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. 2023;96(1):301-311.
doi: 10.3233/JAD-221140.

Metacognition in Community-Dwelling Older Black and African American Adults During the COVID-19 Pandemic

Katherine Kero  1 , Colt M Halter  1 , Allison C Moll  1 , Sophie M Hanna  1 , John L Woodard  1 , Bruno Giordani  2   3 , Ana M Daugherty  1   2 , Voyko Kavcic  1   4
Affiliations

Metacognition in Community-Dwelling Older Black and African American Adults During the COVID-19 Pandemic

Katherine Kero et al. J Alzheimers Dis. 2023.

Abstract

Background: Cognitive assessment of older adults typically includes symptom reports and objective evaluations. However, there is often poor agreement between these measures. Cultural norms, stress, and anxiety may also influence cognitive self-appraisal and performance. Little research describes how other factors affect the self-report/objective test discrepancies noted in the literature.

Objective: This study investigated whether the disparity between subjective cognitive concerns and objective cognitive performance is related to measures of anxiety and stress in older Black and African American adults.

Methods: Telephone screenings were administered to 206 older adults (ages 64-94) during the first year of the pandemic. Demographic data, objective memory (Telephone Interview for Cognitive Status [TICS-m]), an adaptation of the subjective memory measure, the Cognitive Change Questionnaire, emphasizing executive functioning in everyday life [CCQ-e]), Generalized Anxiety Disorder-7 (GAD-7), and Perceived Stress Scale-4 (PSS4) were measured. Metacognition Discrepancy Index (MDI) was calculated from the standardized residual after regressing TICS-m on CCQ-e scores to quantify the discrepancy between cognitive self-appraisal and objective cognitive functioning.

Results: Neither GAD-7 nor PSS-4 moderated the relationship between TICS-m and CCQ-e, and TICS-m scores weakly predicted subjective CCQ-e scores (F(1, 197)=4.37, p = 0.038, R2 = 0.022). The MDI correlated with stress and anxiety (rs = 0.294, 0.396, ps < 0.001).

Conclusion: Discrepancies exist between objectively measured and self-evaluated cognition. Elevations in stress and anxiety are associated with greater overestimation of cognitive difficulties relative to objective performance. Pandemic-related stressors may have worsened anxiety and diminished self-appraisal of cognitive abilities for some individuals, while others may remain reluctant to acknowledge impairments. Social and emotional factors are meaningful considerations in assessing cognitive difficulties.

Keywords: Alzheimer’s disease; affect; anxiety; cognitive decline; metacognition; psychological stress.

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Conflict of interest statement

Conflict of Interest/Disclosure Statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1. Correlates of Metacognition Discrepancy Index
Note. Correlates of the Metacognition Discrepancy Index (MDI) are depicted. Above and to the right of the scatterplots, shaded areas represent histogram data distributions. Panel A. MDI and General Anxiety (GAD-7) correlations are visualized with a scatter plot (r(197) =.40, p<.001; shaded area shows 95% CI). Panel B. MDI and Perceived Stress (PSS-4) are visualized with a scatter plot (r(197) =.33, p<.001; shaded area shows 95% CI). Correlations between MDI (Metacognition Discrepancy Index) and Anxiety (Panel A, GAD-7, Generalized Anxiety Disorder - 7) and Stress (Panel B, PSS-4, Perceived Stress Scale 4) are shown. The shaded area around each line depicts a 95% confidence interval, and the density plot of reported cases is shown above and below plots.
Figure 2
Figure 2. MDI by General Health Group
Note. Metacognition Discrepancy Index (MDI) mean and dispersion plotted by self-reported perceived health groups.
See this image and copyright information in PMC

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