Neurocognitive insight and objective cognitive functioning in schizophrenia

Abstract

Neurocognitive impairment is a core component of schizophrenia affecting everyday functioning; the extent to which individuals with schizophrenia show awareness of neurocognitive impairment (neurocognitive insight) is unclear. This study investigated neurocognitive insight and examined the cross-sectional relationships between neurocognitive insight and objective neurocognition and functional capacity performance in a large outpatient sample. 214 participants with schizophrenia-spectrum disorders completed measures of neurocognition, functional capacity, and self-reported neurocognitive problems. Latent profile analysis classified participants with regard to neuropsychological performance and self-report of neurocognitive problems. The resulting classes were then compared on executive functioning performance, functional capacity performance, and psychiatric symptom severity. More than three quarters of the sample demonstrated objective neurocognitive impairment (global deficit score ≥ 0.50). Among the participants with neurocognitive impairment, 54% were classified as having “impaired” neurocognitive insight (i.e., reporting few neurocognitive problems despite having objective neurocognitive impairment). Participants with impaired vs. intact neurocognitive insight did not differ on executive functioning measures or measures of functional capacity or negative symptom severity, but those with intact neurocognitive insight reported higher levels of positive and depressive symptoms. A substantial portion of individuals with schizophrenia and objectively measured neurocognitive dysfunction appear unaware of their deficits. Patient self-report of neurocognitive problems, therefore, is not likely to reliably assess neurocognition. Difficulty self-identifying neurocognitive impairment appears to be unrelated to executive functioning, negative symptoms, and functional capacity. For those with intact neurocognitive insight, improving depressive and psychotic symptoms may be a valuable target to reduce illness burden.

A Transnosographic Self-Assessment of Social Cognitive Impairments (ACSO): First Data

“…These results are consistent with recent studies focusing on "neurocognitive insight" in schizophrenia, i.e. awareness into cognitive deficits (42–48). These studies reported indeed that the lack of insight on psychiatric symptoms (49) could be extended to cognitive impairments.…”

Self-Awareness Deficits of Cognitive Impairment in Individuals With Schizophrenia. Really?

“…negative symptoms), and cognitive complaint in the clinical group. Regarding psychoaffective factors this is in accordance with some (20,21,26,34) but not all studies on this subject (35,36) in schizophrenia. In our study, and similarly to the study of Bayard et al (26) we used the Beck depression Inventory 2 which is a self-rated measure of depression whereas Potvin et al (36) for example used the Calgary Depression Scale for Schizophrenia which consist on a semi-structured interview (37).…”

“…negative symptoms), and cognitive complaint in the clinical group. Regarding psychoaffective factors this is in accordance with some ( 20 , 21 , 26 , 34 ) but not all studies on this subject ( 35 , 36 ) in schizophrenia. In our study, and similarly to the study of Bayard et al.…”

“…Several findings emerged from this meta-analysis and can be summarized as follows: 1) individuals with schizophrenia reported higher cognitive complaints than nonclinical controls; 2) modest associations between measures of objective and subjective cognition were found (the higher for problem-solving domain) 3) these relationships were higher when the study used the SSTICS to measure self-reported cognitive functioning in comparison with other scales, and 4) a weak association was found between depressive symptoms and cognitive complaint. Interestingly, several studies have been published after this meta-analysis, reporting as a whole similar results (19)(20)(21)(22). However, and surprisingly, none of these studies about metacognitive awareness of cognitive functioning in schizophrenia examined and compared correlations between measures of objective and subjective cognition in a comparison group of non-clinical controls.…”

Cognitive Impairment in Schizophrenia: Description and Cognitive Familiar Endophenotypes. A Review of the Literature

“…Those who are better aware of their deficits are not associated with a lower use of treatment, nor with a lesser deterioration of executive function. But they do have better results in the rehabilitation of some cognitive domains, in adherence to treatment and in their functional capacity [41,42].…”