Impaired explicit self-awareness but preserved behavioral regulation in patients with Alzheimer Disease

Objectives: Impairments of metacognitive skills represent a critical symptom in Alzheimer Disease (AD) because it frequently results in a lack of self-awareness. However, recent findings suggest that, despite an inability to explicitly estimate their own cognitive functioning, patients might demonstrate some implicit recognition of difficulties. In this study, we tested whether a behavioral dissociation between explicit and implicit measures of metacognition can be found in both healthy older controls (n = 20) and AD patients (n = 20).
Methods: Our two groups of participants (AD vs. Controls) were asked to complete a forced-choice perceptual identification test and to explicitly rate their confidence in each decision (i.e., explicit measure of metacognition). Moreover, they also had the opportunity to ask for a cue to help them decide if their response was correct (i.e., implicit measure of metacognition).
Results: Data revealed that all participants asked for a cue more often after an incorrect response than after a correct response in the forced-choice identification test, indicating a good ability to implicitly introspect on the results of their cognitive operations. On the contrary, only healthy participants displayed metacognitive sensitivity when making explicit confidence judgments.
Conclusion: Our findings suggest that implicit metacognition may be less affected than explicit metacognition in Alzheimer’s disease.