Abstract
OBJECTIVE: For individuals with neurologic disorders, self-awareness of cognitive impairment is associated with indicators of better treatment course and clinical outcomes. Lower self-appraisal accuracy has been found to be associated with impairments in neuropsychological test performance, but individuals who perform unusually well may be equally vulnerable to inaccurate self-ratings. The mixed pattern of cognitive strengths and deficits in individuals with neurologic disorders complicates development of formal metrics for assessment of self-awareness. It remains unclear to what extent distortions in self-appraisal represent a deficit associated with impaired cognitive functioning, or a normal reliance on the "representativeness-heuristic" that results in greater bias in self-ratings in both strong and poor performers. METHOD: The present study investigated these hypotheses using a common-metric approach (Rothlind, Dukarm, and Kraybill, 2016). Participants included 199 adults, recruited from community sources, including healthy adult volunteers and individuals at-risk for neuropsychological impairment secondary to human immunodeficiency virus (HIV) positive status or active heavy alcohol consumption or both. Immediately following completion of standardized neuropsychological tests, participants estimated their own performance percentile ranking. RESULTS: Both high and low-scoring examinees displayed a conservative bias in ranking their own neuropsychological performance. However, lower scores were associated with least accurate self-appraisals overall. CONCLUSION: Findings suggest that cognitive impairments are associated with lower accuracy in self-rating of cognitive ability, but also that normal biases complicate interpretation of self-appraisal ratings across the spectrum of neuropsychological functioning. The importance of recognizing these biases in clinical research and practice is emphasized, and directions for future research are discussed.