Assessing metacognition during or after basic-level and high-level cognitive tasks? A comparative study in a non-clinical sample.

This study explored in a non-clinical sample whether metacognitive awareness assessments measured during ("on line") and after ("end line") a neuropsychological task lead to comparable results in tests exploring basic-level or high-level cognitive functions. Short-term memory and working memory tests (forward and backward digit recall of the WAIS-III) were used to measure basic-level cognitive function. A social cognition test, the French adaptation of the Faces Test, was used to assess high-level cognitive function through recognition of facial emotions. For these two tests, we explored "on line" metacognitive awareness using a method based upon Koriat and Goldsmith's protocol. After each answer, participants were asked to rate their level of confidence in the correctness of their response. Persons had also to rate their confidence in their answer only once, at the end of the neuropsychological test, in order to explore "end line" metacognitive awareness. They were then asked "do you feel you have passed this test?" and had to rate their feeling of success on a 4-point Likert-type scale ("no", "rather not", "rather yes", "yes"). No association was found between "on line" and "end line" metacognitive awareness scores on memory tests. Poor "end line" metacognitive awareness was associated with lower "on line" metacognitive awareness score in the social cognition test. It might be of interest to assess both "on line" and "end line" metacognitive awareness in persons with schizophrenia to better take into accounts the multi-faceted structure of metacognition.

The evaluation of behavioural changes in brain-injured patients: SOFMER recommendations for clinical practice.

UNLABELLED: Behavioural changes are the main cause of difficulties in interpersonal relationships and social integration among traumatic brain injury (TBI) patients. The Société française de médecine physique et réadaptation (SOFMER) decided to develop recommendations for the treatment and care provision for these problem under the auspices of the French health authority, the Haute Autorité de la santé (HAS). Assessment of behaviour is essential to describe, understand and define situations, assess any change and suggest lines for intervention. The relationship of these behavioural changes with the brain lesion is likewise of crucial importance in legal and forensic expertise. AIMS: Using a literature review and expert opinions, the aim was to define the optimal conditions for the collection of data on behavioural changes in individuals having sustained brain trauma, to identify the situations in which they arise, to review the instruments available, and to suggest lines of intervention. METHODS: A literature search identified 981 articles, among which 122 on the target subject were selected and analysed in detail and confronted with the experience of professionals and user representatives. A first draft of the recommendations was produced by the working group, and then submitted to a review group for opinions and complements. RESULTS: The literature on this subject is heterogeneous, and presents low levels of evidence. No article enabled the development of recommendations above the "expert opinion" level. After prior clarification of the aims of the evaluation, it is recommended first to carefully describe the changes in behaviour, from patient and third-person narratives, and where possible from direct observations. The information enabling the description of the phenomena occurring should be collected by different individuals (multi-source evaluation): the patient, his or her close circle, and professionals with different training backgrounds (multidisciplinary evaluation). The analysis of triggering or associated factors requires an assessment of cognitive functions and any neurological pathology (seizures). After confrontation and synthesis, the information should be completed using one or several behavioural scales, which provide objectivity and reproducibility. The main generic and specific scales are presented, with their advantages, drawbacks and validation references. The group did not wish to recommend any one of them in particular. CONCLUSION: The evaluation of behavioural changes is essential, since without it a therapeutic strategy and appropriate orientation cannot be implemented. The emphasis should be put on contextualised, multi-source and multidisciplinary evaluation, including validated behavioural scales. In this area, nevertheless, evaluation is still restricted by several methodological limitations. Further research is needed to improve the standardisation of data collection and the psychometric properties of the instruments. A European harmonisation of these procedures is also greatly needed.

Assessing metacognition during a cognitive task: impact of "on-line" metacognitive questions on neuropsychological performances in a non-clinical sample.

Whereas metacognition is of great interest for neuropsychological practice, little is known about the impact of metacognitive questions during a neuropsychological assessment. This study explored the impact of measuring "on-line" metacognitive processes on neuropsychological performances in a non-clinical population. Participants were randomly assigned to a "standard" or a "metacognitive" neuropsychological test procedure. The "standard" procedure assessed executive functions (Modified Card Sorting Test), episodic memory ("Rappel libre Rappel indicé" 16), working memory (digit span test Wechsler Adult Intelligence Scale III) and social cognition (Faces Test). In the "metacognitive" procedure, two questions were added after each item of these tests to evaluate "on-line" metacognitive monitoring and control. Working memory performances were better and episodic memory performances lower in the "metacognitive" versus the "standard" procedure. No significant difference was found concerning executive functioning or social cognition. The assessment of "on-line" metacognition might improve working memory performances by enhancing concentration, and might impair episodic memory performances by acting as a distractor. These findings may have implications for the development of cognitive remediation programs.

Participation restrictions in patients with psychiatric and/or cognitive disabilities: preliminary results for an ICF-derived assessment tool.

UNLABELLED: Participation in community life is a major challenge for most people with psychiatric and/or cognitive disabilities. Current assessments of participation lack a theoretical basis. However, the new International Classification of Functioning, Disability and Health (ICF) provides a relevant framework. AIMS: The present study used an ICF-derived assessment tool to activity limitations and participation restrictions in two groups of participants with disabilities linked to schizophrenia or traumatic brain injury respectively. METHODS: Twenty-six items (related to six ICF sections) were selected by reviewing the literature and gathering the clinician's opinions and representatives of patient associations. These items, yielded an ordinal rating of activity limitations, participation restrictions and contextual factors (social support, attitudes and, systems & politics). Special attention was paid to contextual and environmental factors. The final checklist (called the Grid for Measurements of Activity and Participation, G-MAP) was administered to 16 participants with traumatic brain injury (the TBI group) and 15 participants with schizophrenic disorders (the SD group). Psychometric assessments of cognition and, neurobehavioural, psychological and psychosocial functioning were also performed. RESULTS: The internal consistencies for activity limitations (Cronbach's alpha coefficient=0.89) and participation restriction (Cronbach's alpha coefficient=0.89) were satisfactory. We did not observe any significant differences between the two groups in terms of the psychometric test results. The G-MAP scores demonstrated that the two groups were confronted with the same limitations in self care, domestic life, leisure and community life (i.e., the intergroup differences were not statistically significant in Mann-Whitney tests). However, interpersonal relationships and economic and social productivity appeared to be more severely limited in the SD group than in the TBI group. Similarly, participation restrictions in domestic life, interpersonal relationships and economic and social productivity were more severe in the SD group than in the TBI group. CONCLUSION: G-MAP is a useful, feasible, relevant tool for performing a detailed, individualized assessment of participation restrictions in people with psychiatric and/or cognitive disabilities.

[Characteristics and impact of metacognitive deficits in schizophrenia]. / Caractéristiques et impact des déficits métacognitifs dans la schizophrénie. Revue de la littérature.

OBJECTIVES: The aim of this review of the literature is to summarise the definitions of metacognition, the measurement tools, the results of studies investigating metacognition in persons with schizophrenia and the therapeutic perspectives. METHOD: This review is based upon a selection of articles identified using a PubMed search containing the terms "schizophrenia" and "metacognition". RESULTS: Cognitive deficits are present in 75 to 85% of persons with schizophrenia. According to the disability model of the World Health Organization, these cognitive deficits have an impact on social functioning, community integration and quality of life. However, heterogeneous results have been obtained by studies exploring the functional impact of cognitive deficits, suggesting that there is no direct relationship between these two characteristics. One possible explanation is that subjective factors, notably metacognition, may play an intermediate role moderating the link between cognitive deficits and functional impairment. Metacognition is defined as the evaluation and regulation of its own cognitive processes. The evaluation (or monitoring) monitors the accuracy and reliability of the cognitive task performance. Regulation (or control) promotes behavioural adjustment. Studies carried out in persons with schizophrenia show that most of them experience deficits in metacognitive performance. These metacognitive deficits are thought to be a key barrier to functioning in schizophrenia. Measurement tools are classified into two types: "independent" measurement of the cognitive task and "on line" measurements performed during the cognitive task. The subjective scale to investigate cognition in schizophrenia (SSTIC) and the metacognitive assessment scale (MAS) are two examples of questionnaires measuring metacognition independently of the cognitive task. Online measurements assess the metacognitive "monitoring" by asking the subject to evaluate between 0 and 100% of his/her degree of confidence in his/her response to a question. The metacognitive "control" is assessed by asking the subject to validate his/her answer. Convergent findings are reported by studies exploring metacognitive persons in people with schizophrenia. Dissociation between metacognitive monitoring and metacognitive control has been reported. Regarding metamemory, which has been currently the most studied area, no difference is observed between persons with schizophrenia and controls with respect to the metamemory judgement. However, subgroups of persons with schizophrenia differ significantly from controls: they are over-confident in their response if it is incorrect and they estimate more frequently than the controls if they do not know when their answer is correct. The relationships between metacognitive and cognitive deficits are complex in persons with schizophrenia, with poor matching between subjective and objective deficits. Several studies have reported that metacognitive difficulties strongly interfere with social functioning. It has been suggested that metacognitive deficits more strongly predict community functioning in persons with schizophrenia than cognitive deficits. Metacognitive skills may hence be viewed as a key factor in translating cognitive performance skills in daily life. CONCLUSION: These data suggest that remediation programs specifically targeting metacognitive deficits have to be further developed.

[Cognitive predictors of the community functioning dimensions in schizophrenia: state of the art and future directions]. / Prédicteurs cognitifs des différentes dimensions du fonctionnement dans la communauté dans la schizophrénie: revue de la littérature et perspectives.

INTRODUCTION: Despite progress in antipsychotic medication, psychosocial functioning limitations remain a major source of disability in schizophrenia. For this purpose, rehabilitation programs, aimed at enhancing community functioning, are currently developed. An important question raised by rehabilitation programs is to identify clinical predictors of psychosocial functioning which could in turn be targets of intervention. LITERATURE FINDINGS: It has been suggested that a greater part of the variance in community functioning may be explained by cognitive functioning rather than by symptoms. Moreover, cognitive factors predict community functioning improvement over time. However, community functioning is a multidimensional construct and little is known about the specificity of associations between community functioning dimensions and cognitive factors. Recent studies suggest that functions like memory and executive processes are particularly associated with instrumental and social dimensions of community functioning. Memory processes are associated with both dimensions, whereas executive processes are more related to instrumental aspects of functioning. They could be specifically targeted in interventions aimed at enhancing functioning in those particular dimensions. However, these associations need to be further explored. DISCUSSION: A lot of methodological and theoretical difficulties limit the possibility to compare studies and to draw clinically useful information. Theoretical models of disability could help in better defining particular community abilities, their level of complexity and the way they could be related to specific cognitive factors. Future results will provide relevant information for enhancing the usefulness of cognitive evaluation, as well as improving the efficiency of rehabilitation programs.

Antibodies to Neospora caninum in wild animals from Kenya, East Africa.

The prevalence of antibodies to Neospora caninum was examined in six wild Artiodactyla species, and in five wild Carnivora species from Kenya. Blood sera (104 wild ungulates from Marula Estates (MEs), and 31 wild carnivores from Masai-Mara reserve and from other wildlife areas in northern and Southern Kenya), were screened using a Neospora agglutination test (NAT), with a twofold dilution (1:40-1:320 titres). Presence of NAT antibodies to N. caninun is reported here for the first time in zebra (Equus burchelli), eland (Taurotragus oryx), African buffalo (Syncerus caffer), Thompson gazelle (Gazella thompsoni), impala (Aepyceros melampus), warthog (Phacochoerus aethiopicus), spotted hyena (Crocuta crocuta) and in free-ranging cheetah (Acinonyx jubatus). At 1:80 dilution, prevalence was 61.5% in eland, 58.5% in zebra, 19.2% in Thompson gazelle, 33.3% in warthog, 50% in African buffalo, 30% in lion (Panthera leo), 20% in cheetah, and 33.3% in spotted hyena. Antibodies up to 1:320 titre were detected in eland (38.4%), zebra (19.5%), Thompson gazelle (3.8%) and lion (5%). Amongst herbivores, sero-prevalence was significantly (P<0.05) higher, at all dilutions, in "grazer/digger" species (e.g. eland and zebra) than in non-"grazer/digger" species (e.g. impala and Thompson gazelle). No antibodies to N. caninum were found in two leopards (Panthera pardus) and one serval (Felis serval). Our results indicates a steady presence of N. caninum in wild mammals from Kenya. The hypothesis of a sylvatic cycle of N. caninum could be suggested, but more data are needed to verify the hypothesis, as to evaluate the role of N. caninum infection on the dynamics of wild animals population in the study area.