Department of Psychiatry and Behavioral Sciences (PDH, MS), Miller School of Medicine, University of Miami, Miami, FL; Research Service (PDH), Miami VA Healthcare System, Miami, FL.
Don Souffer High School (AS), Aventura, FL.
Am J Geriatr Psychiatry. 2023 Dec;31(12):1117-1128. doi: 10.1016/j.jagp.2023.07.009. Epub 2023 Jul 22.
Self-assessment of cognitive abilities can be an important predictor of clinical outcomes. This study examined impairments in self-assessments of cognitive performance, assessed with traditional neuropsychological assessments and novel virtual reality tests among older persons with and without human immunodeficiency virus (HIV) and mild cognitive impairment (MCI).
One hundred twenty-two participants (82 persons with HIV; 79 MCI+) completed a traditional neuropsychological battery, DETECT virtual reality cognitive battery, and self-reported their general cognitive complaints, depressive symptoms, and perceptions of DETECT performance. Relationships between DETECT performance and self-assessments of performance were examined as were the correlations between general cognitive complaints and performance. These relations were evaluated across HIV and MCI status, considering the associations of depressive symptoms, performance, and self-assessment.
We found no effect of HIV status on objective performance or self-assessment of DETECT performance. However, MCI+ participants performed worse on DETECT and traditional cognitive tests, while also showing a directional bias towards overestimation of their performance. MCI- participants showed a bias toward underestimation. Cognitive complaints were reduced compared to objective performance in MCI+ participants. Correlations between self-reported depressive symptoms and cognitive performance or self-assessment of performance were nonsignificant.
MCI+ participants underperformed on neuropsychological testing, while overestimating performance. Interestingly, MCI- participants underestimated performance to approximately the same extent as MCI+ participants overestimated. Practical implications include providing support for persons with MCI regarding awareness of limitations and consideration that self-assessments of cognitive performance may be overestimated. Similarly, supporting older persons without MCI to realistically appraise their abilities may have clinical importance.
认知能力的自我评估可能是临床结果的重要预测指标。本研究检查了在患有和不患有人类免疫缺陷病毒（HIV）和轻度认知障碍（MCI）的老年人中，使用传统神经心理学评估和新型虚拟现实测试评估的认知表现自我评估中的障碍。
122 名参与者（82 名 HIV 感染者；79 名 MCI+）完成了传统的神经心理学测试，DETECT 虚拟现实认知测试，并自我报告了他们的一般认知抱怨，抑郁症状和对 DETECT 表现的看法。检查了 DETECT 表现与自我表现评估之间的关系，以及一般认知抱怨与表现之间的相关性。考虑到抑郁症状，表现和自我评估的关联，评估了这些关系在 HIV 和 MCI 状态下的相关性。
我们没有发现 HIV 状态对 DETECT 表现的客观表现或自我评估有影响。但是，MCI+参与者在 DETECT 和传统认知测试中的表现较差，同时表现出高估其表现的方向性偏差。MCI-参与者表现出低估的倾向。与 MCI+参与者的认知抱怨相比，认知抱怨与客观表现相比有所减少。自我报告的抑郁症状与认知表现或对表现的自我评估之间的相关性无统计学意义。
MCI+参与者在神经心理学测试中表现不佳，同时高估了表现。有趣的是，MCI-参与者低估了表现，与 MCI+参与者高估的程度大致相同。实际意义包括为 MCI 患者提供有关认识局限性的支持，并考虑到对认知表现的自我评估可能被高估。同样，支持没有 MCI 的老年人现实地评估自己的能力可能具有临床意义。
