Metamemory in multiple sclerosis

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.The concept of metamemory proposes that supplementary to typically measured memory abilities, memory monitoring and control processes are used to optimise learning. Accurate memory monitoring appears to be underpinned by a range of cognitive, and possibly affective, contributions. In populations with these deficits, metamemory has been shown to be impaired. In Multiple Sclerosis (MS), only a limited metamemory literature exists, surprising given that MS is a leading cause of disability among people of working age, and cognitive and mood disorder is common. Using structural equation modelling, this study of 100 people with MS explored factors contributing to performance on episodic Judgment of Learning, Retrospective Confidence and Feeling of Knowing. Given its negative influence on cognitive domains in MS, the impact of information processing deficits on metamemory was also investigated. Finally, memory self-report, a frequently used clinical indicator of memory functioning, was assessed. Findings suggest that memory complaint is associated with mood, and is unrelated to tested memory. Second, Retrospective Confidence Judgments were predictive of memory performance, even in the presence of memory impairment. Third, an unusual finding of maintained underconfidence at delay was observed in the Judgment of Learning task. Finally, Feeling of Knowing judgments related to executive, but not to memory ability. A novel finding in respect of this judgment was of processing speed relating negatively to accuracy, in the context of executive dysfunction. This suggests that some top-down direction of processing resources may be a factor in supporting accuracy, rather than the speed at which information is processed. Of all the task-based judgments, accuracy in this judgment was the only one with a reliable association with mood. Faster processing speed, executive dysfunction and least depression symptomatology related to low accuracy, perhaps typifying a profile of disinhibition seen in MS, characterised by poorly constrained processing and apparently elevated mood