Memory and our own beliefs and confidence in our ability to remember are important for our daily lives. For example, low confidence may hold us back from doing certain tasks, whereas misplaced high confidence in our memories may lead us to false beliefs about what has happened in the past.

However, it is not fully understood how people form their beliefs about their memory abilities. These beliefs we hold about how good our memory is are form of evaluation of our own abilities known as 'metacognition'. The purpose of this study is to better understand how individuals, both with and without diagnosed memory difficulties, perform memory tasks and examine whether their metacognition of their memory performance depends on the type of memory task. That is, the study examines metacognition for different forms of memory; for example memory of our experienced life events as compared to memory for facts. There is still much more to learn about how individuals experience and think about their memories and memory abilities; and understanding this is important as some evidence suggests that good metacognition is associated with better outcomes after diagnosis of cognitive impairment. Understanding metacognitive beliefs about memory could be a route to earlier diagnosis and enable us to identify people who are likely to develop dementia.

Our confidence in our memory ability is important for our wellbeing, especially in older age as many of us begin to fear developing dementia. The ability to judge our own cognitive abilities, such as our memory, is called metacognition. The confidence we have in our memory can be affected by changes in these metacognitive skills. Many older individuals are referred to memory clinics because they believe that their memory ability has decreased. Some individuals with these memory complaints, but without dementia, demonstrate signs of impairment to their thinking processes when tested by clinicians and are given the diagnosis Mild Cognitive Impairment (MCI). Others show no impairment when tested and are given the diagnosis Subjective Cognitive Decline (SCD). A sparse amount of research has investigated the metacognitive abilities of these groups of individuals; both those with MCI and those with SCD. Investigation of these abilities is important as some work suggests that good metacognition is associated with better symptom outcomes (Chi et al., 2022; Zhuang et al., 2022). Understanding the mechanisms underlying metacognitive beliefs about memory could be a route to earlier diagnosis and enable us to identify people who are likely to develop dementia. In this study we will recruit individuals with both MCI or SCD and age-matched controls, who do not feel that they have memory impairments, in order to investigate their metacognitive beliefs about their memory abilities.

Primary Objective: The primary objective of the study is to measure whether metacognitive judgements of memory performance differ between older healthy individuals and patients who have been referred to memory clinics. The study will include patients diagnosed with Mild Cognitive Impairment (MCI) and those with Subjective Cognitive Decline (SCD) to examine how they judge their ability to remember, compared to healthy older individuals.

To achieve this objective, the following will be assessed:

How do people rate their own memory in daily life and does this vary across different memory domains? (this is known as self-belief)

How do people rate their ability to complete the tasks we ask them to take part in? (known as global metacognition)

How confident are people in their memory when they take part in a memory task? (known as local metacognition)

Are there differences in 1), 2) and 3) between individuals with and without memory complaints?

The 'global' and 'local' metacognition examined in 2) and 3) will be compared across different types of cognitive task. The cognitive tasks assess semantic and episodic memory and visual perception. This will allow examination of the following:

Are there differences in global (how confident they think about completing the task overall) and local metacognition (hoe confident they are for each response they give) between the different tasks, e.g., between semantic memory and episodic memory?

What is the relationship between self-beliefs, global and local metacognition? Examined through a self-belief questionnaire at the start and the self-rated confidence values given throughout the tasks.

Are there differences in 5) and 6) between individuals with and without memory complaints?

Secondary objective:

Are there differences in cognitive performance between those with and without memory complaints? This is assessed through the scores people achieve on the tasks used - rather than on the confidence ratings people give while completing the tasks.

Are there differences in cognitive performance between the three types of task? Performance will be examined for each individual task separately (e.g., spatial information and object information maintenance - both of which are art of the episodic memory battery.

Does dementia worry moderate the metacognitive processes of the individuals? This will be assessed by examining responses given in the Dementia Worry questionnaire and comparing their level of dementia worry (high, medium, low) to the confidence ratings they give throughout.

Inclusion Criteria:

• In age range given above
• Referred to memory clinic
• No other current psychiatric or neurological disorders, except for migraine
• Can understand verbal or written information given in English.

Exclusion Criteria:

• Outside age range given above
• If they have a diagnosis of dementia and/or inability to provide informed consent.
• Diagnosis of other neurological and/ or psychiatric problems.
• Healthy participants will be excluded if they have participated in the previous study (King's REC ref: HR/DP-21/22-302230), as this study is a continuation of that.

Participants will be identified through the South London and Maudsley (SLaM) NHS memory clinics, the Joint Dementia research internal database REDCap and the Brain health Clinic at King's College London. Service users who satisfy the inclusion criteria of the study will be identified by clinics and research teams in the respective services and informed about the study. If participants give consent to contact (provided by the services mentioned above), the research team will contact the participants through email and provide further information about the study. Should the participant agree to participate, they will be offered to come to the test lab at King's College London Guy's campus.

We may share outcome measures with the CARE network at KCL as they are putting us in contact with their healthy control participant database.