Assessment of Impaired Self-Awareness by Cognitive Domain After Traumatic Brain Injury

Purpose: To examine self-awareness in chronic traumatic brain injury (TBI) by cognitive domain, compare domain-specific self-awareness to global impaired self-awareness, and evaluate change in self-appraisal of cognitive ability from before to after neuropsychological testing. Method: Secondary analysis of a cross-sectional cohort of 59 participants with chronic TBI. We grouped participants as underestimators, fair estimators, and overestimators of their memory and executive functioning. We then compared these groups by global self-awareness measures, other clinical measures, and pre- to-posttest change in self-appraisal of cognitive performance. Results: Analyses revealed no significant differences in global self-awareness measures or depression between fair or underestimators and overestimators in Memory or Executive Function Domains. Only 12.50% of participants in the Memory Composite Domain and 6.89% of participants in the Executive Function Composite Domain changed their pre- to postneuropsychological test self-appraisal of cognitive ability. Conclusion: This study revealed most participants did not change their self-appraisal in response to completing neuropsychological testing alone. In conjunction with our findings that suggest global self-awareness measures may not adequately capture domain-specific self-awareness deficits in chronic TBI, this study provides support for development of targeted self-awareness assessment tools and the need for structured feedback, rather than naturalistic feedback alone, to improve self-awareness in chronic TBI.