Differences in metacognition between multiple sclerosis phenotypes: cognitive impairment and fatigue are key factors

Clàudia Coll-Martinez; Judit Salavedra-Pont; Maria Buxó; Ester Quintana; Ana Quiroga-Varela; René Robles-Cedeño; Marc Puig; Gary Álvarez-Bravo; Lluís Ramió-Torrentà; Jordi Gich

doi:10.3389/fpsyg.2023.1163112

Differences in metacognition between multiple sclerosis phenotypes: cognitive impairment and fatigue are key factors

Front Psychol. 2023 Aug 23:14:1163112. doi: 10.3389/fpsyg.2023.1163112. eCollection 2023.

Authors

Clàudia Coll-Martinez^{1

2

3}, Judit Salavedra-Pont^{1

2}, Maria Buxó⁴, Ester Quintana², Ana Quiroga-Varela^{2

3}, René Robles-Cedeño^{1

2

3

5}, Marc Puig^{1

2}, Gary Álvarez-Bravo^{1

2}, Lluís Ramió-Torrentà^{1

2

3

5}, Jordi Gich^{1

2

5}

Affiliations

¹ Girona Neuroimmumology and Multiple Sclerosis Unit, Neurology Department, Dr. Josep Trueta University Hospital and Santa Caterina Hospital, Girona, Spain.
² Neurodegeneration and Neuroinflammation Research Group, Girona Biomedical Research Institute (IDIBGI), Salt, Spain.
³ Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Enfermedades inflamatorias (RD21/0002/0063), Instituto de Salud Carlos III, Madrid, Spain.
⁴ Statistical Unit, Girona Biomedical Research Institute (IDIBGI), Salt, Spain.
⁵ Medical Sciences Department, University of Girona, Girona, Spain.

Abstract

Background: Cognitive impairment is present in 40-65% of patients with multiple sclerosis (pwMS). Objectively measured cognitive performance often does not match patients' subjective perception of their own performance.

Objective: We aimed to compare cognitive performance and subjective perception of cognitive deficits between pwMS and healthy controls (HCs), as well as the accuracy of subjective perception.

Methods: In total, 54 HC and 112 pwMS (relapsing-remitting, RRMS, and progressive PMS) underwent neuropsychological evaluation and completed perceived deficit, fatigue, and anxiety-depression scales. Participants were classified according to their consistency between subjective self-evaluation of cognitive abilities and objective cognitive performance to assess accuracy. Regression models were used to compare cognitive performance between groups and explore factors explaining inaccuracy in the estimation of cognitive performance.

Results: PMS showed greater and more widespread cognitive differences with HC than RRMS. No differences were found between pwMS and HC in the perception of deficit. PMS had higher ratios of overestimators. In explaining inaccuracy, fatigue and cognitive preservation were found to be risk factors for underestimation, whereas physical disability and cognitive impairment were risk factors for overestimation.

Conclusion: PwMS have metacognitive knowledge impairments. This study provides new information about metacognition, data on the prevalence of impairments over a relatively large sample of PwMS, and new insights into factors explaining it. Anosognosia, related to cognitive impairment, may be present in pwMS. Fatigue is a key factor in underestimating cognition.

Keywords: cognition; cognitive impairment; deficit awareness; metacognitive knowledge; multiple sclerosis.

Grants and funding

This work was supported by the Departament de Salut of the Generalitat de Catalunya [SLT017/20/000115, 2021]; Instituto de Salud Carlos III, RICORS -Red de Enfermedades Inflamatorias [RD21/0002/0063, 2021]; and Norvartis, who partially funded the ConnectiMS project. The funders were not involved in the study design, collection, analysis, interpretation of data, the writing of this article or the decision to submit it for publication.