National Multiple Sclerosis Foundation, Maassluis, The Netherlands.
Eur J Neurol. 2012 Apr;19(4):562-9. doi: 10.1111/j.1468-1331.2011.03538.x. Epub 2011 Oct 18.
Self-reports of cognitive functioning are not always related to objective measures. We examined psychological characteristics of patients with multiple sclerosis (MS) who underestimate, overestimate or accurately estimate their executive performance.
The first phase was an inventory of cognitive complaints by means of self-reported (and partner-reported) questionnaires. At the second phase (January-October 2009), 114 of the 128 participants met the inclusion and exclusion criteria and underwent cognitive and neurological assessments.
A total of 19% (N = 22) of participants reported subjective executive impairment, whilst 81% (N = 92) reported no subjective executive impairment. Based on Behavioural Assessment of the Dysexecutive Syndrome-Dysexecutive Questionnaire self-reports, 67% (N = 76) of the participants accurately reported no subjective executive impairment, 14% (N = 16) overestimated, and 15% underestimated (N = 17) their executive performance; 78% of the informants accurately reported no subjective executive impairment, 15% overestimated the patient's executive performance, and 4% underestimated the patient's executive performance. Patients with MS underestimating their executive performance were characterized by more depression (F(2,106 = 12.9, P < 0.001), anxiety (F(2,105) = 7.4, P = 0.001) and psychosocial stress (F(2,103) = 17.8, P < 0.001), more often used the coping style 'disclosure of emotions' (H(2) = 12.1, P = 0.002) than accurate estimators and overestimators and displayed a more passive reaction pattern (F(2,104) = 4.4, P = 0.014) than accurate estimators.
Self-reports of executive performance are generally reliable, but 29% of patients with MS underestimated or overestimated their abilities. It is especially important to identify underestimators as they display underlying psychological problems and dysfunctional coping styles in need of further psychological treatment. Informants are valuable in this respect, but should not be seen as the 'gold standard' to identify cognitive impairment.
认知功能的自我报告并不总是与客观测量相关。我们研究了低估、高估或准确估计执行功能的多发性硬化症（MS）患者的心理特征。
第一阶段通过自我报告（和伴侣报告）问卷进行认知抱怨的清单。在第二阶段（2009 年 1 月至 10 月），128 名参与者中有 114 名符合纳入和排除标准，并接受了认知和神经评估。
共有 19%（N=22）的参与者报告主观执行障碍，而 81%（N=92）报告无主观执行障碍。根据行为评估的执行功能障碍综合征-执行功能障碍问卷的自我报告，67%（N=76）的参与者准确报告无主观执行障碍，14%（N=16）高估，15%（N=17）低估；78%的报告者准确报告无主观执行障碍，15%高估患者的执行功能，4%低估患者的执行功能。低估自身执行功能的 MS 患者表现为更严重的抑郁（F（2，106）=12.9，P<0.001）、焦虑（F（2，105）=7.4，P=0.001）和心理社会压力（F（2，103）=17.8，P<0.001），更常使用“情绪暴露”的应对方式（H（2）=12.1，P=0.002）比准确估计者和高估者，表现出更被动的反应模式（F（2，104）=4.4，P=0.014）比准确估计者。
执行功能的自我报告通常是可靠的，但 29%的 MS 患者低估或高估了他们的能力。特别重要的是要识别低估者，因为他们表现出潜在的心理问题和需要进一步心理治疗的功能失调应对方式。报告者在这方面很有价值，但不应被视为识别认知障碍的“金标准”。
