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Published on: September 1, 2023
Impaired Metacognition of Voluntary Movement in Functional Movement Disorder
Julius Verrel1, Fabian Chwolka1, Elisa Filevich2,3,4
1Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany.
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 self-performed 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. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Insights
Patients with functional movement disorders (FMDs) show impaired metacognitive judgments about their own movements. This reduced insight into motor control may contribute to FMDs and inform future treatments.
Area of Science:
- Neuroscience
- Movement Disorders
- Cognitive Science
Background:
- Functional movement disorders (FMDs) involve involuntary motor symptoms that resemble voluntary actions.
- Evidence suggests FMDs are linked to altered self-monitoring, control, and subjective experience of movements.
Purpose of the Study:
- To investigate if FMDs are associated with a reduced capacity for accurate metacognitive judgments regarding self-performed movements.
- To compare metacognitive performance in FMD patients versus healthy controls.
Main Methods:
- A visuomotor-metacognitive paradigm was used, comparing 24 FMD patients with 24 healthy controls.
- Participants made movements with restricted visual feedback and judged trajectory accuracy, reporting confidence levels.
- Metacognitive performance was assessed by the correlation between confidence and decision accuracy.
Main Results:
- Motor performance and response accuracy were similar between FMD patients and controls.
- FMD patients demonstrated reduced visuomotor sensitivity and impaired metacognitive performance.
- Confidence ratings in FMD patients were less predictive of their decision accuracy, particularly in functional gait disturbance and tremor subgroups.
Conclusions:
- FMD patients exhibit deficits in both visuomotor decision-making and metacognitive evaluation of their movements.
- Impaired metacognitive insight into motor control may be a key factor in FMD pathophysiology.
- These findings suggest potential avenues for developing novel therapeutic strategies for FMDs.
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