Cognitive awareness in people with multiple sclerosis before and after neuropsychological assessment

The association between subjective and objective cognitive functioning in people with multiple sclerosis (PwMS) is weak, making it difficult for clinicians to determine if referral for neuropsychological assessment is needed. We examined cognitive awareness in PwMS, its change after undergoing neuropsychological assessment, and its association with mood, fatigue, and objective cognitive functioning.

PwMS were recruited as part of an observational study (Don't be late!). Participants estimated their performance on the Minimal Assessment of Cognitive Function in MS (MACFIMS) battery before and after the assessment, relative to a demographically matched peer group. Participants were classified as overestimators, accurate estimators, or underestimators, based on discrepancies between subjective and objective percentile scores. Symptoms of mood and fatigue were assessed with the Hospital Anxiety and Depression Scale and the Modified Fatigue Impact Scale.

The sample included 228 PwMS (mean age = 48.39 ± 11.15 years; 70.2% female). Prior assessment, 123 participants (54%) overestimated, 70 (31%) accurately estimated, and 35 (15%) underestimated their cognitive performance. After assessment, fewer participants overestimated their performance (N = 89; 39%), while more accurately estimated (N = 89; 39%) or underestimated (N = 50; 22%) their performance. Fatigue and objective cognitive functioning predicted cognitive awareness at both time points (all p < 0.005); depression only before testing (p = 0.040), and anxiety was not a significant predictor (p > 0.417).

About half of PwMS overestimate their cognitive performance before neuropsychological assessment. While task experience generally improves estimation accuracy, it also leads to increased underestimation in some PwMS.