Metacognition in Alzheimer’s Disease

Abstract

It has long been recognized that a significant proportion of patients with Alzheimer's disease (AD) display some degree of unawareness for disease related memory loss. Historically, the majority of studies examining awareness in AD have implemented subjective assessment tools including clinician rating scales and informant based discrepancy measures. In the past two decades, there has been increasing focus on the objective assessment of metacognition in AD. These studies have made important strides in advancing our understanding of the nature of awareness deficits in AD and the mechanisms which may contribute to metacognitive variability in AD. However, there are several methodological issues that may complicate interpretation of existing data and that require consideration as this field moves forward. This chapter will: (1) review several commonly used subjective and objective approaches to measuring memory awareness in AD; (2) highlight important dissociations that characterize metacognitive functioning in AD; (3) evaluate specific models of metacognitive deficits (i.e., anosognosia) in AD and; (4) discuss future directions for metacognitive research in AD.

Electrical stimulation of the dorsolateral prefrontal cortex improves memory monitoring

“…Accurate memory monitoring can serve to improve learning and memory (Thiede et al, 2003) and can be impaired in certain clinical populations (Stepanie Cosentino et al, 2007). Impaired memory monitoring can delay seeking help and, therefore, early detection of memory impairments (Stephanie Cosentino, 2014). Our findings indicate that the left DLPFC has a causal role in monitoring accuracy, and that HD-tDCS over the left DLPFC is a potential target for developing interventions for impairments in metamemory.…”

Domain-specific impairment in metacognitive accuracy following anterior prefrontal lesions

“…Impairments in metacognition are found in a range of clinical syndromes, including traumatic brain injury, Alzheimer’s disease, schizophrenia and drug addiction (for reviews see Pannu et al , 2005; Goldstein et al , 2009; David et al , 2012; Cosentino, 2014). In these conditions, impaired awareness of deficits is linked to reduced engagement in remediation treatment, poor adherence to medication and impaired management of functional difficulties (Goldstein et al , 2009; Medley and Powell, 2010; Carretti et al , 2011; Cosentino, 2014). However, despite a clear imperative to understand and ameliorate these deficits, the cognitive architecture supporting metacognition remains poorly understood (Fleming and Dolan, 2012).…”

Reduced Awareness of Memory Deficit is Associated With Increased Medicare Home Health Care Use in Dementia

“…Although awareness would be expected to relate to disease severity over the course of the entire disease spectrum, the lack of association between awareness and CDR in the current and other studies of mild to moderate disease is consistent with the idea that disordered awareness is not simply a marker for more severe disease or specific cognitive dysfunction. 34 Indeed, some proposals suggest that unawareness might reflect compromise to one or more cognitive processes specific to self-evaluation (ie, metacognition). 34 Awareness was also not associated with the measured caregiving variables, suggesting that the caregiver-based awareness discrepancy score operated in a similar way across caregivers regardless of their relationship to the patient, or whether they lived with the patient.…”