A-146: Discrepancies in Patient- and Informant-Report of Executive Functioning on the Test of Everyday Cognition-Revised: Examining Domain-Specific Insight

Abstract

Objective: Emerging literature suggests patients and informants differ in domain-specific insight on self-report measures. Notably, patients in preclinical disease stages may more accurately identify executive difficulties than informants. These findings demonstrate the importance of examining domain-specific discrepancies beyond global ratings. This study investigated whether global cognitive status and objective executive functioning are associated with patient insight into executive abilities, as measured by patient–informant discrepancy scores on the Test of Everyday Cognition-Revised (ECog-II). Method/Data Selection: Participants were 206 consecutive adults (Mage=70.17; Meducation=13.74; 53.9% female, 46.1% male; 89.8% White, 6.3% Black, 2.9% Hispanic, 0.5% Asian, 0.5% Other) referred to an academic medical center for comprehensive neuropsychological evaluation. All participants completed the Mini-Mental State Examination (MMSE), Trail Making Test-Part B, Stroop Color-Word Interference Test, and the ECog-II (patient and informant forms). A two-way ANOVA examined the effects of global cognition (MMSE) and objective executive functioning on ECog-II executive discrepancy scores. Results/Data Synthesis: There were no significant main or interaction effects of global cognition (F(1,198)=3.561, p=.061, ηp2=.018) or executive functioning (F(1,198)=1.077, p=.301, ηp2=.005) on ECog-II executive function discrepancy scores (EF*MMSE: F(1,198)=0.293, p=.589, ηp2=.001). Four cases were excluded due to missing data. Conclusions: Findings suggest that subjective executive dysfunction may not reliably correlate with objective cognitive performance, regardless of global cognitive status, highlighting the complex relationship between perceived everyday functioning and neuropsychological test performance. Additionally, ECog-II executive discrepancy scores may have limited correspondence with objective measures, suggesting constraints in external validity. Further exploration of patient-informant discrepancies across cognitive domains is warranted to better identify unreliable reporting in clinical settings.