Neural correlates of metacognitive monitoring in chronic moderate to severe traumatic brain injury.

INTRODUCTION

Metacognition can be negatively affected after moderate to severe traumatic brain injury (TBI). This study utilized functional magnetic resonance imaging (fMRI) to identify patterns of neural activation associated with metacognitive confidence judgments after moderate to severe TBI.

METHOD: Twenty-four adults with chronic moderate to severe TBI and 10 non-injured adults (nonTBIs) were scanned while performing a meta-memory recognition task. Metacognitive accuracy was quantified using a signal detection theory approach. Activation present during the metamemory task, as well as group differences in activation correlated to metacognitive accuracy were identified.

RESULTS

Adults with TBI did not differ in their metacognitive accuracy from nonTBIs; however, differences in neural recruitment were noted. Adults with TBI demonstrated stronger relationships between metacognitive performance and activation in the left angular gyrus and left supramarginal gyrus, while nonTBIs showed stronger associations in the left superior parietal lobule, left lateral occipital cortex, left precuneus, and left occipital fusiform gyrus.

CONCLUSIONS

The findings suggest that different neural resources may be used after TBI to facilitate metacognitive processing and to modulate the direction of confidence accuracy. Particularly, greater activation in the angular gyrus may reflect strategies to rely on monitoring processes and enhanced memory to facilitate metacognitive processing post-injury.