Abstract
Functional Cognitive Disorder (FCD) is a common diagnosis at the memory clinic. FCD is characterised by significant self-reported cognitive symptoms in the absence of external evidence of cognitive dysfunction. A potential explanation for this is a deficit in metacognition, the process by which we internally judge our own abilities. Here we investigated differences in accuracy, confidence, and metacognition between people with FCD (N = 20), neurodegenerative mild cognitive impairment (nMCI; N = 14), and healthy controls (N = 23). The groups were assessed on forced choice memory and perceptual tasks, with trial by trial confidence ratings. FCD and nMCI participants showed lower accuracy on the memory task (means FCD 63.65%, nMCI 63.96%, HC 71.22%), with a significant difference between the FCD and HC groups after controlling for age and sex. There were no between-group differences in memory task confidence (means FCD 3.19, nMCI 3.59, HC 3.71). The FCD group showed greater confidence when longer time was allowed on the memory task. No between group differences in perceptual task accuracy (means FCD 63.97%, nMCI 64.50%, FCD 65.86%) or confidence (means FCD 3.71, nMCI 3.43, HC 3.88) were found. No differences in metacognitive efficacy emerged between the groups, either on the memory or perceptual task (Memory Meta-d’/d’:FCD 0.63, nMCI 0.94 HC 0.85; Perceptual Meta-d’,d’: FCD 0.50, nMCI 0.51, HC 0.72). Participants showed greater metacognitive efficacy on the memory task compared to the perceptual task. The difficulties experienced by people with FCD do not appear to be due to metacognitive deficits. Their performance was similar to people with nMCI over aspects of the memory tasks, which suggests that the primary issue may lie with memory encoding or retrieval, rather than with their judgement of performance accuracy.
Highlights
Metacognition refers to our knowledge of our own abilities and attributes; how good you are at certain tasks and where you may struggle
There is emerging evidence that metacognition may be affected even in the early stages of prodromal neurodegeneration. Those with mild cognitive impairment (MCI) and impaired metacognition are more likely to progress to future dementia than those with intact awareness [3]
Functional Cognitive Disorder (FCD) and neurodegenerative mild cognitive impairment (nMCI) were compared with a healthy control group with metacognitive efficacy, confidence, and performance accuracy evaluated across memory and perceptual forced choice tasks
Summary
Metacognition refers to our knowledge of our own abilities and attributes; how good you are at certain tasks and where you may struggle. One potential reason for the disconnect between perceived and actual cognitive functioning in FCD is a deficit in metacognition In this instance, unlike the lack of symptom awareness seen in neurodegeneration, individuals over-estimate the severity of their cognitive symptoms. This hypothesis is based on the inconsistency between self-reported cognitive functioning and performance in FCD [4,9]. Altered insight has been demonstrated in people with MCI due to neurodegeneration, and may be an early indicator that the individual is at high risk of progressing to dementia [13] This led to the second part of our hypothesis, namely that those with nMCI would show an excess of confidence in their performance. FCD and nMCI were compared with a healthy control group with metacognitive efficacy, confidence, and performance accuracy evaluated across memory and perceptual forced choice tasks
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