Prospective and Retrospective Metacognitive Abilities and Their Association with Impaired Self-awareness in Patients with Traumatic Brain Injury

Abstract

Metacognitive impairment often occurs in patients with traumatic brain injury (TBI) and is associated with clinical problems. The aim of this study was to clarify the pathology of metacog-nitive impairment in TBI patients using a behavioral task, clinical assessment of self-awareness, and lesion-symptom mapping. Metacognitive abilities of TBI patients and healthy controls were assessed using a modified perceptual decision-making task. Self-awareness was assessed using the Patient Competency Rat-ing Scale and the Frontal Systems Behavior Scale. The associa-tions between estimated metacognitive abilities, self-awareness, and neuropsychological test results were examined. The corre-spondence between metacognitive disabilities and brain lesions was explored by ROI-based lesion-symptom mapping using structural magnetic resonance images. Overall, 25 TBI patients and 95 healthy controls were included in the analyses. Com-pared with that in healthy controls, the prospective metacog-nitive ability of TBI patients was lower, with metacognitive evaluations revealing a bias toward overestimating their abili-ties. Retrospective metacognitive ability showed a negative correlation with self-awareness but not with neuropsycholog-ical test results. In the lesion-symptom mapping analysis, the left pFC was associated with lower retrospective metacognitive ability. This study contributes to a better understanding of the pathology of metacognitive and self-awareness deficits in TBI patients and may explain the cause of impaired realistic goal setting and adaptive behavior in these patients.