Metacognition in the behavioral variant of frontotemporal dementia and Alzheimer’s disease.

Abstract

Objective Impaired self-awareness is characteristic of nearly all dementias, including Alzheimer’s disease (AD), but the deficit is most severe in the behavioral variant of frontotemporal dementia (bvFTD). The prominence of frontal pathology in bvFTD suggests that failure of online monitoring, the process by which individuals monitor their own cognitive processing in real time, is an important contributor. Metacognitive research offers several approaches to measure self-assessment, some more and others less sensitive to online monitoring. The goal of this study was to assess metacognition in bvFTD using several approaches, and compare the results with those in AD. Methods We examined metacognition in 12 patients with bvFTD, 14 with AD and 35 healthy controls using Feeling of Knowing (FOK), Ease of Learning (EOL), Judgment of Learning (JOL), and Retrospective Confidence Rating (CR) tasks, as well as response to feedback about performance. Results BvFTD and AD were both impaired at FOK compared with controls, although AD showed some sparing. Both groups were similarly impaired at CR and neither group was impaired at JOL after accounting for memory performance. Most strikingly, bvFTD patients failed to appropriately adjust their predictions about future memory performance even after receiving explicit feedback that they had performed worse than they expected. Conclusions Both bvFTD and AD show deficits in online monitoring, although the deficit appears more severe in bvFTD. The insensitivity of bvFTD patients to overt feedback may point to unique mechanisms, possibly frontally mediated, that add to their severe lack of self-awareness.

Feeling, learning from and being aware of inner states: interoceptive dimensions in neurodegeneration and stroke

“…Focus on internal visceral signals and constant monitoring and feedback updating of internal predictions are important for the construction of subjective feeling states, and their disruption could explain the patients' behavioural failures [11,70,71]. In this sense, previous reports show that BA10 (i) supports emotional processing of internal states [72], (ii) is related to information retrieval and prospective memory [72] and (iii) could contribute to anosognosia, a typical symptom of dementias [30]. Our results converge with these findings, showing that interoceptive awareness is affected in bvFTD patients, with major compromise of connections between PFC and OFC hubs.…”

“…Although this metacognitive dimension has not been examined in neurological populations, impaired awareness and diminished insight are core features of dementia [30,31]. Thus, we predicted that bvFTD and AD would be worse than controls at estimating self-performance.…”

Concepts and objects of awareness in Alzheimer’s disease: an updated systematic review

“…Different concepts were used to define the construct of awareness [12][13][14][15][16][17][18][19][20] , anosognosia [21][22][23][24][25][26][27][28][29][30][31][32] , self-awareness 33,34 , self -appraisal 35 , insight 36,37 , cognitive insight 38 , metacognition [39][40][41] , unawareness of deficits 42 , awareness of deficit 43,44 , awareness of disease 1,45 , awareness of functioning 46 , awareness of cognitive deficits 47 , awareness of disabilities 48 , awareness of performance 49 , unawareness of memory 42,[50][51][52] , anosognosia of memory 53 , awareness of memory deficits 54,55 , awareness of memory function and functional abilities 56 , unawareness of psychosis or behavioral problems …”

“…Metacognition was the knowledge about cognition, including the ability to think about one's own basic cognitive abilities (such as episodic memory or executive functions) 41 . It was also defined as a process by which we understand and alter our own thinking 39 . Some concepts were used to define impairment in awareness, which may range from general to specific impairments, such as anosognosia of memory.…”

Prosocial deficits in behavioral variant frontotemporal dementia relate to reward network atrophy

“…Although previous studies have determined that patients with bvFTD lack empathy, perspective‐taking, insight, and social understanding (Clark et al., 2015; Kumfor & Piguet, 2012; Rosen et al., 2014; Shany‐Ur et al., 2014; Snowden et al., 2008), relatively little is known about how prosociality deteriorates in bvFTD. Recent studies have shown that despite intact perceptions of fairness and basic bargaining skills, patients with bvFTD are unable to use socially relevant contextual information and, therefore, tend to make decisions that benefit themselves over others (Ibanez et al., 2016, 2017; Melloni et al., 2016; O'Callaghan & Hornberger, 2017; O'Callaghan et al., 2016).…”