in Non-Clinical Samples

Objective

For individuals with neurologic disorders, self-awareness of cognitive impairment is associated with improved treatment course and clinical outcome. However, methods for assessment of levels of self-awareness are limited, and most require collateral information, which may not be readily available. Although distortions in self-awareness are most often associated with low cognitive ability, the frequently mixed pattern of cognitive strengths and deficits in individuals with neurologic disorders complicates assessment. The present study explores relationships between actual test performance and self-ratings, utilizing a brief probe administered during testing. The "common-metric" approach solicits self-appraisal ratings in percentile equivalents and capitalizes on available normative data for specific standardized neuropsychological tests to allow direct comparisons.

Method

A convenience sample of 199 adults recruited from community sources participated in this study, including healthy adults and neuropsychologically "at-risk" volunteers who were HIV positive and/or endorsing heavy current alcohol consumption. Immediately following completion of standardized neuropsychological tests, participants estimated their own percentile ranking.

Results

Across study groups, participant's estimates of their own percentile rank were modestly correlated with actual performance ranking. Highest correlations were obtained for tests of learning, memory and conceptual reasoning, and executive function, with smaller correlations for simple tests of motor and psychomotor speed.

Conclusions

The study reveals normal biases affecting the self-appraisal during standardized testing, and suggests that a common-metric approach for assessing self-appraisal may play a role in establishing clinical thresholds and identifying and quantifying reductions in insight in persons with neuropsychological deficits.

Can medical students accurately predict their learning? A study comparing perceived and actual performance in neuroanatomy

It is important that clinicians are able to adequately assess their level of knowledge and competence in order to be safe practitioners of medicine. The medical literature contains numerous examples of poor self-assessment accuracy amongst medical students over a range of subjects however this ability in neuroanatomy has yet to be observed. Second year medical students attending neuroanatomy revision sessions at the University of Southampton and the competitors of the National Undergraduate Neuroanatomy Competition were asked to rate their level of knowledge in neuroanatomy. The responses from the former group were compared to performance on a ten item multiple choice question examination and the latter group were compared to their performance within the competition. In both cohorts, self-assessments of perceived level of knowledge correlated weakly to their performance in their respective objective knowledge assessments (r = 0.30 and r = 0.44). Within the NUNC, this correlation improved when students were instead asked to rate their performance on a specific examination within the competition (spotter, rS = 0.68; MCQ, rS = 0.58). Despite its inherent difficulty, medical student self-assessment accuracy in neuroanatomy is comparable to other subjects within the medical curriculum. Anat Sci Educ 9: 488-495. © 2016 American Association of Anatomists.

Decreased Self-Appraisal Accuracy on Cognitive Tests of Executive Functioning Is a Predictor of Decline in Mild Cognitive Impairment

OBJECTIVE

Mild cognitive impairment (MCI) in older individuals is associated with increased risk of progression to dementia. The factors predicting progression are not yet well established, yet cognitive performance, particularly for memory, is known to be important. Anosognosia, meaning lack of awareness of one's impaired function, is commonly reported in dementia and is often also a feature of MCI, but its association with risk of progression is not well understood. In particular, self-appraisal measures provide an autonomous measure of insight abilities, without the need of an informant.

METHODS

The present study examined the utility of self-appraisal accuracy at baseline for predicting cognitive decline in 51 patients using an informant-free assessment method. Baseline task performance scores were compared to self-assessments of performance to yield a discrimination score (DS) for tasks tapping into memory and executive functions.

RESULTS

Linear regression revealed that a larger DS for executive function tasks in MCI predicted functional decline, independent of age, education, and baseline memory and executive task scores.

CONCLUSION

These findings indicate that objective estimates of self-appraisal can be used to quantify anosognosia and increase predictive accuracy for decline in MCI.

Self-awareness of peer-rated social attributes in children with traumatic brain injury

OBJECTIVE

This study investigated self-awareness of peer-rated social attributes and its relations to executive function (EF), theory of mind (TOM), and psychosocial adjustment in children with traumatic brain injury (TBI).

METHODS

Self- and peer perceptions of classroom social behavior were assessed for 87 children 8-13 years of age: 15 with severe TBI, 40 with complicated mild/moderate TBI, and 32 with orthopedic injury. Participants completed measures of EF and TOM, and parents rated children's psychosocial adjustment.

RESULTS

Self-ratings of classroom social behavior did not differ between injury groups. Self- and peer ratings generally agreed, although children with severe TBI rated themselves as less rejected/victimized than did their peers. Higher EF predicted better self- and peer ratings and smaller self-peer discrepancies, which in turn predicted better adjustment.

CONCLUSIONS

Children with TBI show variable social self-awareness, which relates to EF and adjustment. Future studies should identify additional factors that contribute to limited insight.

NIH EXAMINER: conceptualization and development of an executive function battery

Executive functioning is widely targeted when human cognition is assessed, but there is little consensus on how it should be operationalized and measured. Recognizing the difficulties associated with establishing standard operational definitions of executive functioning, the National Institute of Neurological Disorders and Stroke entered into a contract with the University of California-San Francisco to develop psychometrically robust executive measurement tools that would be accepted by the neurology clinical trials and clinical research communities. This effort, entitled Executive Abilities: Measures and Instruments for Neurobehavioral Evaluation and Research (EXAMINER), resulted in a series of tasks targeting working memory, inhibition, set shifting, fluency, insight, planning, social cognition and behavior. We describe battery conceptualization and development, data collection, scale construction based on item response theory, and lay the foundation for studying the battery's utility and validity for specific assessment and research goals.