Metacognitive unawareness correlates with executive function impairment after severe traumatic brain injury

Paola Ciurli, Umberto Bivona, Carmen Barba, Graziano Onder, Daniela Silvestro, Eva Azicnuda, Jessica Rigon, Rita Formisano

Research output: Contribution to journalArticlepeer-review


The aim of this study was to evaluate clinical, neuropsychological, and functional differences between severe traumatic brain injury (TBI) outpatients with good and/or heightened metacognitive self-awareness (SA) and those with impaired metacognitive SA, assessed by the Patient Competency Rating Scale (PCRS). Fifty-two outpatients were recruited from a neurorehabilitation hospital based on the following inclusion criteria: 1) age ≥ 15 years; 2) diagnosis of severe TBI; 3) availability of neuroimaging data; 4) post-traumatic amnesia resolution; 5) provision of informed consent. Measures: A neuropsychological battery was used to evaluate attention, memory and executive functions. SA was assessed by the PCRS, which was administered to patients and close family members. Patients were divided into two groups representing those with and without SA. Patients with poor SA had more problems than those with good SA in some components of the executive system, as indicated by the high percentage of perseverative errors and responses they made on the Wisconsin Card Sorting Test. Moreover, a decrease in metacognitive SA correlated significantly with time to follow commands (TFC). This study suggests the importance of integrating an overall assessment of cognitive functions with a specific evaluation of SA to treat self-awareness and executive functions together during the rehabilitation process.

Original languageEnglish
Pages (from-to)360-368
Number of pages9
JournalJournal of the International Neuropsychological Society
Issue number2
Publication statusPublished - Mar 2010


  • Executive functions
  • Metacognitive self-awareness
  • Neuropsychological rehabilitation
  • Perseverative errors
  • SA assessment
  • Severe TBI

ASJC Scopus subject areas

  • Clinical Neurology
  • Psychiatry and Mental health
  • Clinical Psychology
  • Neuroscience(all)

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