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Lookup NU author(s): Dr Calum HamiltonORCiD, Dr Peter GallagherORCiD, Dr Paul DonaghyORCiD, Dr Joanna Ciafone, Dr Michael FirbankORCiD, Professor John-Paul TaylorORCiD, Dr Louise Allan, Professor John O'Brien, Professor Alan ThomasORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
Background: Subjective cognitive complaints are poor predictors of neurodegenerative disease and future dementia. Errors in metacognition, positive or negative differences between actual and perceived performance, may partially explain this. We aimed to assess whether hypothesised indicators of underlying neurodegenerative factors (e.g. hippocampal atrophy) in mild cognitive impairment (MCI) were associated with overestimation of actual cognitive performance, and hypothesised non-degenerative factors (e.g. depression) were associated with under-estimation of performance. Methods: Metacognitive error was estimated from paired subjective and objective cognitive assessments using the Multifactorial Memory Questionnaire and Addenbrooke’s Cognitive Examination – Revised, respectively. A normative model was developed with cognitively healthy older adults (n=36), and applied to individuals with suspected MCI due to Alzheimer’s disease or MCI with Lewy bodies (total n=88).Theorised predictors of subjective over- or under-estimation of performance (metacognitive error) were assessed, including demographics, Alzheimer’s disease biomarkers, mental and physical ill health. Metacognitive error was also assessed as a predictor of conversion to dementia. Results: Underestimation of cognitive function was associated with depressive symptoms (β=-0.40, p<0.001), anxiety (β=-0.28, p=0.016), and self-reported autonomic symptoms (β=-0.30, p=0.009). Overestimation of cognitive function was associated with age (β=0.36, p<0.001), hippocampal atrophy (β=0.52, p<0.001), plasma glial fibrillary acidic protein (β=0.31, p=0.005) and subsequent dementia conversion (Odds Ratio=1.38, p=0.038). Conclusions: Underestimation of cognitive function may reflect functional cognitive changes linked to mental and physical ill health, while overestimation of function may be a marker of neurodegenerative changes. Quantifying metacognitive error may provide a non-invasive screening tool for progressive MCI, requiring investigation in an independent sample.
Author(s): Hamilton CA, Gallagher P, Donaghy PC, Ciafone J, Firbank M, Greenfinch G, Heslegrave A, Zetterberg H, Taylor JP, Allan LM, O'Brien JT, Thomas AJ
Publication type: Article
Publication status: Published
Journal: Psychological Medicine
Year: 2026
Volume: 56
Online publication date: 14/01/2026
Acceptance date: 11/12/2025
Date deposited: 17/12/2025
ISSN (print): 0033-2917
ISSN (electronic): 1469-8978
Publisher: Cambridge University Press
URL: https://doi.org/10.1017/S0033291725102997
DOI: 10.1017/S0033291725102997
Data Access Statement: Data from the cohorts used in these analyses are available through the Dementias Platform UK data portal. R code to replicate these analyses is available upon request from the corresponding author.
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