Assessment of impaired self-awareness after moderate-to-severe traumatic brain injury: a comparison of assessment tools

ABSTRACT

Objective

To compare different assessment methods of impaired self-awareness (ISA).

Methods

We included 37 patients with moderate-to-severe traumatic brain injury (TBI) at a subacute/chronic stage, and 33 healthy controls. ISA was assessed with three methods: discrepancy scores (comparison between patient and proxy ratings) on three scales (Patient Competency Rating Scale (PCRS), Awareness Questionnaire (AQ) and Dysexecutive Questionnaire (DEX)); clinician rating with the Self-Awareness of Deficits Interview (SADI); and the difference between prediction or estimation of performance and actual performance on two cognitive tasks.

Results

Clinician–patient discrepancy scores appeared more sensitive than relative–patient discrepancy. The AQ was the most sensitive. The discrepancy scores were strongly correlated one with each other. Correlations with the SADI were weaker. Patients did not overestimate their performance on cognitive tasks, and the prediction did not significantly correlate with other measures of ISA.

Discussion/conclusion

Results support the multidimensional nature of ISA: discrepancy scores assess meta-cognitive knowledge (understanding that a function/skill is affected), while the SADI takes into account anticipatory awareness (ability to set realistic goals) and estimation of performance assesses anticipatory and situational awareness. Assessment of these different domains may provide a comprehensive overview of an individual’s self-awareness.

KEYWORDS:

• Traumatic brain injury
• self-awareness
• anosognosia
• cognition
• Neuropsychological Assessment

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The work was supported by the Fondation des Gueules Cassées [33-2017].