The relationship between self-reported executive performance and psychological characteristics in multiple sclerosis

Background and purpose: Self-reports of cognitive functioning are not always related to objective measures. We examined psychological characteristics of patients with multiple sclerosis (MS) who underestimate, overestimate or accurately estimate their executive performance. Methods: The first phase was an inventory of cognitive complaints by means of self-reported (and partner-reported) questionnaires. At the second phase (January-October 2009), 114 of the 128 participants met the inclusion and exclusion criteria and underwent cognitive and neurological assessments. Results: A total of 19% (N = 22) of participants reported subjective executive impairment, whilst 81% (N = 92) reported no subjective executive impairment. Based on Behavioural Assessment of the Dysexecutive Syndrome-Dysexecutive Questionnaire self-reports, 67% (N = 76) of the participants accurately reported no subjective executive impairment, 14% (N = 16) overestimated, and 15% underestimated (N = 17) their executive performance; 78% of the informants accurately reported no subjective executive impairment, 15% overestimated the patient's executive performance, and 4% underestimated the patient's executive performance. Patients with MS underestimating their executive performance were characterized by more depression (F(2,106 = 12.9, P < 0.001), anxiety (F-2,F-105 = 7.4, P = 0.001) and psychosocial stress (F-2,F-103 = 17.8, P < 0.001), more often used the coping style 'disclosure of emotions' (H-2 = 12.1, P = 0.002) than accurate estimators and overestimators and displayed a more passive reaction pattern (F-2,F-104 = 4.4, P = 0.014) than accurate estimators. Conclusions: Self-reports of executive performance are generally reliable, but 29% of patients with MS underestimated or overestimated their abilities. It is especially important to identify underestimators as they display underlying psychological problems and dysfunctional coping styles in need of further psychological treatment. Informants are valuable in this respect, but should not be seen as the 'gold standard' to identify cognitive impairment.