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Annals of Behavioral Medicine

, 18:177 | Cite as

Towards patient collaboration in cognitive assessment: Specificity, sensitivity, and incremental validity of self-report

  • Carolyn E. Schwartz
  • Elizabeth Kozora
  • Qi Zeng
Empirical Research

Abstract

The present work addressed the specificity and sensitivity of patient-reported cognitive ability using both cross-sectional and longitudinal data, and the incremental validity of patient self-report in addition to knowledge gained through neuropsychological tests. We examined a sample of individuals with multiple sclerosis (N=130) as a model of chronic illness where neuropsychological deficits are relatively common. Results revealed that 64% of the sample reported noticing some problems with memory or confusion. Very high levels of reported problems were not consistent with objective testing, whereas moderate levels of noticing problems were congruent with test results. This pattern suggests a curvilinear relationship between self-reported and objective assessment. The moderate reporters seem to be attending to subtle increases in deficits over time. Results also supported the incremental validity of combining subjective and objective indices, but only when the high reporters were excluded. We conclude that patients can provide important complementary data which may promote preventive care.

Keywords

Multiple Sclerosis Expand Disability Status Scale Behavioral Medicine Cognitive Problem Incremental Validity 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. (1).
    Chelune GJ, Heaton RK, Lehman RAW: Neuropsychological and personality correlates of patients’ complaints of disability. In Goldstein G, Tarter RE (eds),Advances in Clinical Neuropsychology (Vol. 3). New York: Plenum Press, 1986, 95–118.Google Scholar
  2. (2).
    Priddy DA, Mattes D, Lam CS: Reliability of self-report among non-oriented head-injured adults.Brain Injury. 1988,2:248–253.CrossRefGoogle Scholar
  3. (3).
    Beatty WW, Monson N: Metamemory in multiple sclerosis.Journal of Clinical and Experimental Neurology. 1991,13:309–327.CrossRefGoogle Scholar
  4. (4).
    Bijlsma JWJ, Huiskes CJAE, Kraaimaat FW, Vanderveen MJ, Huber-Bruning O: Relation between patients’ own health assessment and clinical and laboratory findings in rheumatoid arthritis.Journal of Rheumatology. 1991,18:650–653.PubMedGoogle Scholar
  5. (5).
    Kwoh CK, O’Connor GT, Regan-Smith MG, et al: Concordance between clinician and patient assessment of physical and mental health status.Journal of Rheumatology. 1992,19(7):1031–1037.PubMedGoogle Scholar
  6. (6).
    Gulick EE, Cook SD, Troiano R: Comparison of patient and staff assessment of MS patients’ health status.Acta Neurologica Scandinavia. 1993,88(2):87–93.Google Scholar
  7. (7).
    Lezak MD: The problem of assessing executive functions.International Journal of Psychology. 1982,17:281–297.CrossRefGoogle Scholar
  8. (8).
    Babinski MJ: Contribution a l’etude des troubles mentaux dans l’hemiplegie organique cerebrale (Anosognosie). [Contribution to the study of mental disturbance in organic cerebral hemiplegia. (Anosognosie).]Revue Neurologique. 1914,12:845–848.Google Scholar
  9. (9).
    McGlynn SM, Schacter DL: Unawareness of deficits in neuropsychological syndromes.Journal of Clinical and Experimental Neuropsychology. 1989,11:143–205.PubMedCrossRefGoogle Scholar
  10. (10).
    Taylor R: Relationships between cognitive test performance and everyday cognitive difficulties in multiple sclerosis.British Journal of Clinical Psychology. 1990,29:251–252.PubMedGoogle Scholar
  11. (11).
    Allen CC, Ruff RM: Self-rating versus neuropsychological performance of moderate versus severe head-injured patients.Brain Injury. 1990,4:7–17.PubMedCrossRefGoogle Scholar
  12. (12).
    Jorm AF, Christensen H, Henderson AS, et al: Complaints of cognitive decline in the elderly: A comparison of reports by subjects and informants in a community survey.Psychological Medicine. 1994,24:365–374.PubMedGoogle Scholar
  13. (13).
    Sullivan MJL, Edgley K, Dehoux E: A survey of multiple sclerosis. Part 1: Perceived cognitive problems and compensatory strategy use.Canadian Journal of Rehabilitation. 1990,4:99–105.Google Scholar
  14. (14).
    Goldstein G, McCue M: Differences between patient and informant functional outcome ratings in head-injured patients.International Journal of Rehabilitation and Health. 1995,1(1):25–35.CrossRefGoogle Scholar
  15. (15).
    Minden SL, Orav J, Reich P: Depression in multiple sclerosis.General Hospital Psychiatry. 1987,9:426–434.PubMedCrossRefGoogle Scholar
  16. (16).
    Honer WB, Hurwitz T, Li DKB, Palmer M, Paty DW: Temporal lobe involvement in multiple sclerosis patients with psychiatric disorders.Archives of Neurology. 1987,44:187–190.PubMedGoogle Scholar
  17. (17).
    Schiffer RB, Weitkamp LR, Wineman NM, Guttormsen S: Multiple sclerosis and affective disorder: Family history, sex, and HLA-DR antigens.Archives of Neurology. 1988,45:1345–1348.PubMedGoogle Scholar
  18. (18).
    Lachman ME, Steinberg ES, Trotter SD: Effects of control beliefs and attributions on memory self-assessments and performance.Psychology and Aging. 1987,2(3):266–271.PubMedCrossRefGoogle Scholar
  19. (19).
    Wilkins JW, Robertson KR, Snyder CR, et al: Implications of self-reported cognitive and motor dysfunction in HIV-positive patients.American Journal of Psychiatry. 1991,148:641–643.PubMedGoogle Scholar
  20. (20).
    Grafman J, Rao S, Bernardin L, Leo GJ: Automatic memory processes in patients with multiple sclerosis.Archives of Neurology. 1991,48:1072–1075.PubMedGoogle Scholar
  21. (21).
    Lewinsohn PM, Mischel W, Chaplin W, Barton R: Social competence and depression: The role of illusory self-perceptions.Journal of Abnormal Psychology. 1980,89:203–212.PubMedCrossRefGoogle Scholar
  22. (22).
    Edgley K, Sullivan MJL, Dehoux E: A survey of multiple sclerosis. Part 2. Determinants of employment status.Canadian Journal of Rehabilitation. 1991,4(3):127–132.Google Scholar
  23. (23).
    Naugle RI, Chelune GJ: Integrating neuropsychological and “real-life” data: A neuropsychological model for assessing everyday functioning. In Tupper DE, Cicerone KD (eds),The Neuropsychology of Everyday Life: Assessment of Basic Competencies. Boston, MA: Kluwer Academic Publishers, 1990, 57–73.Google Scholar
  24. (24).
    Sullivan MJL, Dehoux E, Buchanan DC: An approach to cognitive rehabilitation in multiple sclerosis.Canadian Journal of Rehabilitation. 1989,3:77–85.Google Scholar
  25. (25).
    Gregg ME, Brady MJ, Andrykowski MA: Relationship between behavioral and self-report measures of cognitive impairment. 50th Anniversary Meeting of the American Psychosomatic Society. New York: April 1992.Google Scholar
  26. (26).
    Thompson LL, Heaton RK: Use of demographic information in neuropsychological assessment. In Tupper DE, Cicerone KD (eds),The Neuropsychology of Everyday Life: Assessment of Basic Competencies. Boston, MA: Kluwer Academic Publishers, 1990, 75–98.Google Scholar
  27. (27).
    Rao SM, Leo GJ, Bernardin L, Unverzagt F: Cognitive dysfunction in multiple sclerosis: I. Frequency, patterns, and prediction.Neurology. 1991a,41:685–691.PubMedGoogle Scholar
  28. (28).
    Rao SM, Leo GJ, Haughton VM, St. Aubin-Faubert P, Bernardin L: Correlation of magnetic resonance imaging with neuropsychological testing in multiple sclerosis.Neurology. 1989,39:161–166.PubMedGoogle Scholar
  29. (29).
    Rao SM, Leo GJ, Ellington L, et al: Cognitive dysfunction in multiple sclerosis: II. Impact on employment and social functioning.Neurology. 1991b,41:692–696.PubMedGoogle Scholar
  30. (30).
    Schwartz CE, Rogers M: Designing a psychosocial intervention to teach coping flexibility.Rehabilitation Psychology. 1994,39(1): 61–76.CrossRefGoogle Scholar
  31. (31).
    Martyn C. The epidemiology of multiple sclerosis. In Matthews WB (ed),McAlpine’s Multiple Sclerosis (2nd Ed.). New York: Churchill Livingstone, 1991, 3–40.Google Scholar
  32. (32).
    Schwartz CE, Fox BH: Who says yes? Identifying selection biases in a psychosocial intervention study of multiple sclerosis.Social Science and Medicine. 1995,40(3):359–370.PubMedCrossRefGoogle Scholar
  33. (33).
    Kurtzke JF: Rating neurologic impairment in multiple sclerosis: An expanded disability status scale (EDSS).Neurology. 1983,33: 1444–1452.PubMedGoogle Scholar
  34. (34).
    Bergner M, Bobbitt RA, Kressel S, et al: The Sickness Impact Profile: Conceptual formulation and development revision of a health status measure.International Journal of Health Services. 1976,6:393–415.PubMedCrossRefGoogle Scholar
  35. (35).
    Pollard WE, Bobbitt RA, Bergner M, Martin DP, Gilson BS: The Sickness Impact Profile: Reliability of a health status measure.Medical Care. 1976,14:146–155.PubMedCrossRefGoogle Scholar
  36. (36).
    Bergner M, Bobbitt RA, Carter WB, Gilson BS: The Sickness Impact Profile: Development and final revision of a health status measure.Medical Care. 1981,19:787–805.PubMedCrossRefGoogle Scholar
  37. (37).
    Berg EA: A simple objective technique for measuring flexibility in thinking.Journal of General Psychology. 1948,39:15–22.PubMedGoogle Scholar
  38. (38).
    Reitan RM: Validity of the Trail-Making Test as an indication of organic brain dagame.Perceptual Motor Skills. 1959,8:271–276.Google Scholar
  39. (39).
    Buschke H: Selective reminding from analysis of memory and learning.Journal of Verbal Learning and Verbal Behavior. 1973,12:543–550.CrossRefGoogle Scholar
  40. (40).
    Spreen O, Strauss E:A Compendium of Neuropsychological Tests: Administration, Norms, and Commentary. New York: Oxford University Press, 1991.Google Scholar
  41. (41).
    Spreen O, Benton AL:Neurosensory Center Comprehensive Examination for Aphasia (NCCEA) (Revised Edition). Victoria, British Columbia, Canada: University of Victoria, Neuropsychological Laboratory, 1969.Google Scholar
  42. (42).
    Spreen O, Benton AL:Neurosensory Center Comprehensive Examination for Aphasia (NCCEA). Victoria, British Columbia, Canada: University of Victoria, Neuropsychological Laboratory, 1977.Google Scholar
  43. (43).
    Gronwall D, Wrightson P: Recovery after minor head injury.Lancet. 1974,2:1452.PubMedCrossRefGoogle Scholar
  44. (44).
    Gronwall DMA: Paced auditory serial-addition task: A measure of recovery from concussion.Perceptual Motor Skills. 1977,44: 367–373.Google Scholar
  45. (45).
    Smith A:Symbol Digit Modalities Test (Revised). Los Angeles: Western Psychological Services, 1982.Google Scholar
  46. (46).
    Rao SM, St. Aubin-Faubert P, Leo GJ: Information processing speed in patients with multiple sclerosis.Journal of Clinical and Experimental Neuropsychology. 1989,11:471–477.PubMedCrossRefGoogle Scholar
  47. (47).
    Drewe EA: The effect of type and area of brain lesion on Wisconsin Card Sorting Test performance.Cortex. 1974,10:159–170.PubMedGoogle Scholar
  48. (48).
    Heaton RK, Chelune GJ, Talley JL, Kay GG, Curtiss G:Wisconsin Card Sorting Test Manual: Revised and Expanded. Odessa, FL: Psychological Assessment Resources, Inc., 1993.Google Scholar
  49. (49).
    Arnett PA, Rao SM, Bernardin L, et al: Relationship between frontal lobe lesions and Wisconsin Card Sorting Test performance in patients with multiple sclerosis.Neurology. 1994,44:420–425.PubMedGoogle Scholar
  50. (50).
    Lezak MD:Neuropsychological Assessment (2nd Ed.). New York: Oxford University Press, 1983.Google Scholar
  51. (51).
    Heaton RK, Grant I, Matthews CG:Comprehensive Norms for an Extended Halstead-Reitan Battery. Odessa, FL: Psychological Assessment Resources, Inc., 1991.Google Scholar
  52. (52).
    Reitan RM, Wolfson D:The Halstead-Reitan Neuropsychological Test Battery. Tucson, AZ: Neuropsychology Press, 1985.Google Scholar
  53. (53).
    Hennekens CH, Buring JE.Epidemiology in Medicine. Boston, MA. Little, Brown & Company, 1987.Google Scholar
  54. (54).
    Willett JB, Ayoub CC, Robinson D: Using growth modeling to examine systematic differences in growth: An example of change in the functioning of families at risk of maladaptive parenting, child abuse, or neglect.Journal of Consulting and Clinical Psychology. 1991,59(1):38–47.PubMedCrossRefGoogle Scholar
  55. (55).
    Francis DJ, Fletcher JM, Stuebing KK, Davidson KC, Thompson NM: Analysis of change: Modeling individual growth.Journal of Consulting and Clinical Psychology. 1991,59(1):27–37.PubMedCrossRefGoogle Scholar
  56. (56).
    Newton Suter W, Wilson D, Naqvi A: Using slopes to measure directional change.Nursing Research. 1991,40(4):250–252.CrossRefGoogle Scholar
  57. (57).
    Laird NM, Ware JH: Random effects models for longitudinal data.Biometrics. 1982,38:963–974.PubMedCrossRefGoogle Scholar
  58. (58).
    SAS Institute, Inc.:SAS/STAT User’s Guide (Release 6.03). Cary, NC: SAS Institute, 1988.Google Scholar
  59. (59).
    Statistical Sciences, Inc.:S-PLUS User’s Manual. Seattle, WA: Statistical Sciences, Inc., 1991.Google Scholar
  60. (60).
    Berrol S: Issues in cognitive rehabilitation.Archives of Neurology. 1990,47:219–224.PubMedGoogle Scholar
  61. (61).
    Bennett T, Dittmar C, Raubach S: Multiple sclerosis: Cognitive deficits and rehabilitation strategies.Cognitive Rehabilitation. 1991,Sept/Oct:18–23.Google Scholar
  62. (62).
    Barsky AJ, Cleary PD, Klerman GL: Determinants of perceived health status of medical outpatients.Social Science and Medicine. 1992,34(10):1147–1154.PubMedCrossRefGoogle Scholar
  63. (63).
    Seidenberg M, Haltiner A, Taylor MA, Hermann BB, Wyler A: Development and validation of a multiple ability self-report questionnaire.Journal of Clinical and Experimental Neuropsychology. 1994,16:93–104.PubMedCrossRefGoogle Scholar
  64. (64).
    Heaton RK, Pendleton MG: Use of neuropsychological tests to predict adult patients’ everyday functioning.Journal of Consulting and Clinical Psychology. 1981,49:807–821.PubMedCrossRefGoogle Scholar
  65. (65).
    Connelly JE, Smith GR, Philbrick JT, Kaiser DL: Healthy patients who perceive poor health and their use of primary care services.Journal of General Internal Medicine. 1991,6:47–51.PubMedCrossRefGoogle Scholar

Copyright information

© The Society of Behavioral Medicine 1996

Authors and Affiliations

  • Carolyn E. Schwartz
    • 1
  • Elizabeth Kozora
    • 2
  • Qi Zeng
    • 3
  1. 1.Frontier Science & Technology Research Foundation, Inc., Department of Psychiatry Deaconess HospitalHarvard Medical SchoolBostonUSA
  2. 2.National Jewish Center for Immunology & Respiratory MedicineUniversity of Colorado School of MedicineUSA
  3. 3.Harvard School of Public HealthBostonUSA

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