Impaired Metacognition of Voluntary Movement in Functional Movement Disorder

Abstract

A BS TRACT: Background: Motor symptoms in functional movement disorders (FMDs) are experienced as involuntary but share characteristics of voluntary action. Clinical and experimental evidence indicate alterations in monitoring, control, and subjective experience of selfperformed movements. Objective: The objective of this study was to test the prediction that FMDs are associated with a reduced ability to make accurate (metacognitive) judgments about self-performed movements. Methods: We compared 24 patients with FMD (including functional gait disturbance, functional tremor, and functional tics) with 24 age-and sex-matched healthy control subjects in a novel visuomotor-metacognitive paradigm. Participants performed target-directed movements on a graphics tablet with restricted visual feedback, decided which of two visually presented trajectories was closer to their preceding movement, and reported their confidence in the visuomotor decision. We quantified individual metacognitive performance as participants' ability to assign high confidence preferentially to correct visuomotor decisions.Results: Patients and control subjects showed comparable motor performance, response accuracy, and use of the confidence scale. However, visuomotor sensitivity in the trajectory judgment was reduced in patients with FMD compared with healthy control subjects. Moreover, metacognitive performance was impaired in patients, that is, their confidence ratings were less predictive of the correctness of visuomotor decisions. Exploratory subgroup analyses suggest metacognitive deficits to be most pronounced in patients with a functional gait disturbance or functional tremor. Conclusions: Patients with FMD exhibited deficits both when making visuomotor decisions about their own movements and in the metacognitive evaluation of these decisions. Reduced metacognitive insight into voluntary motor control may play a role in FMD pathophysiology and could lay the groundwork for new treatment strategies.

Postural motion perception during vestibular stimulation depends on the motion perception threshold in persistent postural-perceptual dizziness

“…The reproduction task not only reflects normal metacognitive judgement of their own posture during GVS (normal posture-perceptual scaling) but also indicates normal perceptual-motor transformation in our patients. Impaired metacognitive performance (judgement about self-performed movements) and reduced confidence of the correctness of visuomotor decisions have been proposed to underlie functional movement disorders [55].…”

Pathophysiologie funktioneller Bewegungsstörungen

“…Passend dazu zeigten insbesondere Patienten mit einer funktionellen Gangstörung oder einem Tremor eine geringere visuomotorische Sensitivität und reduzierte metakognitive Fähigkeiten in einem Experiment, in dem sie eine selbst generierte, zielgerichtete Handbewegung mit eingeschränkter visuomoto-rischen Kontrolle durchführen sollten, bei der sowohl das Endziel als auch die Trajektorien verändert wurden. Das bedeutet, dass sie ein Defizit in visuomotorischen Entscheidungen ihrer Bewegung und der metakognitiven Einschätzung haben; ein Umstand, den man sich therapeutisch zunutze machen kann [27].…”

Objective and subjective neurocognitive functioning in functional motor symptoms and functional seizures: preliminary findings

“…Discrepancies between subjective and objective measures of neurocognitive performance have also been reported, indicating that individuals with FND might underestimate their own abilities and performance, both in FS (Breier et al, 1998 ; Fargo et al, 2004 ; Prigatano & Kirlin, 2009 ) and FCD (Bhome et al, 2022 ; McWhirter, Ritchie et al, 2022 ; Pennington, Hayre, Newson, & Coulthard, 2015 ; Teodoro et al, 2023 ). However, empirical evidence on local and global metacognition in FND is preliminary and there have been mixed findings in FMS (Bègue et al, 2018 ; Matthews et al, 2020 : Verrel et al, 2023 ) and FCD (Pennington et al, 2021 ; Teodoro et al, 2023 ), with a lack of focused metacognitive studies in FS. In addition, frequent cognitive complaints and poor concordance between objective and subjective neurocognitive functioning have also been observed in healthy adults (e.g., Burmester et al, 2016 ; Crumley et al, 2014 ; McWhirter, King et al, 2022 ).…”