Metacognition in Individuals Aging with Traumatic Brain Injury

OBJECTIVE: To measure metacognition in adults aging with moderate-severe traumatic brain injury (TBI) through objective (task-based) and subjective (self-report) measures to determine association between measures, and ability to predict executive functioning (EF), emotional functioning, and functional outcome.METHOD: 130 individuals (TBI n = 102; healthy controls (HC) n = 28) were included. Participants completed objective tasks of metacognition and EF, and self-reported measures of metacognition (MCQ-30), psychiatric symptoms (BSI-18), and community participation (PART-O). The objective metacognitive task and MCQ-30 subscales were used as predictors of EF, anxiety, and community participation. Post-hoc analyses examined the association between objective and subjective metacognitive measures in TBI subgroups (overconfident, metacognitively accurate). RESULTS: The objective metacognitive task and one self-report subscale predicted EF [F(2) = 9.69, p < 0.001, R2 = 0.17]. Two self-report subscales predicted anxiety [F(2) = 19.15, p < 0.001, R2 = 0.28]. No variables predicted community participation. There was a significant interaction between the metacognitive groups (overconfident, accurate) and MCQ-30 on objective metacognitive performance [R2 = 0.23, p = 0.037].CONCLUSION: Individuals aging with TBI demonstrated metacognitive deficit 45% of the time and when they did, ~90% over-estimated their ability. Both objective and subjective metacognitive measures predicted aspects of functional outcomes. However, self-report and objective metacognitive measures are related only when objective metacognitive performance is high, confirming long-standing concerns that self-report may be unreliable when awareness of deficit is present. These findings challenge the predictive validity of self-report measures of metacognition.

Risk Factors for Depression in Children and Adolescents with High Functioning Autism Spectrum Disorders

The objective of our study was to examine, discuss, and provide proposals on diagnostic comorbidity of depression in children and adolescents with high functioning autism spectrum disorder (HFASD) in the following aspects. (1)Prevalence. It was concluded that there are an elevated depression rate and the need for longitudinal studies to determine prevalence and incidence based on functioning level, autistic symptoms, gender, age, type of depression, prognosis, duration, and treatment. (2)Explicative Hypotheses and Vulnerability. The factors that present the greatest specific risk are higher cognitive functioning, self-awareness of deficit, capacity for introspection, stressful life events, adolescence, quality of social relationships, and alexithymia. (3)Risk of Suicide. The need for control and detection of suicidal tendencies and bullying is emphasised. (4)Depressive Symptoms. Indicators for early detection are proposed and their overlap with HFASD is analysed, examining theassessment techniquesused and arguing that specific adapted tests are needed.

Metacognitive Monitoring in Moderate and Severe Traumatic Brain Injury

The ability to engage in self-reflective processes is a capacity that may be disrupted after neurological compromise; research to date has demonstrated that patients with traumatic brain injury (TBI) show reduced awareness of their deficits and functional ability compared to caretaker or clinician reports. Assessment of awareness of deficit, however, has been limited by the use of subjective measures (without comparison to actual performance) that are susceptible to report bias. This study used concurrent measurements from cognitive testing and confidence judgments about performance to investigate in-the-moment metacognitive experiences after moderate and severe traumatic brain injury. Deficits in metacognitive accuracy were found in adults with TBI for some but not all indices, suggesting that metacognition may not be a unitary construct. Findings also revealed that not all indices of executive functioning reliably predict metacognitive ability. (JINS, 2011,17, 720–731)

Consciência da doença na demência do tipo Alzheimer: uma revisão sistemática de estudos longitudinais

OBJETIVOS: Avaliar as definições, métodos de avaliação e hipóteses etiológicas utilizadas em estudos longitudinais sobre consciência da doença na demência do tipo Alzheimer. MÉTODO: Pesquisa, nas bases de dados Medline, ISI, Lilacs e SciELO, de estudos longitudinais sobre consciência da doença na demência do tipo Alzheimer entre 1999 e 2009. As palavras-chave utilizadas foram: "Alzheimer", "dementia", "anosognosia", "awareness of deficit", "awareness of disease", "insight" e "longitudinal study". Os artigos examinados foram classificados conforme as hipóteses etiológicas encontradas. RESULTADOS: Os nove artigos selecionados foram divididos em duas áreas: hipóteses etiológicas biológicas e hipóteses etiológicas psicossociais. Os termos "falta de consciência dos déficits", "consciência do déficit", "insight" e "negação do déficit de memória" são utilizados nos estudos como sinônimos do termo "anosognosia", mesmo sendo, conceitualmente, diferentes. O método de avaliação mais utilizado foi o uso de questionários de discrepância entre os relatos dos pacientes e cuidadores. CONCLUSÕES: Os estudos longitudinais apresentam hipóteses etiológicas heterogêneas, além da inexistência de um padrão conceitual e metodológico de avaliação. Essas dificuldades impossibilitam a obtenção de resultados homogêneos, o que gera a necessidade de aprofundamento dos estudos na área.