Awareness of cognitive abilities in the execution of activities of daily living after acquired brain injury: an evaluation protocol

Jose Antonio Merchán-Baeza, Maria Rodriguez-Bailon, Giorgia Ricchetti, Alba Navarro-Egido, María Jesús Funes, Jose Antonio Merchán-Baeza, Maria Rodriguez-Bailon, Giorgia Ricchetti, Alba Navarro-Egido, María Jesús Funes

Abstract

Introduction: One of the main limitations that can be observed after acquired brain injury (ABI) is the alteration of the awareness of the deficits that can occur in the cognitive skills necessary for performing activities of daily living (ADL). According to the Dynamic Comprehensive Model of Awareness (DCMA), consciousness is composed of offline component, which contains the information stored about characteristics of the tasks and stable beliefs about one's own capabilities and online awareness, which is activated in the context of the performance of a specific task. The main objective of this project was to generate and validate a detailed cognitive assessment protocol within the context of ADL to evaluate the components of DCMA.

Methods and analysis: The proposed protocol consists of two ecological tools: The Cog-Awareness ADL Scale to measure offline component and the Awareness ADL-task: Basic and Instrumental ADL performance-based test to measure online awareness. The aim is to identify the presence of cognitive deficits and anosognosia in patients with ABI within the context of everyday life activities. These two measures will be administered to a group of patients with ABI. In addition, these participants will complete another series of classic tests on anosognosia and cognitive functions in order to find the convergent validity of the two tests proposed in this protocol. The external validity of the Cog-Awareness ADL Scale and the relationships between awareness components within the same ADL domain will be also analysed.

Ethics and dissemination: This study was approved by the Ethics Committee of Biomedical Research of Andalusia, on 13 January /2017 (Proceeding 1/2017). All participants are required to provide written informed consent. The findings from this will be disseminated via scientific publication.

Trial registration number: NCT03712839.

Keywords: adult neurology; neurological injury; stroke.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Possible presentation of the different objects in each of the awareness ADL: Orange juice with butter and jam and upper dress task. ADL, activities of daily living.

References

    1. Prigatano GP, Bruna O, Mataro M, et al. . Initial disturbances of consciousness and resultant impaired awareness in Spanish patients with traumatic brain injury. J Head Trauma Rehabil 1998;13:29–38. 10.1097/00001199-199810000-00005
    1. Fischer S, Gauggel S, Trexler LE. Awareness of activity limitations, goal setting and rehabilitation outcome in patients with brain injuries. Brain Inj 2004;18:547–62. 10.1080/02699050310001645793
    1. Hartman-Maeir A, Soroker N, Katz N. Anosognosia for hemiplegia in stroke rehabilitation. Neurorehabil Neural Repair 2001;15:213–22. 10.1177/154596830101500309
    1. Hartman-Maeir A, Soroker N, Oman SD, et al. . Awareness of disabilities in stroke rehabilitation--a clinical trial. Disabil Rehabil 2003;25:35–44. 10.1080/0963828021000007897
    1. Flavell JH. Metacognition and cognitive monitoring: a new area of cognitive-developmental inquiry. Am Psychol 1979;34:906–11. 10.1037/0003-066X.34.10.906
    1. Nelson TO. Metamemory: a theoretical framework and new findings. 26 Academic Press, 1990.
    1. Crosson B, Barco PP, Velozo CA, et al. . Awareness and compensation in postacute head injury rehabilitation. J Head Trauma Rehabil 1989;4:46–54. 10.1097/00001199-198909000-00008
    1. Agnew SK, Morris RG. The heterogeneity of anosognosia for memory impairment in Alzheimer’s disease: a review of the literature and a proposed model. Aging Ment Health 1998;2:7–19. 10.1080/13607869856876
    1. Toglia J, Kirk U. Understanding awareness deficits following brain injury. NeuroRehabilitation 2000;15:57–70. 10.3233/NRE-2000-15104
    1. Dockree PM, Tarleton YM, Carton S, et al. . Connecting Self-Awareness and Error-Awareness in patients with traumatic brain injury. J Int Neuropsychol Soc 2015;21:473–82. 10.1017/S1355617715000594
    1. Robertson K, Schmitter-Edgecombe M. Self-awareness and traumatic brain injury outcome. Brain Inj 2015;29:848–58. 10.3109/02699052.2015.1005135
    1. Mograbi DC, Morris RG. Anosognosia. Cortex 2018;103:385–6. 10.1016/j.cortex.2018.04.001
    1. Morris RG, Mograbi DC, Anosognosia MDC. Anosognosia, autobiographical memory and self knowledge in Alzheimer's disease. Cortex 2013;49:1553–65. 10.1016/j.cortex.2012.09.006
    1. Mograbi DC, Brown RG, Morris RG. Anosognosia in Alzheimer’s disease-the petrified self. Conscious Cogn 2009;18:989–1003. 10.1016/j.concog.2009.07.005
    1. O'Keeffe F, Dockree P, Moloney P, et al. . Awareness of deficits in traumatic brain injury: a multidimensional approach to assessing metacognitive knowledge and online-awareness. J Int Neuropsychol Soc 2007;13:38–49. 10.1017/S1355617707070075
    1. Al Banna M, Redha NA, Abdulla F, et al. . Metacognitive function poststroke: a review of definition and assessment. J Neurol Neurosurg Psychiatry 2016;87:161–6. 10.1136/jnnp-2015-310305
    1. Harty S, O'Connell RG, Hester R, et al. . Older adults have diminished awareness of errors in the laboratory and daily life. Psychol Aging 2013;28:1032–41. 10.1037/a0033567
    1. Fitzgerald LM, Arvaneh M, Dockree PM. Domain-specific and domain-general processes underlying metacognitive judgments. Conscious Cogn 2017;49:264–77. 10.1016/j.concog.2017.01.011
    1. Hurst FG, Ownsworth T, Beadle E, et al. . Domain-specific deficits in self-awareness and relationship to psychosocial outcomes after severe traumatic brain injury. Disabil Rehabil 2018:1–9.
    1. Hart JT. Memory and the feeling-of-knowing experience. J Educ Psychol 1965;56:208–16. 10.1037/h0022263
    1. Duke LM, Seltzer B, Seltzer JE, et al. . Cognitive components of deficit awareness in Alzheimer’s disease. Neuropsychology 2002;16:359–69. 10.1037/0894-4105.16.3.359
    1. Rosen HJ, Alcantar O, Rothlind J, et al. . Neuroanatomical correlates of cognitive self-appraisal in neurodegenerative disease. Neuroimage 2010;49:3358–64. 10.1016/j.neuroimage.2009.11.041
    1. Sunderaraman P, Cosentino S. Integrating the constructs of anosognosia and Metacognition: a review of recent findings in dementia. Curr Neurol Neurosci Rep 2017;17:27. 10.1007/s11910-017-0734-1
    1. Fleming SM, Ryu J, Golfinos JG, et al. . Domain-specific impairment in metacognitive accuracy following anterior prefrontal lesions. Brain 2014;137:2811–22. 10.1093/brain/awu221
    1. Chiou KS, Carlson RA, Arnett PA, et al. . Metacognitive monitoring in moderate and severe traumatic brain injury. J Int Neuropsychol Soc 2011;17:720–31. 10.1017/S1355617711000658
    1. Rotenberg-Shpigelman S, Rosen-Shilo L, Maeir A. Online awareness of functional tasks following ABI: the effect of task experience and associations with underlying mechanisms. NeuroRehabilitation 2014;35:47–56. 10.3233/NRE-141101
    1. Goverover Y, Genova H, Griswold H, et al. . Metacognitive knowledge and online awareness in persons with multiple sclerosis. NeuroRehabilitation 2014;35:315–23. 10.3233/NRE-141113
    1. Chen P, Toglia J. Online and offline awareness deficits: anosognosia for spatial neglect. Rehabil Psychol 2019;64:50–64. 10.1037/rep0000207
    1. Rabbitt PM. Error correction time without external error signals. Nature 1966;212:438. 10.1038/212438a0
    1. McAvinue L, O’Keeffe F, McMackin D, et al. . Impaired sustained attention and error awareness in traumatic brain injury: implications for insight. Neuropsychol Rehabil 2005;15:569–87. 10.1080/09602010443000119
    1. O'Keeffe FM, Dockree PM, Robertson IH. Poor insight in traumatic brain injury mediated by impaired error processing? Evidence from electrodermal activity. Brain Res Cogn Brain Res 2004;22:101–12. 10.1016/j.cogbrainres.2004.07.012
    1. Cosentino S, Brickman AM, Griffith E, et al. . The right insula contributes to memory awareness in cognitively diverse older adults. Neuropsychologia 2015;75:163–9. 10.1016/j.neuropsychologia.2015.05.032
    1. di Pellegrino G, Ciaramelli E, Làdavas E. The regulation of cognitive control following rostral anterior cingulate cortex lesion in humans. J Cogn Neurosci 2007;19:275–86. 10.1162/jocn.2007.19.2.275
    1. Larson MJ, Perlstein WM, Demery JA, et al. . Cognitive control impairments in traumatic brain injury. J Clin Exp Neuropsychol 2006;28:968–86. 10.1080/13803390600646860
    1. Wessel JR, Klein TA, Ott DVM, et al. . Lesions to the prefrontal performance-monitoring network disrupt neural processing and adaptive behaviors after both errors and novelty. Cortex 2014;50:45–54. 10.1016/j.cortex.2013.09.002
    1. Doig E, Fleming J, Ownsworth T, et al. . An occupation-based, metacognitive approach to assessing error performance and online awareness. Aust Occup Ther J 2017;64:137–48. 10.1111/1440-1630.12322
    1. Fleming JM, Strong J, Ashton R. Self-awareness of deficits in adults with traumatic brain injury: how best to measure? Brain Inj 1996;10:1–15. 10.1080/026990596124674
    1. Bettcher BM, Giovannetti T, Macmullen L, et al. . Error detection and correction patterns in dementia: a breakdown of error monitoring processes and their neuropsychological correlates. J Int Neuropsychol Soc 2008;14:199–208. 10.1017/S1355617708080193
    1. Hart T, Giovannetti T, Montgomery MW, et al. . Awareness of errors in naturalistic action after traumatic brain injury. J Head Trauma Rehabil 1998;13:16–28. 10.1097/00001199-199810000-00004
    1. Hendry K, Ownsworth T, Beadle E, et al. . Cognitive deficits underlying error behavior on a naturalistic task after severe traumatic brain injury. Front Behav Neurosci 2016;10:190. 10.3389/fnbeh.2016.00190
    1. Wise K, Ownsworth T, Fleming J. Convergent validity of self-awareness measures and their association with employment outcome in adults following acquired brain injury. Brain Inj 2005;19:765–75. 10.1080/0269905050019977
    1. Schwartz MF, Segal M, Veramonti T, et al. . The naturalistic action test: a standardised assessment for everyday action impairment. Neuropsychol Rehabil 2002;12:311–39. 10.1080/09602010244000084
    1. Giovannetti T, Libon DJ, Hart T. Awareness of naturalistic action errors in dementia. J Int Neuropsychol Soc 2002;8:633–44. 10.1017/S135561770280131X
    1. Bettcher BM, Giovannetti T. From cognitive neuroscience to geriatric neuropsychology: what do current conceptualizations of the action error handling process mean for older adults? Neuropsychol Rev 2009;19:64–84. 10.1007/s11065-009-9081-6
    1. Bettcher BM, Giovannetti T, Klobusicky E, et al. . To err is human, to monitor divine: environmental adaptations reduce everyday errors but do not improve monitoring. J Clin Exp Neuropsychol 2011;33:1049–58. 10.1080/13803395.2011.595395
    1. Kessler RK, Giovannetti T, MacMullen LR. Everyday action in schizophrenia: performance patterns and underlying cognitive mechanisms. Neuropsychology 2007;21:439–47. 10.1037/0894-4105.21.4.439
    1. Rodríguez-Bailón M, Montoro-Membila N, Garcia-Morán T, et al. . Preliminary cognitive scale of basic and instrumental activities of daily living for dementia and mild cognitive impairment. J Clin Exp Neuropsychol 2015;37:339–53. 10.1080/13803395.2015.1013022
    1. Niki C, Maruyama T, Muragaki Y, et al. . Disinhibition of sequential actions following right frontal lobe damage. Cogn Neuropsychol 2009;26:266–85. 10.1080/02643290903028484
    1. Rodríguez-Bailón M, García-Morán T, Montoro-Membila N, et al. . Positive and negative consequences of making coffee among breakfast related irrelevant objects: evidence from MCI, dementia, and healthy ageing. J Int Neuropsychol Soc 2017;23:481–92. 10.1017/S135561771700025X
    1. Bettcher BM, Giovannetti T, Libon DJ, et al. . Improving everyday error detection, one picture at a time: a performance-based study of everyday task training. Neuropsychology 2011;25:771–83. 10.1037/a0024107
    1. Toglia J. Weekly calendar planning activity: a performance test of executive function [online], 2015. Available: [Accessed 30 Nov 2019].
    1. Wilson B, Cockburn J, Halligan P. Development of a behavioral test of visuospatial neglect. Arch Phys Med Rehabil 1987;68:98–102.
    1. Gaertner LHC, Tsur N, Haller CS. Patients’ recovery after severe TBI is associated with their close relatives’ interpersonal functioning: a 12-months prospective cohort study. Brain Inj 2020;34:766–74. 10.1080/02699052.2020.1753241
    1. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–98. 10.1016/0022-3956(75)90026-6
    1. Rey A. L’examen clinique en psychologie. Paris: Presses universitaires de France, 1964.
    1. Torralva T, Roca M, Gleichgerrcht E, et al. . INECO frontal screening (IFS): a brief, sensitive, and specific tool to assess executive functions in dementia. J Int Neuropsychol Soc 2009;15:777–86. 10.1017/S1355617709990415
    1. D’Elia L, Satz P, Uchiyama C, et al. . Color trails test. professional manual. Odessa, FL: Psychological Assessment Resources, 1996.
    1. Ownsworth T, Fleming J, Tate R, et al. . Do people with severe traumatic brain injury benefit from making errors? A randomized controlled trial of Error-Based and Errorless learning. Neurorehabil Neural Repair 2017;31:1072–82. 10.1177/1545968317740635
    1. Sherer M, Hart T, Nick TG. Measurement of impaired self-awareness after traumatic brain injury: a comparison of the patient competency rating scale and the awareness questionnaire. Brain Inj 2003;17:25–37. 10.1080/0269905021000010113
    1. Martín-Pérez C, Navas JF, Perales JC, et al. . Brief group-delivered motivational interviewing is equally effective as brief group-delivered cognitive-behavioral therapy at reducing alcohol use in risky College drinkers. PLoS One 2019;14:e0226271. 10.1371/journal.pone.0226271
    1. Cohen J. Statistical power analysis for the behavioral sciences. Routledge, 2013.
    1. Macbeth G, Razumiejczyk E, Ledesma RD. Cliff′s delta calculator: a non-parametric effect size program for two groups of observations. Univ Psychol 2011;10:545–55. 10.11144/Javeriana.upsy10-2.cdcp

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