Metacognitive performance in Functional Cognitive Disorder (FCD): A meta-analysis.

Area of Science:

• Neuroscience
• Cognitive Psychology
• Psychiatry

Background:

• Functional Cognitive Disorder (FCD) is characterized by subjective cognitive complaints not aligning with objective neuropsychological test performance.
• A leading hypothesis suggests FCD involves a dissociation between global and local metacognitive self-monitoring mechanisms.

Purpose of the Study:

• To quantitatively synthesize evidence on global and local metacognitive performance in individuals with FCD using meta-analysis.
• To investigate the proposed dissociation between different forms of metacognition in FCD.

Main Methods:

• Systematic review and meta-analysis of studies comparing metacognitive performance in FCD with healthy controls and mild cognitive impairment (MCI).
• Global metacognition assessed via self-appraisal; local metacognition via trial-by-trial confidence accuracy (e.g., meta-d'/d').
• Pooled effect sizes (Cohen's d) calculated using random-effects models.

Main Results:

• Meta-analysis of three studies revealed significantly impaired global metacognition in FCD (Cohen's d = -1.07).
• Analysis of one study indicated preserved local metacognition in FCD (Cohen's d = 0.00).
• Findings support a dissociation: disrupted global self-monitoring with intact local self-monitoring in FCD.

Conclusions:

• Meta-analytic evidence demonstrates a substantial deficit in global metacognitive insight in FCD, with preserved local metacognitive abilities.
• Results provide a potential mechanistic explanation for the subjective-objective performance discrepancy in FCD.
• Interventions targeting global metacognitive appraisal may improve clinical outcomes, though findings are preliminary due to limited studies.