Trial Report Perceived cognitive impairment is related to internalizing psychopathology but unrelated to objective cognitive performance, etc., 2023, Finley et al

https://www.tandfonline.com/doi/abs/10.1080/13854046.2023.2241190

Perceived cognitive impairment is related to internalizing psychopathology but unrelated to objective cognitive performance among nongeriatric adults presenting for outpatient neuropsychological evaluation
John-Christopher A. Finley
Andrea Cladek
Christopher Gonzalez
&
Michael Brook
Received 14 Mar 2023, Accepted 20 Jul 2023, Published online: 30 Jul 2023

• Abstract

Objective:

This study investigated the relationship between perceived cognitive impairment, objective cognitive performance, and intrapersonal variables thought to influence ratings of perceived cognitive impairment.

Method:

Study sample comprised 194 nongeriatric adults who were seen in a general outpatient neuropsychology clinic for a variety of referral questions. The cognition subscale score from the WHO Disability Assessment Schedule served as the measure of perceived cognitive impairment. Objective cognitive performance was indexed via a composite score derived from a comprehensive neuropsychological battery. Internalizing psychopathology was indexed via a composite score derived from anxiety and depression measures. Medical and neuropsychiatric comorbidities were indexed by the number of different ICD diagnostic categories documented in medical records. Demographics included age, sex, race, and years of education.

Results:

Objective cognitive performance was unrelated to subjective concerns, explaining <1% of the variance in perceived cognitive impairment ratings. Conversely, internalizing psychopathology was significantly predictive, explaining nearly one-third of the variance in perceived cognitive impairment ratings, even after accounting for test performance, demographics, and number of comorbidities. Internalizing psychopathology was also highly associated with a greater discrepancy between scores on perceived and objective cognitive measures among participants with greater cognitive concerns. Clinically significant somatic symptoms uniquely contributed to the explained variance in perceived cognitive impairment (by ∼13%) when analyzed in a model with internalizing symptoms.

Conclusions:

These findings suggest that perceived cognitive impairment may be more indicative of the extent of internalizing psychopathology and somatic concerns than cognitive ability.

 

Or, maybe, the patients actually have objective cognitive impairment your tests are not capable of measuring, and being denied and mocked by doctors is reflected in the anxiety and depression scores. Or alternatively, those scores reflect symptoms of organic illness (you know, the same illness giving the cognitive impairment) which you arbitrarily decided to interpret as psychosocial distress.

 

This testing is just a snap shot.

IME it takes being with someone for several hours to days to see cognitive problems.To note deficit patterns. To keep track of the number of times there are cognitive slip-ups. Plus, people can be very good at hiding their cognitive failings.

Some practitioners seem loathe to order MRI brain scans for their clients. Maybe if they did, results indicating neurological conditions might upend their applecart.

 

Internalizing Psychopathology - its place in the hierarchy (yes seriously) but it's fine there's a nice chart: Hierarchical Taxonomy of Psychopathology

"The internalizing spectrum comprises maladaptive traits of emotional lability, anxiousness, separation insecurity, submissiveness, perseveration, and anhedonia, as well as symptom dimensions characteristic of distress, fear, eating problems, and sexual problems; also symptom dimensions of mania are linked to this spectrum provisionally. The internalizing spectrum includes some signs and symptoms of such disorders as major depressive disorder, dysthymia, generalized anxiety disorder, posttraumatic stress disorder, borderline personality disorder, agoraphobia, obsessive-compulsive disorder, panic disorder, social anxiety disorder, specific phobias, anorexia nervosa, binge eating disorder, bulimia nervosa, sexual problems such as arousal difficulties, low desire, orgasmic dysfunction, and sexual pain, and provisionally bipolar disorders."

 

Oh hell no. A relative has bipolar disorder, and she feels like her mood fluctuations are more related to some sort of neurological effect than "internalizing."

 

SO true! People with dementia can often hide it for it a long time.

 

Medicine is the only discipline where they will see their tests fail and be unable to think that it's their tests that are obviously inadequate. Do they really actually think that they have all the objective tests for all the things? They clearly know better, so why do they pretend here?

Ridiculous.