Characteristics associated with the discrepancy between subjective and objective executive functioning in depression

Executive Function Predicts the Validity of Subjective Memory Complaints in Older Adults beyond Demographic, Emotional, and Clinical Factors.

Background and objective: We examined the relationship between self-reported pre- and post-injury changes in executive dysfunction, apathy, disinhibition, and depression, and performance on neuropsychological tests of executive function, attention/processing speed, and memory in relation to mood levels and effort test performance in individuals in the early stages of recovery from mild to moderate traumatic brain injury (TBI). Method: Participants were 71 noncombat military personnel who were in a semiacute stage of recovery (<3 months post injury) from mild to moderate TBI. Pre- and post-TBI behaviors were assessed with the Frontal Systems Behavior Scale (FrSBe; Grace & Malloy, 2001) and correlated with levels of depressive symptoms, effort test performance, and performance on objective measures of attention, executive function, and memory. Results: Self-reported symptoms of executive dysfunction generally failed to predict performance on objective measures of executive function and memory, although they predicted poorer performance on measures of attention/processing speed. Instead, higher levels of depressive symptomatology best predicted poorer performance on measures of executive function and memory. However, the relationship between memory performance and TBI symptoms was no longer significant when effort performance was controlled. Conclusions: Our findings suggest that, among individuals in early recovery from mild to moderate TBI, self-reported depressive symptoms, rather than patients' cognitive complaints, are associated with objective executive function. However, self-reported cognitive complaints may be associated with objectively measured inattention and slow processing speed.

Older adults in the earliest stages of cognitive decline often present with subjective cognitive complaints which may not be fully reflected in objective measures of cognition. Previous research suggests that a relationship exists between negative emotions, stress and metacognition, but these relationships have not yet been examined in the context of COVID-19. The purpose of this study was to examine the role of stress and emotions in perceived cognition in the context of the COVID-19 pandemic. Telephone screenings were administered to 206 older African Americans (aged 64–94 years). Objective cognition (Telephone Interview for Cognitive Status [TICS]), subjective cognition (Cognitive Change Questionnaire [CCQ]), perceived stress scale 4 (PSS-4), and survey questions about affective responses to COVID-19 experiences were measured. Objective TICS scores predicted subjective CCQ executive function scores (F(1, 197)=4.37, p=.038, R2=.022). Discrepancy scores were calculated as the standardized residual variance between objective and subjective measures. Survey items describing emotional states were summarized with emodiversity scores following Quoidbach and colleagues’ (2014) formula. Discrepancy scores were correlated with perceived stress, as well as global and negative emodiversity (Spearman r=.294, .279, .318, p<.001). In conclusion, we have shown that objective and subjective measures of cognition are related, but discrepancies exist between objectively-measured and self-perceived cognition. Increased stress and greater negative emotions are associated with greater overestimation of cognitive difficulties relative to one’s objective level of cognition. As stress and negative emotions have increased for many during the pandemic, individuals may also have depreciated their self-appraisal of cognitive abilities in the present climate.

A-09 The Relationship Between Subjective Cognitive Complaints, Depression, and Executive Functioning in mTBI Veterans

ABSTRACTIntroduction: Cognitive complaints are common in fibromyalgia, but it is unclear whether they represent an objective cognitive dysfunction or whether they could be explained by depressive symptoms. Here, we aim to elucidate the frequency of subjective cognitive complaints in a sample of women with fibromyalgia, in addition to analyzing associations between these subjective complaints and objective measures linked to the attention and executive cognitive domains. Finally, we aim to investigate the ability of demographic, clinical, and psychological variables to explain the subjective complaints observed. Method: One hundred and five women aged 30–55 years diagnosed with fibromyalgia completed a neuropsychological assessment, which included measures of attention and executive functions. They also completed self-report inventories of subjective cognitive complaints, depression, anxiety, intensity of pain, sleep quality, everyday physical functioning, and quality of life. Results: Eighty-four percent of the patients reported subjective cognitive complaints. Depression scores, everyday physical functioning, and working memory performance were most strongly associated with subjective cognitive complaints. These three variables were significant predictors for subjective cognitive complaints with a final model explaining 32% of the variance. Conclusions: Cognitive complaints are very frequent in patients with fibromyalgia, and these are related to functional and cognitive impairment as well as to depressive symptoms.

Background: Alterations in executive functions, emotion regulation, and their interaction are common concomitants of depression. Executive dysfunction frequently lingers after treatment, has adverse effects on daily life, and predisposes to recurrence of depression. Yet, sensitive measures of executive function for reliable assessment of cognitive outcomes are still lacking in clinical practice. To better understand the impact of depression and its most effective treatment, electroconvulsive therapy (ECT), on cognition, we assessed executive functions pre- and post-ECT and whether objective measures reflecting alterations in emotion–executive function interaction correlate with depression severity or with cognitive outcome.Methods: Executive functions were assessed in 21 patients with major depressive disorder (MDD) before and after ECT using subjective measures from the Behavior Rating Inventory of Executive Function—Adult version (BRIEF-A) and objective cognitive performance measures derived from computer-based test of executive function, Executive Reaction Time (RT) Test. In addition, we created novel indices reflecting emotional modulation of cognitive performance by subtracting different performance measures in the context of neutral distractors from those in the context of threat-related distractors. We correlated these indices with Beck Depression Inventory (BDI) and BRIEF-A scores.Results: Depression was significantly alleviated, and executive functions improved post-ECT, as seen in reduced BDI scores, BRIEF-A scores, and number of errors in Executive RT Test. Pre-ECT BDI scores correlated with threat modulation of RT (tmRT) and threat modulation of working memory (tmWM). Post-ECT tmRT correlated with several Behavioral Regulation scales and tmWM with several Metacognition scales of BRIEF-A.Conclusion: While caution is warranted, results from both subjective and objective measures suggest that ECT significantly improves executive functions and emotion regulation along with alleviation of depression. Novel indices derived from threat modulation of executive function and working memory show promise as objective biomarkers of depression severity pre-ECT and cognitive outcome post-ECT with potential for guiding depression treatments.

Moderators of metacognitive strategy training for executive functioning in early schizophrenia and psychosis risk

ObjectiveThe aim of this study is to evaluate the discrepancy between objective cognitive measures and cognitive subjective complaints in a sample of euthymic patients with bipolar disorder (BD). MethodsOne hundred and sixteen participants (83 euthymic patients with BD and 33 healthy controls) were enrolled for this study. Patients were assessed with a comprehensive neuropsychological battery and they also reported their subjective cognitive complaints with the Cognitive Complaints in Bipolar Disorder Rating Scale (COBRA). The discrepancy between objective and subjective data was calculated using a novel methodology proposed in a previous study (Miskowiak, 2016). Statistical analyses included Pearson correlations and multiple linear regression. ResultsHigher number of previous depressive episodes was identified as one variable associated with the global sensitivity composite score (Beta = 0.25; t = 2.1; p = 0.04) and with the verbal learning and memory sensitivity score (Beta = 0.26; t = 2.16; p = 0.03). That is, patients with more previous depressive episodes tend to over-report cognitive complaints. In contrast, higher number of previous hospitalizations was associated with stoicism in the global total score (Beta = −0.27; t = −2.24: p = 0.029) and in the domain of attention/processing speed (Beta = −0.34; t = −2.52; p = 0.016), indicating patients with more hospitalizations tend to report less cognitive complaints. DiscussionOur study identified some factors that might help to explain the discrepancy between objective and subjective cognitive measures in BD, including number of previous depressive episodes and number of previous hospitalizations. This highlights the need of the combined use of both types of cognitive measures to make an accurate assessment of cognitive dysfunctions and their effective treatment.

Purpose: Childhood acute lymphoblastic leukemia (ALL) is associated with executive dysfunction in long-term survivorship. This is evidenced by subjective and objective measures of executive functions (EFs). However, the two measures do not always align, and the EF discrepancy in this population is understudied. This cross-sectional study aimed to examine the association between global measures of subjective and objective EF in young adult (YA) survivors of childhood ALL. Second, we aimed to explore how psychological distress, fatigue, self-efficacy, and estimated IQ relate to the discrepancy between these measures. Methods: A total of 53 subjects (age 18-34) participated in a clinical trial baseline assessment (clinicaltrials.gov NCT04541056). The Behavior Rating Inventory of Executive Function for Adults assessed subjective EFs. Results from six neurocognitive tests were combined to represent objective EFs. Discrepancy scores were calculated by subtracting the objective EF composite score from the subjective EF score. Spearman's correlations and simple and multiple linear regression analyses were performed to explore associations and predictors for the global EF discrepancy. Results: Subjective and objective measures of EF were moderately correlated (rs = 0.407). The regression analyses showed that psychological distress (R2 = 0.44), fatigue (R2 = 0.29), and self-efficacy (R2 = 0.24) significantly predicted the global EF discrepancy (p < .001). Only psychological distress explained unique variation (B = -0.46). Conclusion: Neurocognitive tests and self-reports offer valuable insights into EF assessment for YA survivors. Psychological distress emerged as the most central contributor to the overall EF discrepancy. Consequently, screening for anxiety and depression alongside subjective EF complaints will be of significance.

Healthcare workers commonly rely on patient self-report to identify problems with cognitive functioning among Persons Living with HIV (PLWH). Self-reported cognitive complaints may not accurately reflect objective cognitive performance and may be obscured by co-occurring depression. The purpose of the current study was to examine the relationships among depression, subjective cognitive complaints, and objective cognitive performance in PLWH using measures easily administered by healthcare workers. Particularly, this study assessed the association between subjective cognitive complaints (MOS-HIV) and objective cognitive performance (mHDS) using a simple screening tool, as well as whether depressive symptoms (CES-D 10) moderated this relationship. This was a secondary data analysis of a parent study that enrolled participants (N=207) from outpatient HIV clinics in Florida between 2009 and 2011. Most participants identified themselves as African American (82.6%) and heterosexual (81.6%). Almost half of the participants were male (46.4%). Fifty-one percent of participants had a score of 10 or greater on CES-D, indicating clinical depression. This study found no association between subjective and objective cognitive measures; depressive symptoms exhibited no moderating effect on the relationship between subjective cognitive complaints and objective cognitive performance. Depressive symptoms were significantly associated with subjective perceptions of cognitive ability. Results suggest that subjective cognitive complaints may be an inadequate tool for identifying objective cognitive impairments among PLWH. Additionally, treatment of depressive symptoms may help alleviate subjective cognitive complaints.

Objective Versus Subjective Measures of Executive Functions: Predictors of Participation and Quality of Life in Parkinson Disease?

Metacognition in older African American adults during the COVID‐19 pandemic

Discrepancy between objective and subjective cognition in major depressive disorder

Biased neurocognitive self-perception in depressive and in healthy persons

The assessment of cognitive functions of adults with attention deficit hyperactivity disorder (ADHD) comprises self-ratings of cognitive functioning (subjective assessment) as well as psychometric testing (objective neuropsychological assessment). The aim of the present study was to explore the utility of these assessment strategies in predicting neuropsychological impairments of adults with ADHD as determined by both approaches. Fifty-five adults with ADHD and 66 healthy participants were assessed with regard to cognitive functioning in several domains by employing subjective and objective measurement tools. Significance and effect sizes for differences between groups as well as the proportion of patients with impairments were analyzed. Furthermore, logistic regression analyses were carried out in order to explore the validity of subjective and objective cognitive measures in predicting cognitive impairments. Both subjective and objective assessment tools revealed significant cognitive dysfunctions in adults with ADHD. The majority of patients displayed considerable impairments in all cognitive domains assessed. A comparison of effect sizes, however, showed larger dysfunctions in the subjective assessment than in the objective assessment. Furthermore, logistic regression models indicated that subjective cognitive complaints could not be predicted by objective measures of cognition and vice versa. Subjective and objective assessment tools were found to be sensitive in revealing cognitive dysfunctions of adults with ADHD. Because of the weak association between subjective and objective measurements, it was concluded that subjective and objective measurements are both important for clinical practice but may provide distinct types of information and capture different aspects of functioning.