Impaired explicit self-awareness but preserved behavioral regulation in patients with Alzheimer disease

Abstract

Objectives

Impairments of metacognitive skills represent a critical symptom in Alzheimer Disease (AD) because it frequently results in a lack of self-awareness. However, recent findings suggest that, despite an inability to explicitly estimate their own cognitive functioning, patients might demonstrate some implicit recognition of difficulties. In this study, we tested whether a behavioral dissociation between explicit and implicit measures of metacognition can be found in both healthy older controls (n = 20) and AD patients (n = 20).

Methods

Our two groups of participants (AD vs. Controls) were asked to complete a forced-choice perceptual identification test and to explicitly rate their confidence in each decision (i.e. explicit measure of metacognition). Moreover, they also had the opportunity to ask for a cue to help them decide if their response was correct (i.e. implicit measure of metacognition).

Results

Data revealed that all participants asked for a cue more often after an incorrect response than after a correct response in the forced-choice identification test, indicating a good ability to implicitly introspect on the results of their cognitive operations. On the contrary, only healthy participants displayed metacognitive sensitivity when making explicit confidence judgments.

Conclusion

Our findings suggest that implicit metacognition may be less affected than explicit metacognition in Alzheimer’s disease.

Keywords:

• Alzheimer disease
• metacognition
• monitoring
• self-awareness

Disclosure statement

We have no conflict of interest to declare.

Additional information

Funding

This research was supported by a grant from the National Fund for Scientific Research (NFSR).