Levy Sarah, Gansler David, Huey Edward, Wassermann Eric, Grafman Jordan
Department of Psychology, Suffolk University College of Arts and Sciences, Boston, MA, USA.
Departments of Psychiatry and Neurology, Columbia University, NY, USA.
Arch Clin Neuropsychol. 2018 Aug 1;33(5):519-529. doi: 10.1093/arclin/acx105.
We compared two different methods of assessing self-awareness (clinician-rated vs. self- and caregiver report) in participants with neurodegenerative conditions. Additionally, we examined the contribution of memory dysfunction to assessment of self-awareness.
Sixty-seven participants with various neurodegenerative disorders participated in this study. Data were collected on brain volume, neurocognitive function, demographic characteristics, and two measures of patient self-awareness, defined as (1) the discrepancy between patient and caregiver ratings of dysexecutive syndrome and (2) clinician-observed rating of patient insight. Penalized regression with best subset variable selection and 10-fold cross-validation was used to evaluate three neurocognitive frameworks: self-regulation, language, and perspective-taking, each predicting the results from the two methods of self-awareness measurement.
The self-regulation framework was more robustly predictive for both the clinician rating and discrepancy method than language or perspective-taking. Frameworks in which the clinician rating was the criterion were more robust than those with the discrepancy method as criterion. When a measure of memory functioning was added to the framework, there was no appreciable improvement in the prediction of self-awareness.
A self-regulation neurocognitive framework, consisting of regions of interest and neuropsychological test scores, was more effective in understanding patient self-awareness than perspective-taking or language frameworks. Compared to the discrepancy method, a clinician rating of self-awareness was more robustly associated with relevant clinical variables of regional brain volume and neuropsychological performance, suggesting it may be a useful measure to aid clinical diagnosis.
我们比较了两种评估神经退行性疾病患者自我意识的不同方法（临床医生评定与自我及照料者报告）。此外，我们研究了记忆功能障碍对自我意识评估的影响。
67名患有各种神经退行性疾病的参与者参与了本研究。收集了关于脑容量、神经认知功能、人口统计学特征以及患者自我意识的两项测量数据，自我意识定义为：（1）患者与照料者对执行功能障碍综合征评定的差异；（2）临床医生观察到的患者洞察力评定。采用最佳子集变量选择和10折交叉验证的惩罚回归来评估三个神经认知框架：自我调节、语言和观点采择，每个框架预测两种自我意识测量方法的结果。
与语言或观点采择框架相比，自我调节框架对临床医生评定和差异法都具有更强的预测能力。以临床医生评定为标准的框架比以差异法为标准的框架更稳健。当在框架中加入记忆功能测量指标时，自我意识预测方面没有明显改善。
一个由感兴趣区域和神经心理学测试分数组成的自我调节神经认知框架，在理解患者自我意识方面比观点采择或语言框架更有效。与差异法相比，临床医生对自我意识的评定与区域脑容量和神经心理学表现的相关临床变量联系更紧密，表明它可能是有助于临床诊断的有用指标。
