Metacognition and Perspective-Taking in Alzheimer’s Disease: A Mini-Review

Abstract

Metacognition refers to the monitoring and regulation of cognitive processes and its impairment can lead to a lack of self-awareness of deficits, or anosognosia. In the context of different neurological and psychiatric disorders (e.g., traumatic brain injury, dementia, and schizophrenia), studies have shown that patients who present impairments in metacognitive abilities may be able to recognize such difficulties in others and in themselves when exposed to material in a third-person perspective. Considering that metacognitive impairments are an important characteristic of dementia, especially in Alzheimer’s Disease (AD), studies of the relationship between metacognition and perspective-taking may be relevant to improve the quality of life of people with dementia. The current paper first briefly addresses the theme of metacognition and the impact of metacognitive deficits in people with AD. The focus then turns to the relationship between metacognition and perspective-taking in different neurological and psychiatric disorders, particularly AD. This relationship is also discussed based on theoretical models, particularly the Cognitive Awareness Model (CAM). Specifically, the CAM suggests the existence of distinct memory systems for self- and other-information, an idea which is supported by neuroimaging findings. We suggest that the Default Mode Network, as it has been shown to be implicated in self vs. other processing and is affected early in AD, could explain the impact of perspective-taking on awareness of deficits in AD. Finally, we present possible clinical implications of the relationship between metacognition and perspective-taking in AD. Indeed, we considered the possibility of improving patient’s awareness through the use of a third-person perspective, which, consequently, may decrease the negative impacts of anosognosia in AD.

Commentary: Metacognition and Perspective-Taking in Alzheimer's Disease: A Mini-Review

“…Focusing on AD, Bertrand et al ( 2016 ) dwelt on the association between metacognition and perspective-taking as a key aspect for improving quality of life in AD patients. These authors specified that “ metacognition refers to the monitoring and regulation of cognitive processes and its impairment can lead to a lack of self-awareness of deficits, or anosognosia ” (Bertrand et al, 2016 , p. 1).…”

“…Bertrand et al ( 2016 ) suggested that the Default Mode Network may be useful to shed light on the role of perspective-taking in awareness of deficits in AD. They presented this relationship by referring to the Cognitive Awareness Model (CAM), which incorporates a comparator system within the central executive to detect mismatches between a personal database and experience of failures and successes (Agnew and Morris, 1998 ).…”

“…This could be due to the fact that the central executive system is a metacognitive facility of interest in controlling the flow of information in tasks requiring initiation, planning, set-shifting, strategy allocation, monitoring and inhibition (Amanzio et al, 2011 , 2013 ). As indicated by Bertrand et al ( 2016 ), the CAM is one of the most fruitful models for understanding the irrefutable liaison between executive system dysfuntion, metacognitive disabilities and the occurrence of reduced self-awareness. The issues raised in this commentary have implications in considering executive-metacognitive disabilities as a neuropsychological marker for reduced self-awareness in AD.…”

miR-103 Promotes Neurite Outgrowth and Suppresses Cells Apoptosis by Targeting Prostaglandin-Endoperoxide Synthase 2 in Cellular Models of Alzheimer’s Disease

“…A recent meta-analysis review suggests that approximately 35.6 million people live with dementia in 2010, and the number would increase to 65.7 million in 2030 and 115.4 million in 2050, among which 60% were on account of AD (Prince et al, 2013 ). In addition to decreased function, memory and cognition, quality of life and so on in AD patients, AD also increases caregiver burden in family members and elevated labor loss as well as social cost (Bertrand et al, 2016 ; Svendsboe et al, 2016 ; Deb et al, 2017 ). Thus AD becomes an increasingly critical issue to human health in the world.…”

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“…Consequently, it becomes difficult to predict others’ reactions and respond accordingly because of the deterioration of thinking abilities. Monitoring and managing one's own behaviors also becomes difficult, owing to the deterioration of self‐monitoring and self‐control abilities …”