Dissertation committee:
Στεφανής Λεωνίδας, Καθηγητής, Ιατρική, ΕΚΠΑ
Βουμβουράκης Κωνσταντίνος, Καθηγητής, Ιατρική, ΕΚΠΑ
Γιαννής Γιώργος, Καθηγητής, Σχολή Πολιτικών Μηχανικών, ΕΜΠ
Δουζένης Αθανάσιος, Αναπ. Καθηγητής, Ιατρική, ΕΚΠΑ
Παπαγεωργίου Γ. Σωκράτης, Αναπ. Καθηγητής, Ιατρική, ΕΚΠΑ
Οικονόμου Αλεξάνδρα, Αναπ. Καθηγήτρια, Ψυχολογία, ΕΚΠΑ
Ζαλώνης Ιωάννης, Αναπ. Καθηγητής, Ιατρική, ΕΚΠΑ
Summary:
Background: Self-awareness is defined as the ability to perceive subjectively someone’s own performance in a particular task or situation in relatively objective terms. Self-awareness is a multidimensional ability, which is not limited only to the assessment of mental performance but can also include aspects of daily functioning and independent living such as working and driving skills. So far, few studies have been systematically examining the phenomenon in both clinical and healthy population. In addition, in the existing studies, the methodology and tools used are either too poor or inadequate to examine the finer and more qualitative features of self-awareness. Comparisons with reports from caregivers and vague scales of self-assessment are the ones that are being mostly used, making uncertain conclusions.
Objective: The aim of the present study was to develop a tool for the study of self-awareness in normal as well as clinical population with neurodegenerative disorders such as Mild Cognitive Impairment (MCI), Alzheimer's disease and Parkinson's disease. Self-evaluation capacity was investigated both at the cognitive level (evaluation of performance in neuropsychological tests) and at the functional level (evaluation of driving ability through a driving simulator).
Methods: Fifty-eight patients with amnestic Mild Cognitive Impairment, 30 patients with Alzheimer's disease and 30 patients with Parkinson's disease participated in the study. Disease diagnosis was based on the established clinical criteria following a thorough clinical examination conducted by a group of neurologists, neuropsychiatrists and neuropsychologists. At the same time, participants with the possibility that their clinical symptoms were due to secondary causes or causes other than the neurodegenerative diseases studied were excluded. All participants were evaluated with a wide array of tests evaluating episodic memory, attention (focused and divided), executive functions, visuospatial perception, and reaction time. After each neuropsychological test, the scale used for the self-evaluation of performance was administered. Each participant was encouraged to compare his performance with the performance of other people of the same age and educational level and to report on a scale of -100% to + 100% (with 10-point intervals) how well he believed he had performed on the particular neuropsychological test. In addition, participants’ driving skills were evaluated through a driving simulator. To assess participants' self-awareness of their driving performance, a similar scale for the self-evaluation of performance was administered immediately after the experiment was completed. This scale ranged again from -100 to +100 with 10-point intervals and evaluated the assessment of their performance against other individuals of the same age and educational level in the following driving parameters: (a) average speed; (b) headway distance, (c) reaction time and (d) steering wheel position variation.
Results:
1. Self-awareness of cognitive ability in patients with MCI: Our results showed that patients with MCI presented significant difficulties in accurately assessing their performance, overestimating their abilities in all neuropsychological tests examined, as opposed to the control group that was accurate in its assessment in the majority of the tests.
2. Self-awareness of driving ability in patients with MCI: The findings of the specific analysis suggested that, in relation to healthy elderly drivers, MCI patients have considerable difficulty in accurately assessing their performance in the simulator. However, it should be noted that the elements from the environment seemed to contribute significantly to the level of self-awareness presented by drivers with MCI on their performance.
3. Self-awareness of cognitive ability in patients with Alzheimer’s disease: The results of this study showed that patients with Alzheimer's disease significantly overestimated their performance in all the neuropsychological tests examined, presenting significant self-assessment difficulties in all cognitive domains examined.
4. Self-awareness of driving ability in patients with Alzheimer’s disease: According to our results, a significant number of differences were identified in the subjective assessment of driving performance especially in the urban environment. In particular, patients with Alzheimer's disease showed significant discrepancies between subjective and objective performance in the estimation of average speed and steering wheel position variation in the urban environment, and significantly overestimated their reaction time to unexpected events in both the urban and rural environment.
5. Self-awareness of cognitive ability in patients with Parkinson’s disease: The results of this analysis showed that patients with Parkinson's disease presented impaired self-awareness over the control group in all the neuropsychological tests examined. Particularly, Parkinson's disease patients significantly overestimated their performance in all cognitive domains while the control group, although accurate in their estimates, presented a tendency to underestimate their performance.
6. Self-awareness of driving ability in patients with Parkinson’s disease: According to our results, patients with Parkinson's disease presented significant difficulties in assessing their driving performance, with this difficulty being more pronounced in the rural environment, where there were significant discrepancies between subjective and objective performance across all variables examined. On the other hand, in the urban environment, they presented significant difficulties in assessing their driving behavior only in the variable of reaction time, where they significantly overestimated their performance.
Conclusion: In summary, this PhD dissertation aims to the investigation of self-awareness in a multifaceted and global way, overcoming the limitations of previous research studies. At the same time, an important effort has been made to approach the complexity of this process as effectively as possible in order to make the best possible use of its results in the context of the applied clinical practice. The findings so far suggest that impaired self-awareness appears even at the early stages of cognitive decline, both in cognitive and functional areas. However, it seems that feedback can significantly improve self-assessment ability in these clinical groups, thus underlining the need for appropriate intervention programs to enhance self-awareness in these patients and consequently to offer the opportunity to improve the quality of life both of themselves and their families.
Keywords:
Self-awareness, Neuropsychological assessment, Driving, Mild Cognitive Impairment, MCI, Alzheimer's disease, Parkinson's disease
