Awareness of Executive Deficits in People with Parkinson's Disease

Abstract

Executive functioning is frequently impaired among people with Parkinson's disease (PD). Little is known about awareness of executive functioning, in the sense of being able to accurately appraise functioning or performance, in people with PD, or about whether awareness is particularly affected in those who have impaired executive functioning. This study explored awareness of executive functioning at the levels of evaluative judgment (comparison of self- and informant ratings of executive functioning), and performance monitoring (comparison of performance on cognitive tests and self-ratings of that performance). Awareness levels were assessed in people with PD with and without executive deficits, and in healthy controls. When the level of agreement between self- and informant ratings was considered, people with PD in both groups appeared as accurate in evaluating their overall executive functioning as healthy controls. When appraising their performance as the specific tasks were completed, people with PD who had impairments in executive functioning appeared less accurate than controls and people with PD without executive impairments. People with PD who have executive deficits may lack the ability to recognize their limitations while performing specific tasks, which may have implications for their functional abilities.

Integrating the Constructs of Anosognosia and Metacognition: a Review of Recent Findings in Dementia

“…For example, in PD patients, it has been recently shown that self-ratings of executive functioning, particularly in those with executive dysfunction, were higher and less accurate than informant ratings [16]. Similar to AD and FTD patients, those with PD irrespective of the presence of global cognitive impairment have impaired metamemory for episodic information [22, 23, 61].…”

“…Historically, the vast majority of metacognitive research has examined the phenomenon of self-reflection in the healthy brain, and young adults in particular, [11, 12]. In recent years, metacognition has also advanced to study older adults [2, 13], especially those with clinical deficits and across a range of clinical populations [14-16]. Not only does metacognitive work provide the foundation for understanding how the self operates, but it informs wide ranging practical issues such as the development of optimal educational strategies, and the variables to be considered when evaluating or relying on eyewitness testimony in forensic settings.…”

Lack of Accurate Self‐appraisal is Equally Likely in MCI from Parkinson's Disease and Alzheimer's Disease

“…Nonetheless, impairments in self‐appraisal ability (inappropriately positive or negative self‐appraisal) have been noted in previous reports among MCI subjects . In this regard, there is limited information on the self‐appraisal ability of PD‐MCI subjects, although efforts are beginning to be made in reporting impaired accuracy of PD patient self‐reports of dyskinesias and cognitive deficits . Additionally, there is a significant literature on the factors (e.g., memory performance, depression) that relate to anosognosia in dementia and lack of accurate patient self‐appraisal in MCI, but little is known about the nature of factors impacting patient self‐appraisal ability among PD‐MCI subjects.…”

Research consent capacity varies with executive function and memory in Parkinson's disease

“…They suggest the need to attend to deficits in memory and executive function, as subtle disruption in these areas increases the likelihood that a patient is not capable of giving consent. Indeed, people with PD MCI may also have reduced awareness of executive function impairment, potentially compromising safety and judgment in naturalistic settings 15 . In such cases, study precautions should be considered, including a structured assessment of capacity and asking the patient to designate a study partner.…”