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Articles

Subjective cognitive assessments and N-back are not correlated, and they are differentially affected by anxiety and depression

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Pages 591-601 | Published online: 10 Sep 2021
 

Abstract

Cognitive function (CF) is a core feature related to all psychiatric disorders. However, self-report scales of CF (SRSC) may not always correlate with CF’s objective measures and may have different mediators. Tools to select for evaluating CF in diverse psychiatric populations and their determinants need to be studied. In this study, we aimed to assess the association of SRSC (Perceived Deficit Questionnaire-Depression (PDQ-D), and World Health Organization’s Adult Attention Deficit Hyperactivity Disorder Self-Report Scale (ASRS) and its inattentiveness subscale) with Letter-N-back as an objective measure of CF, and to analyze their association with psychopathology. Two hundred nine (131 nonclinical, and 78 clinical with a psychiatric diagnosis of ICD10 F31-39 [mood disorders excluding Bipolar I] or F40-F49 [neurotic, stress-related or psychosomatic disorder] categories) participants were evaluated with PDQ-D, ASRS, Beck Depression Inventory (BDI), and Beck’s Anxiety Inventory (BAI), and N-back. Both groups’ data were included in the analysis. PDQ-D showed a small correlation with N-back scores, whereas ASRS showed no correlation. PDQ-D and ASRS showed a large correlation. Age and BAI scores significantly predicted both PDQ-D and ASRS, whereas the cognitive subscale of BDI predicted PDQ-D, but not ASRS. Only BAI scores predicted N-back results. The mediation model revealed that 2-back scores of N-back task directly affects PDQ-D scores, independent of BDI scores. However, the cognitive subscale of BDI moderated 2-back and PDQ-D association. On the contrary, BAI scores significantly mediated the association of 2-back scores with PDQ-D. The direct effect of 2-back scores in PDQ-D was insignificant in the mediation of BAI scores. Our study validates the discordance between SRSC and an objective measurement of CF. Anxiety may affect both self-report and objective measurement of CF, whereas depressive thought content may lead to higher cognitive dysfunction reports in nondemented participants.

Acknowledgments

The authors gratefully acknowledge the use of the services and facilities of the Koç University Research Center for Translational Medicine (KUTTAM), funded by the Republic of Turkey Ministry of Development. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Ministry of Development.

We would also like to thank Elif Ozdogan, Ilay Caliskan, Fatma Ezgi Ogulmus, Begum Naz Gungil, Ayse Varol, Aziz Yepren, and Merve Tan who helped to assess participants. We would also thank all our patients and participants who contributed to the study.

Author contributions

H. Yapici-Eser, M. Yalcinay-Inan, and O. Aydemir designed the study. HYE, OK, and ACE conducted the clinical evaluations and psychiatric diagnosis. MUK, CMK, SY, and ND contributed to data collection and data entry. SY organized N-back scores. Statistical analysis has been conducted by H. Yapici-Eser and M. Yalcinay-Inan. O. Aydemir supervised the study. H. Yapici-Eser wrote the manuscript. All authors read, contributed, and agreed on the final version of the manuscript.

Disclosure statement

Authors have no declaration of interest.

Data availability statement

Data is available upon request.

Additional information

Funding

H. Yapıcı Eser's studies are partly supported by the Science Academy.

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