Self-Awareness Moderates the Association Between Executive Dysfunction and Functional Independence After Acquired Brain Injury

Abstract

Objective Impaired self-awareness (SA) is a common symptom after suffering acquired brain injury (ABI) which interferes with patient’s rehabilitation and their functional independence. SA is associated with executive function and declarative memory, two cognitive functions that are related to participants’ daily living functionality. Through this observational study, we aim to explore whether SA may play a moderator role in the relation between these two cognitive processes and functional independence. Method A sample of 69 participants with ABI completed a neuropsychological assessment focused on executive function and declarative memory which also included a measure of SA and functional independence. Two separated linear models were performed including functional independence, SA, and two neuropsychological factors (declarative memory and executive function) derived from a previous principal component analysis. Results Moderation analysis show a significant interaction between SA and executive function, reflecting an association between lower executive functioning and poorer functional outcome, only in participants with low levels of SA. Notwithstanding, declarative memory do not show a significant interaction with SA, even though higher declarative memory scores were associated with better functional independence. Conclusions SA seems to play a moderator effect between executive function, but not declarative memory, and functional independence. Accordingly, participants with executive deficits and low levels of SA might benefit from receiving specific SA interventions in the first instance, which would in turn positively impact on their functional independence.

A literature review of outcome and treatment options after acquired brain injury: Suggestions for adult offenders using knowledge from the general population

“…Treatment of impaired self-awareness has been associated with a broad range of outcomes, such as depressive symptoms, functional independence and enhanced activity and participation (Engel et al, 2019;Smeets et al, 2017;Villalobos et al, 2020). In addition, goal setting, especially individually made treatment goals, can improve therapy adherence (Brett et al, 2017;Knutti et al, 2020).…”

Memory in Social Interactions: The Effects of Introspection on Destination Memory in Traumatic Brain Injury

“…While our findings mirror the general neurological and cognitive heterogeneity of TBI [ 37 , 38 ], they demonstrate that some patients with TBI can benefit from introspection to improve their memory performances. TBI are heterogeneous in nature, and patients with TBI have significant variations in the location and severity of injury, resulting in a significant variation in cognitive performances and insight [ 33 , 48 , 49 , 50 ]. This cognitive variation may explain why some patients with TBI may benefit from introspection to improve destination memory while others fail to do so.…”

Translation, cross-cultural adaptation and validation of the 10-item Weekly Calendar Planning Activity in Spanish-speaking ABI patients: a multicenter study

“…In the same vein, previous studies have also identified lower use of cognitive strategies such as self-checking and pausing and re-reading during WCPA completion as important indicators of self-monitoring deficits in stroke patients (Jaywant et al, 2022 ) and in an older patients population (Arora et al, 2021 ). Additionally, several studies (Villalobos et al, 2020 ; Fogel, 2022 ) have considered the use of strategies and metacognition (i.e. self-awareness) as factors capable of modulating the typical relationship between ADL and EF.…”

“…Evidence from neuropsychological and occupational studies has shown that the impairment of these processes is one of the leading causes of functional alterations, keeping individuals from independently returning to their home, community, and job (Kennedy et al, 2008 ), significantly affecting their employment status (Atchison et al, 2004 ; Ownsworth and Shum, 2009 ), and making them incapable of living independently at home (Lipskaya-Velikovsky et al, 2018 ; Ghaffari et al, 2021 ) and engaging in social relationships (Reid-Arndt et al, 2007 ). Furthermore, EF has shown to be a strong predictor of the level of dependency in instrumental activities of daily living (IADL) (Overdorp et al, 2016 ; Villalobos et al, 2020 ), and it can explain a larger percentage of variance in IADL than other cognitive processes (Royall et al, 2007 ; McAlister and Schmitter-Edgecombe, 2016 ). For these reasons, recognizing executive dysfunction and its consequences in everyday activities should be considered when assessing cognitive functions.…”