Carolien Zeetsen

105 CHAPTER Cognitive performance during addiction treatment 5 Another finding is that patients rate their own everyday cognitive functioning to be better than that rated by clinicians. While clinician ratings are significantly lower in patients with KS, followed by patients with ARCI and those with AUD respectively, and thus supporting our hypothesis, patient ratings did not differ between groups. This finding is in line with the literature in which patients do not always report subjective complaints because of a lack of insight into their own cognitive deficits (Walvoort et al., 2016). As opposed to the patient ratings, clinicians do not report a significant change in overall everyday cognitive functioning over the course of treatment, which does not support our hypothesis. This finding can be explained when looking at the four domains separately. As scores for activities of daily living and cognitive abilities improved significantly, scores for interpersonal abilities and emotional lability significantly declined over time. Patients with AUD and ARCI reported significant improvements in overall everyday cognitive functioning, thus partly supporting our hypothesis, and also on the domains activities of daily living, cognitive abilities and emotional lability. These changes may be influenced by the fact that patients were probably in a better emotional state when completing the second assessment, as they were (soon to be) clinically discharged. Although several significant positive correlations were found between changes in cognitive performance and changes in everyday cognitive functioning, the effect sizes remained mostly small to medium. This supports the literature that cognitive performance on objective measures is not predictive for cognitive deficits in the absence of subjective experiences of these deficits (Horner et al., 1999). Correlations were highest between overall cognitive performance and the clinician ratings of everyday cognitive functioning. Interestingly, changes in cognitive performance on orientation also correlated significantly with everyday cognitive functioning and correlations were overall higher for patients with KS. These findings on correlations between cognitive performance and everyday cognitive functioning partly support our hypothesis. There are several strengths to this study. First, being able to include a large group of patients and follow them over a significant amount of time in an inpatient setting, makes the findings highly clinically relevant and generalisable to the population. Second, due to an extensive (multidisciplinary) diagnostic process, it was possible to compare three well–described patient groups. Third, because the patients were clinically admitted information from multiple sources, including from clinicians who were familiar with the patient and his/her abilities, could be included. Finally, two instruments (MoCA and PCRS) were used that are freely available and are easy to administer.