Predicting Cognitive Impairment Using a Self-Report Discrepancy in Older Adults

Danish Imtiaz, Farjad Ikram, Aemen Sultan


Research in neuropsychology demonstrates that cognitive impairment can alter an individual’s perception about their abilities. There is a correlational relationship between functional living and cognition, yet there may be instances when individuals do not provide accurate or reliable self-report to these abilities; corroborative data on IADLs is essential when evaluating for cognitive impairment. To date, no known studies have evaluated how a discrepancy between self-report and performance based measures predict cognitive impairment. This study creates a discrepancy score between these two measures in an attempt to predict level of dementia by examining 198 adults (age 57-90) self-referred for neuropsychological assessment. Test results from the Dementia Rating Scale 2, Texas Functional Living Scale, Lawton IADL, and ACT Word Choice were collected and utilized to create a discrepancy score between self-report and performance. A standard multiple regression was run with the criterion variable as the DRS-2 Total Score, and predictor variables as Lawton, TFLS, Discrepancy Score, and Effort to evaluate the predictive capacity of these variables. The regression model predicted a large percentage of variance in the criterion variable (R² = .54, F(3, 194) = 77.26, p < .001). Specifically, performance-based measures (B = 30.17, β = .44, t = 7.43, p < .001) and effort (B = .74, β = .37, t = 6.21, p < .001) were significantly predictive of cognitive impairment, but not the discrepancy score or self-report. Implications include that importance of including performance measures and effort in neuropsychological batteries. Limitations and directions for future research is discussed.


dementia, mild cognitive impairment, awareness, IADLs, discrepancy

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