Metamemory: A construct with diagnostic utility in a cognitive disorders clinic?

Larner, AJ

doi:10.1002/gps.4766

Cited by 16 publications

(11 citation statements)

References 4 publications

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“…30 FCD patients had significantly lower self-appraisals of memory ability (lower selfperformance estimates) as well as less satisfaction about their memory compared to existing normative data. This is consistent with previous work, 7,11 which also used self-reported questionnaires to measure global metacognition.…”

Section: Discussionsupporting

confidence: 91%

“…7,10 Global metacognition, measured using subjective rating tools, has been shown to be altered in patients with FCD. 7,11,12 Local metacognition -the ability to track changes in moment-to-moment cognitive performance -is focused on the appraisal of individual cognitive decisions as opposed to evaluation of overall cognitive performance. Local metacognition can be characterised by two key parameters -metacognitive bias and metacognitive sensitivity.…”

Section: Introductionmentioning

confidence: 99%

“…Whilst global metacognition has previously been evaluated in people with FCD, 7,[11][12] ours is the first study to objectively measure local metacognition. We did this using a novel protocol comprising task-based measures and hierarchical Bayesian modelling.…”

Section: Introductionmentioning

confidence: 99%

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Metacognition in Functional Cognitive Disorder

Bhome

McWilliams

Price

et al. 2021

Preprint

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Functional cognitive disorder (FCD) is common but underlying mechanisms remain poorly understood. Metacognition, an individual’s ability to reflect on and monitor cognitive processes, is likely to be relevant. Local metacognition refers to an ability to estimate confidence in cognitive performance on a moment-to-moment basis, whereas global metacognition refers to long-run self-evaluations of overall performance. Using a novel protocol comprising task-based measures and hierarchical Bayesian modelling, we compared local and global metacognitive performance in individuals with FCD and evaluated interactions between these levels of metacognition. We also investigated how local and global metacognition were related to the presence of affective symptomatology.Eighteen participants with FCD were recruited to this cross-sectional study. Participants completed computerised tasks that enabled local metacognitive efficiency for perception and memory to be measured using the hierarchical meta-d’ (HMeta-d) model within a signal detection theory framework. Participants also completed the Multifactorial Memory Questionnaire (MMQ) measuring global metacognition (beliefs about memory performance), and questionnaires measuring anxiety and depression. Estimates of local metacognitive efficiency were compared to those estimated from two control groups who had undergone comparable metacognitive tasks. Global metacognition scores were compared to existing normative data. A hierarchical regression model was used to evaluate associations between global metacognition, depression and anxiety and local metacognitive efficiency, while simple linear regressions were used to evaluate whether affective symptomatology and local metacognitive confidence were associated with global metacognition.Participants with FCD had intact local metacognition for perception and memory when compared to controls, with the 95% highest-density intervals for metacognitive efficiency overlapping with the two control groups in both cognitive domains. FCD participants had significantly lower global metacognition scores compared to normative data; MMQ-Ability (t=6.54, p<0.0001) and MMQ-Satisfaction (t=5.04, p<0.0001). Mood scores, global metacognitive measures and metacognitive bias were not significantly associated with local metacognitive efficiency. Increased local metacognitive bias (β= −0.20 (SE=0.09), q= 0.01) and higher depression scores as measured by Patient Health Questionnaire-9 (β= −1.40 (SE=2.56), q= 0.01) were associated with lower global metacognition scores.We show that local metacognition is intact, whilst global metacognition is impaired, in FCD, suggesting a decoupling between the two metacognitive processes. In a Bayesian model, an aberrant prior (impaired global metacognition), may override bottom up sensory input (intact local metacognition), giving rise to the subjective experience of abnormal cognitive processing. Future work should further investigate the interplay between local and global metacognition in FCD and aim to identify a therapeutic target to recouple these processes.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

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Metacognition in Functional Cognitive Disorder

Bhome

McWilliams

Price

et al. 2021

Preprint

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“…In patients self-rating their memory as either poor or fair, and hence classified as SMC+, the sensitivity for a diagnosis of FCD/no cognitive impairment was good (0.87) although the positive predictive value was suboptimal (0.57). This suggested the test may be adequate for ruling in a diagnosis of FCD [32], although the SMC Likert Scale did not appear to have differential diagnostic value for distinguishing dementia and non-dementia cases [53].…”

Section: Fcd: Evidence For Impaired Metacognitionmentioning

confidence: 98%

Functional Cognitive Disorders (FCD): How Is Metacognition Involved?

Larner

2021

Brain Sciences

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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.

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“…In a nephrology clinic cohort of patients with chronic kidney disease and diabetes (n = 112), the sensitivity and specificity for a dementia diagnosis were 0.96 and 0.84, respectively, at the cut point < 25/30 [6]. Studies in a dedicated cognitive disorders clinic have suggested superiority of the MACE to MMSE [7][8][9] and single-item cognitive screening questions [10] and equivalence to the Montreal Cognitive Assessment (MoCA) [9,11,12], and a better performance in those aged > 65 years, with a higher prevalence of cognitive impairment [13]. In a study of patients with mild AD (n = 92) and healthy controls (n = 68), MACE had an area under the receiver operating characteristic (AUC ROC) curve of 0.939, which was superior to ACE-III (0.897), Rowland Universal Dementia Assessment Scale (0.889), MMSE (0.874), Memory Impairment Screen (0.866), and MoCA (0.856) [14].…”

Section: Introductionmentioning

confidence: 99%

MACE for the Diagnosis of Dementia and MCI: 3-Year Pragmatic Diagnostic Test Accuracy Study

Williamson¹,

Larner²

2018

Dement Geriatr Cogn Disord

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Background/Aims: The Mini-Addenbrooke’s Cognitive Examination (MACE) is a relatively new short cognitive screening instrument for the detection of patients with dementia and mild cognitive impairment (MCI). Few studies of the MACE have been reported hitherto. The aim of this study was to undertake a pragmatic diagnostic test accuracy study of MACE in a large cohort of patients seen in a dedicated cognitive disorders clinic. Methods: MACE was administered to consecutive patients referred to a neurology-led Cognitive Function Clinic over the course of 3 years to assess its performance for the diagnosis of dementia and MCI using various test metrics. Results: In a cohort of 599 patients, the prevalence of dementia and MCI by criterion diagnosis was 0.17 and 0.29, respectively. MACE had a high sensitivity (> 0.9) and negative predictive values (> 0.8) with large effect sizes (Cohen’s d > 1) for the diagnosis of both dementia and MCI but a low specificity (< 0.5) and positive predictive values (≤0.5). Conclusion: MACE is an acceptable test for the assessment of cognitive complaints in a secondary care setting with good metrics for identifying cases of both dementia and MCI.

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Metamemory: A construct with diagnostic utility in a cognitive disorders clinic?

Cited by 16 publications

References 4 publications

Metacognition in Functional Cognitive Disorder

Metacognition in Functional Cognitive Disorder

Functional Cognitive Disorders (FCD): How Is Metacognition Involved?

MACE for the Diagnosis of Dementia and MCI: 3-Year Pragmatic Diagnostic Test Accuracy Study

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