Date on Master's Thesis/Doctoral Dissertation

8-2015

Document Type

Doctoral Dissertation

Degree Name

Ph. D.

Department

Psychological and Brain Sciences

Degree Program

Clinical Psychology, PhD

Committee Chair

Mast, Benjamin

Committee Co-Chair (if applicable)

Meeks, Suzanne

Committee Member

Meeks, Suzanne

Committee Member

Irby, Jay

Committee Member

Pani, John

Committee Member

Friedland, Robert

Subject

Executive functions (Neuropsychology); Mild cognitive impairment--Diagnosis; Alzheimer's disease--Diagnosis

Abstract

This study examined the utility of older adults’ awareness of their executive functioning abilities to predict future cognitive decline. The recently revised Cognitive Awareness Model (CAM) forms the conceptual background of this approach, and suggests that executive dysfunction disrupts awareness in a manner distinct from episodic memory dysfunction. The study design examined how awareness of executive functioning ability may predict both continuous decline on neuropsychological testing and qualitative change in diagnostic status. This form of prediction was tested using a longitudinal sample (n = 661) of older adults with either normal cognition, mild cognitive impairment (MCI), or Alzheimer’s disease (AD). Executive functioning awareness was operationalized as Everyday Cognition (ECog) questionnaire discrepancy scores, made up of the difference between informant and subject reports of daily task efficiency. Executive functioning discrepancy scores were shown to have moderate utility at predicting cognitive decline on several measures and modest utility at predicting diagnostic change. However, modest convergent validity and low discriminant validity were observed for executive functioning discrepancy scores in the context of memory discrepancy scores. Future research directions are reviewed, including the need to document the time course of early memory awareness deficits vs. early executive functioning awareness deficits.

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