Practical Judgment and Insight into Memory Functioning are not Associated in MCI

Lena Etzel, Emory University School of Medicine, Atlanta, United States
Liselotte De Wit, Emory University School of Medicine, Atlanta, United States
Felicia Goldstein, Emory University School of Medicine, Atlanta, United States
Kayci Vickers, Emory University School of Medicine, Atlanta, United States


Insight and judgment are key to maintaining functional status in mild cognitive impairment (MCI); however, the relationship between these concepts is not well-understood in the context of cognitive impairment. Validated measures of insight are limited, making it difficult to capture decline and study the impact of changes in these domains. Although psychometrically sound tools have been developed to evaluate practical judgment, this type of judgment is likely distinct from the self-judgments required for insight. The present study aimed to better understand the relationship between practical judgment and insight among patients diagnosed with MCI. In the present study, we hypothesized that greater practical judgment would be associated with better insights (more accurate self-evaluations) of memory performance given involvement of the frontosubcortical network for both abilities.

Participants and Methods:

Participants included 96 individuals with a clinical diagnosis of MCI enrolled in Emory’s Cognitive Empowerment Program (CEP). Participants were predominantly White (81.5%), well-educated (Meducation= 16 years, SDeducation= 2.61), and averaged 74.08 years (SDage = 7.24). Roughly half were male (53%). Data for present analyses were collected at program baseline, before engagement in CEP, and include: (1) Test of Practical Judgment (TOP-J, 9-item; measures practical judgment using scenarios related to safety, medical, social/ethical, and financial issues) (2) Hopkins Verbal Learning Test–Revised recognition discrimination (HVLT-R; measures objective memory performance), and (3) The memory subscale from the Measurement of Everyday Cognition (ECog; measures subjective memory functioning. A proxy for insight into memory functioning was generated based on the discrepancy score between the Z-transformed HVLT-R recognition discrimination score and the inverted and Z-transformed ECog-Memory score. Pearson correlations were calculated between measures of subjective memory, practical judgment, and objective memory performance. A linear regression analysis was conducted to evaluate whether practical judgment was a predictor of the discrepancy between subjective memory and objective memory performance. Age, sex, and education served as control variables.


Bivariate Pearson correlations revealed ECog-Memory was not significantly correlated with HVLT-Recognition discrimination (r = 0.06), suggesting subjective and objective memory difficulties were not aligned among individuals in this study. Moreover, practical judgment (TOP-J) was also not significantly correlated with subjective or objective memory complaints (ECog-Memory r = -0.05; HVLT-Recognition discrimination r = 0.07). Contrary to our hypotheses, practical judgment was not correlated with the degree of discrepancy between subjective and objective memory (r = -0.01). Similarly, a linear regression analysis did not yield any significant predictors of the discrepancy between subjective and objective memory.


The present results showed that subjective and objective memory difficulties were not correlated, potentially suggesting poor insight into memory functioning among the individuals with MCI in our sample. Thus, caution should be taken when relying on the self-report regarding memory in individuals with MCI. Our findings further suggest that practical judgment is not predictive of insight into memory functioning in MCI. As such, practical judgment and evaluative self-judgments may represent separate constructs that need to be assessed separately. Future work should aim to replicate our findings utilizing different methods to assess insight in MCI and pre-clinical Alzheimer’s disease.

Category: MCI (Mild Cognitive Impairment)

Keyword 1: mild cognitive impairment
Keyword 2: memory complaints
Keyword 3: awareness