Abstract Functional cognitive disorder is common but underlying mechanisms remain poorly understood. Metacognition, an individual’s ability to reflect on and monitor cognitive processes, is likely to be relevant. Local metacognition refers to an ability to estimate confidence in cognitive performance on a moment-to-moment basis, whereas global metacognition refers to long-run self-evaluations of overall performance. Using a novel protocol comprising task-based measures and hierarchical Bayesian modelling, we compared local and global metacognitive performance in individuals with functional cognitive disorder. Eighteen participants with functional cognitive disorder (mean age = 49.2 years, 10 males) were recruited to this cross-sectional study. Participants completed computerized tasks that enabled local metacognitive efficiency for perception and memory to be measured using the hierarchical meta-d’ model within a signal detection theory framework. Participants also completed the Multifactorial Memory Questionnaire measuring global metacognition, and questionnaires measuring anxiety and depression. Estimates of local metacognitive efficiency were compared with those estimated from two control groups who had undergone comparable metacognitive tasks. Global metacognition scores were compared with the existing normative data. A hierarchical regression model was used to evaluate associations between global metacognition, depression and anxiety and local metacognitive efficiency, whilst simple linear regressions were used to evaluate whether affective symptomatology and local metacognitive confidence were associated with global metacognition. Participants with functional cognitive disorder had intact local metacognition for perception and memory when compared with controls, with the 95% highest density intervals for metacognitive efficiency overlapping with the two control groups in both cognitive domains. Functional cognitive disorder participants had significantly lower global metacognition scores compared with normative data; Multifactorial Memory Questionnaire-Ability subscale (t = 6.54, P < 0.0001) and Multifactorial Memory Questionnaire-Satisfaction subscale (t = 5.04, P < 0.0001). Mood scores, global metacognitive measures and metacognitive bias were not significantly associated with local metacognitive efficiency. Local metacognitive bias [β = −0.20 (SE = 0.09), q = 0.01] and higher depression scores as measured by the Patient Health Questionnaire-9 [β = −1.40 (SE = 2.56), q = 0.01] were associated with the lower global metacognition scores. We show that local metacognition is intact, whilst global metacognition is impaired, in functional cognitive disorder, suggesting a decoupling between the two metacognitive processes. In a Bayesian model, an aberrant prior (impaired global metacognition), may override bottom-up sensory input (intact local metacognition), giving rise to the subjective experience of abnormal cognitive processing. Future work should further investigate the interplay between local and global metacognition in functional cognitive disorder. Open access, https://academic.oup.com/braincomms/article/4/2/fcac041/6534476
Functional in the context of cognition makes even less sense, though. Until every single neural process is mapped, exhaustively, all cognitive impairments are essentially functional.
I have not put a lot of (any) effort into understanding this, but are the researchers claiming that their subjects don’t have real cognitive issues because they have demonstrated they do have cognitive issues.
This is kind of study is meaningless - they are saying people with "Functional" cognitive disorders rate their cognitive performance worse than it actually is on vague questionnaires, but more accurate on a moment to moment basis. Instead of concluding that the questionnaire answering behaviour is easily biased and so such questionnaires are not reliable, they instead make up some Bayesian nonsense. This persistent "aberrant prior" has no mechanistic basis and Bayesian models would be expected to quickly correct due to repeated iterations of the more accurate local assessment of ability. They are confusing low quality questionnaire responses with perceptual processes "metacognition". They are not the same thing. Patients are likely comparing to their pre-morbid ability and since this study was not prospective, the study can not pass judgement about whether this bias in answering questionnaires is valid or not. They compared FCD to healthy controls, which is completely inadequate - we need prospective studies of FCD compared to recognized diseases that cause cognitive disorder - only then can anyone conclude that there is a 'global metacognitive' bias that is specific to FCD patients. The MMQ is in the appendix of the following study: https://www.baycrest.org/Baycrest_Centre/media/content/form_files/MMQ-Manual-2018_ebook.pdf
Metacognition in functional cognitive disorder: contradictory or convergent experimental results?, 2022, Larner "It has previously been hypothesized that functional cognitive disorders (FCDs), at least in some instances, may be a consequence of disordered metacognitive processes.1,2 Hence the recent article by Bhome et al.3 in Brain Communications, which presented evidence supporting this hypothesis, was of great interest. However, Pennington et al.4 had previously reported that they ‘did not find metacognitive deficits in groups of well characterized patients with FCD’, a study finding not discussed by Bhome et al. This former report may thus potentially jeopardise proposed Bayesian and metacognitive models of FCD.2,5 How are these apparently contradictory findings to be explained, or possibly reconciled?" Open access, https://academic.oup.com/braincomms/article/4/3/fcac138/6593938 Response to: Metacognition in functional cognitive disorder: contradictory or convergent experimental results?, 2022, Bhome et al "Dr Larner1 highlights the findings of a recent paper by Pennington et al.2 in which the authors ‘did not find metacognitive deficits in groups of well-characterized patients with functional cognitive disorder (FCD)’ and suggests that this is both contradictory to our findings and places our proposed Bayesian account in jeopardy.3 In fact (as Dr Larner later admits), the findings from the two studies are convergent. In both our3 and Pennington et al.’s2 studies, local metacognition—the extent to which trial by trial ratings of confidence covary with task performance—was measured in people with FCD. In both studies, across both perceptual and memory tasks, local metacognitive efficiency (meta-d’/d’) was unimpaired relative to controls. As Dr Larner points out, it is difficult to place too much reliability on null results with small samples, which might reflect a consequence of Type 2 errors. Replication of intact local metacognition in FCD across two distinct samples is therefore noteworthy, and we were pleased to see Pennington et al.’s data.2" Open access, https://academic.oup.com/braincomms/article/4/3/fcac139/6591903
I don't even get the concept of functional cognitive disorder. What does it mean? Is functional here meaning non-organic? I mean, how would anyone know?
Fungible neurological disorder. It can mean anything and everything. And just as real and useful as NFTs.
They are saying that the thing they measured by questionnaire only ('global meta' and then for some reason questionnaires on anxiety and depression too) 'influenced' 'prior' the actual cognition performance as that level didn't correlate with controls/norms, so it must have been their 'confidence that they wouldn't do well' before they did the test causing not doing well. But when they measured metacognition locally, on a task basis, using different measuring techniques it was unimpaired ie accurate predictor of how they were about to do on each task, so couldn't be the cause of poor cognition. I'd be intrigued as to whether they ever averaged up those predictions and compares to global prediction to see if that was actually accurate and consistent. Or if they compared the predicted global performance to the actual overal cognitive score. Because the methodology doesn't make it clear they did that - it sounds like they just compared the predictions to norms, then compared the performance to norms - on that overall global score - and claim the performance was low because they thought it would be? If this is actually the case - am I missing something here?? - the obvious conclusion is that FCD has nothing to do with confidence and that those with FCD have accurate metacognition - unless you use dodgy global questionnaires and never compare whether their metacog estimates were accurate of their cognitive performance (like the local method required) But instead the authors have concocted something v strange claiming the questionnaire method one which they didn't compare to performance must be 'where the confidence issue is' and that they've discovered and isolated specifics in the (fake?) illness? It's like asking 2 groups of 10 people if they are a fast runner by questionnaire - ave the estimated speed they suggest they could run across each group A and B and then noting 'group A is less confident of running fast'. Then getting both groups to do 10 x 100m, asking them to estimate how fast they will run before - and for each sprint the difference between predicted and actual speed is calculated. Note both groups are as accurate as each other at saying how fast they will run. Then looking at the ave speed for all runs for each group. Group A was slower than Group B. And saying they must have been slower because they were less confident. Even though it isn't really 'confidence' if it is 'accurate' is it? I'm confused.. does anyone see where they compared their global questionnaire metacognition measure individually (rather than group ave) to performance and used the term 'accurate'? Or if their global metacognition was less than their local metacognition guess?
