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Metacognitive unawareness correlates with executive function impairment after severe traumatic brain injury

Published online by Cambridge University Press:  29 January 2010

PAOLA CIURLI ,
UMBERTO BIVONA ,
CARMEN BARBA ,
GRAZIANO ONDER ,
DANIELA SILVESTRO ,
EVA AZICNUDA ,
JESSICA RIGON  and
RITA FORMISANO
PAOLA CIURLI*
Affiliation:
Post-Coma Unit, Santa Lucia Foundation, Rome, Italy
UMBERTO BIVONA
Affiliation:
Post-Coma Unit, Santa Lucia Foundation, Rome, Italy
CARMEN BARBA
Affiliation:
Pediatric Neurology Unit, Children’s Hospital “Meyer”, Florence, Italy
GRAZIANO ONDER
Affiliation:
Geriatric Department, Catholic University, Rome, Italy
DANIELA SILVESTRO
Affiliation:
Post-Coma Unit, Santa Lucia Foundation, Rome, Italy
EVA AZICNUDA
Affiliation:
Post-Coma Unit, Santa Lucia Foundation, Rome, Italy
JESSICA RIGON
Affiliation:
Neuropsychological Department, San Camillo Hospital, Venice Lido, Italy
RITA FORMISANO
Affiliation:
Post-Coma Unit, Santa Lucia Foundation, Rome, Italy
*
*Correspondence and reprint requests to: Paola Ciurli, Servizio di Diagnosi e Riabilitazione Neuropsicologica, Fondazione Santa Lucia, Via Ardeatina 306, 00179 Roma, Italy. E-mail: p.ciurli@hsantalucia.it
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Abstract

The aim of this study was to evaluate clinical, neuropsychological, and functional differences between severe traumatic brain injury (TBI) outpatients with good and/or heightened metacognitive self-awareness (SA) and those with impaired metacognitive SA, assessed by the Patient Competency Rating Scale (PCRS). Fifty-two outpatients were recruited from a neurorehabilitation hospital based on the following inclusion criteria: 1) age ≥ 15 years; 2) diagnosis of severe TBI; 3) availability of neuroimaging data; 4) post-traumatic amnesia resolution; 5) provision of informed consent. Measures: A neuropsychological battery was used to evaluate attention, memory and executive functions. SA was assessed by the PCRS, which was administered to patients and close family members. Patients were divided into two groups representing those with and without SA. Patients with poor SA had more problems than those with good SA in some components of the executive system, as indicated by the high percentage of perseverative errors and responses they made on the Wisconsin Card Sorting Test. Moreover, a decrease in metacognitive SA correlated significantly with time to follow commands (TFC). This study suggests the importance of integrating an overall assessment of cognitive functions with a specific evaluation of SA to treat self-awareness and executive functions together during the rehabilitation process. (JINS, 2010, 16, 360–368.)

Keywords

Executive functionsMetacognitive self-awarenessPerseverative errorsSevere TBINeuropsychological rehabilitationSA assessment
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 16 , Issue 2 , March 2010 , pp. 360 - 368
Copyright
Copyright © The International Neuropsychological Society 2010

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