Metacognition and Symptom Awareness in Dementia and Other Cognitive Disorders

A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Neuropsychology".

Deadline for manuscript submissions: closed (30 September 2021) | Viewed by 7969

Special Issue Editor


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Guest Editor
1. Edinburgh Dementia Prevention, The University of Edinburgh, Edinburgh, UK
2. NHS Forth Valley, UK
Interests: symptom awareness; insight; metacognition; cognition; neurodegeneration; dementia; functional cognitive disorders; mild cognitive impairment; subjective cognitive impairment

Special Issue Information

Dear Colleagues,

We are pleased to announce the launch of a Special Issue of the journal Brain Sciences on the issue of altered insight and metacognition in cognitive disorders. Altered insight (also called awareness) of symptoms and disease status is a common problem, particularly in people with dementia. Insight may also be affected in those with mild cognitive impairment, and people with psychological causes of cognitive symptomatology. Changes to insight have a huge impact on everyday functioning and quality of life for affected individuals, their loved ones and carers.

This Special Issue aims to attract studies of clinical, neuropsychological and theoretical aspects of insight in adults with cognitive disorders.

Topics of interest include (but are not limited to) the following:

  • Insight measurement techniques
  • Changes to insight over the course of neurogeneration
  • Interactions between insight and global or domain specific cognitive functioning
  • Explorations of the biological basis of insight
  • Insight in people with psychological causes of cognitive impairment

Dr. Catherine Pennington
Guest Editor

Manuscript Submission Information

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Keywords

  • Insight
  • Insight measurement techniques
  • Neurogeneration
  • Cognitive functioning
  • Cognitive impairment

Published Papers (3 papers)

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10 pages, 834 KiB  
Article
Metacognitive Performance on Memory and Visuospatial Tasks in Functional Cognitive Disorder
by Catherine Pennington, Harriet Ball, Marta Swirski, Margaret Newson and Elizabeth Coulthard
Brain Sci. 2021, 11(10), 1368; https://doi.org/10.3390/brainsci11101368 - 19 Oct 2021
Cited by 10 | Viewed by 1762
Abstract
Functional Cognitive Disorder (FCD) is a common diagnosis at the memory clinic. FCD is characterised by significant self-reported cognitive symptoms in the absence of external evidence of cognitive dysfunction. A potential explanation for this is a deficit in metacognition, the process by which [...] Read more.
Functional Cognitive Disorder (FCD) is a common diagnosis at the memory clinic. FCD is characterised by significant self-reported cognitive symptoms in the absence of external evidence of cognitive dysfunction. A potential explanation for this is a deficit in metacognition, the process by which we internally judge our own abilities. Here we investigated differences in accuracy, confidence, and metacognition between people with FCD (N = 20), neurodegenerative mild cognitive impairment (nMCI; N = 14), and healthy controls (N = 23). The groups were assessed on forced choice memory and perceptual tasks, with trial by trial confidence ratings. FCD and nMCI participants showed lower accuracy on the memory task (means FCD 63.65%, nMCI 63.96%, HC 71.22%), with a significant difference between the FCD and HC groups after controlling for age and sex. There were no between-group differences in memory task confidence (means FCD 3.19, nMCI 3.59, HC 3.71). The FCD group showed greater confidence when longer time was allowed on the memory task. No between group differences in perceptual task accuracy (means FCD 63.97%, nMCI 64.50%, FCD 65.86%) or confidence (means FCD 3.71, nMCI 3.43, HC 3.88) were found. No differences in metacognitive efficacy emerged between the groups, either on the memory or perceptual task (Memory Meta-d’/d’:FCD 0.63, nMCI 0.94 HC 0.85; Perceptual Meta-d’,d’: FCD 0.50, nMCI 0.51, HC 0.72). Participants showed greater metacognitive efficacy on the memory task compared to the perceptual task. The difficulties experienced by people with FCD do not appear to be due to metacognitive deficits. Their performance was similar to people with nMCI over aspects of the memory tasks, which suggests that the primary issue may lie with memory encoding or retrieval, rather than with their judgement of performance accuracy. Full article
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12 pages, 1539 KiB  
Article
Differentiating Functional Cognitive Disorder from Early Neurodegeneration: A Clinic-Based Study
by Harriet A. Ball, Marta Swirski, Margaret Newson, Elizabeth J. Coulthard and Catherine M. Pennington
Brain Sci. 2021, 11(6), 800; https://doi.org/10.3390/brainsci11060800 - 17 Jun 2021
Cited by 13 | Viewed by 2346
Abstract
Functional cognitive disorder (FCD) is a relatively common cause of cognitive symptoms, characterised by inconsistency between symptoms and observed or self-reported cognitive functioning. We aimed to improve the clinical characterisation of FCD, in particular its differentiation from early neurodegeneration. Two patient cohorts were [...] Read more.
Functional cognitive disorder (FCD) is a relatively common cause of cognitive symptoms, characterised by inconsistency between symptoms and observed or self-reported cognitive functioning. We aimed to improve the clinical characterisation of FCD, in particular its differentiation from early neurodegeneration. Two patient cohorts were recruited from a UK-based tertiary cognitive clinic, diagnosed following clinical assessment, investigation and expert multidisciplinary team review: FCD, (n = 21), and neurodegenerative Mild Cognitive Impairment (nMCI, n = 17). We separately recruited a healthy control group (n = 25). All participants completed an assessment battery including: Hopkins Verbal Learning Test-Revised (HVLT-R), Trail Making Test Part B (TMT-B); Depression Anxiety and Stress Scale (DASS) and Minnesota Multiphasic Personality Inventory (MMPI-2RF). In comparison to healthy controls, the FCD and nMCI groups were equally impaired on trail making, immediate recall, and recognition tasks; had equally elevated mood symptoms; showed similar aberration on a range of personality measures; and had similar difficulties on inbuilt performance validity tests. However, participants with FCD performed significantly better than nMCI on HVLT-R delayed free recall and retention (regression coefficient −10.34, p = 0.01). Mood, personality and certain cognitive abilities were similarly altered across nMCI and FCD groups. However, those with FCD displayed spared delayed recall and retention, in comparison to impaired immediate recall and recognition. This pattern, which is distinct from that seen in prodromal neurodegeneration, is a marker of internal inconsistency. Differentiating FCD from nMCI is challenging, and the identification of positive neuropsychometric features of FCD is an important contribution to this emerging area of cognitive neurology. Full article
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13 pages, 608 KiB  
Hypothesis
Functional Cognitive Disorders (FCD): How Is Metacognition Involved?
by Andrew J. Larner
Brain Sci. 2021, 11(8), 1082; https://doi.org/10.3390/brainsci11081082 - 18 Aug 2021
Cited by 12 | Viewed by 3189
Abstract
Functional cognitive disorders (FCD) have become a subject of increasing clinical interest in recent years, in part because of their high prevalence amongst patients attending dedicated memory clinics. Empirical understanding of FCD based on observational studies is growing, suggesting a relationship to other [...] Read more.
Functional cognitive disorders (FCD) have become a subject of increasing clinical interest in recent years, in part because of their high prevalence amongst patients attending dedicated memory clinics. Empirical understanding of FCD based on observational studies is growing, suggesting a relationship to other functional neurological disorders (FND) based on shared phenomenology. However, understanding of FCD at the theoretical level has been lacking. One suggestion has been that FCD are disorders of metacognition, most usually of metamemory. In this article, a brief overview of these constructs is presented along with existing evidence for their impairment in FCD. Previous adaptations of theoretical models of FND to accommodate FCD are reviewed. A novel application to FCD of Nelson and Narens’ monitoring and control model of metamemory is then attempted, positing an improper setting of the monitoring function, with examples of ecological relevance. Formulation of FCD in light of a metacognitive model of anosognosia is also considered. Although lacking mechanistic and neuroanatomical sophistication, this metacognitive formulation of FCD may give pointers for future hypothesis-driven research and a pragmatic basis for management strategies. Full article
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