Remembering to Remember: Metamemory Judgments of Prospective Memory after Traumatic Brain Injury

Abstract

Background: Impairments to prospective memory (PM) are ubiquitous after traumatic brain injury (TBI). PM is remembering to complete an intention at a future time – like picking up milk on the way home – and is critical for independent living. PM includes two primary components: recognizing the CUE when a task should occur, and recalling the TASK to be completed. Many adults use memory aids for PM, such as notes or phone alarms. Such strategy use is related to metamemory judgments, or self-assessments of future success. Purpose: The purpose of the current study was to examine how adults with and without TBI consider PM performance. Research questions compared predictions and recall performance at PM, as well as the relationship between PM metamemory predictions and standardized assessments of cognitive function. Methods: Eighteen adults with chronic moderate to severe TBI and 20 matched healthy controls played Tying the String, an online simulated workweek PM game. Participants studied PM items and made two judgments of learning about the likelihood of recognizing a PM CUE, and of recalling the PM TASK. Participants also completed a standard neuropsychological battery. Results: Participants with TBI were less confident in future recall than healthy controls and both groups were less confident about the TASK. For recall performance, healthy controls performed similarly across the CUE and TASK. In contrast, adults with TBI at times recognized a CUE, but were unlikely to remember the corresponding TASK. Absolute difference scores of metamemory accuracy showed that healthy adults were underconfident across PM, whereas adults with TBI were overconfident about the task. Adults with TBI adjusted judgments downward as the game progressed at a rate greater than healthy controls. During standardized testing, participants with TBI chose to use PM strategies, but those strategies were not effective at triggering PM recall. Discussion: Participants with TBI adjusted metamemory expectations downward, but not enough to account for poor recall performance. Individuals with TBI have metamemory awareness to use strategies, but deficient monitoring of memory performance results in incomplete metamemory knowledge. Future work should address linking PM metamemory monitoring with strategy use to direct intervention approaches.