### abstract ###
patients suffering from the behavioral variant of frontotemporal dementia ftd-b often exaggerate their abilities
are those errors in judgment limited to domains in which patients under-perform  or do ftd-b patients overestimate their abilities in other domains
is overconfidence in ftd-b patients domain-specific or domain-general
to address this question  we asked patients at early stages of ftd-b to judge their performance in two domains attention  perception in which they exhibit relatively spared abilities
in both domains  ftd-b patients overestimated their performance relative to patients with dementia of alzheimer type dat and healthy elderly subjects
results are consistent with a domain-general deficit in metacognitive judgment
we discuss these findings in relation to  regression to the mean  accounts of overconfidence and the role of emotions in metacognitive judgments
### introduction ###
how good are you at multitasking
how good are you at remembering people's names
judgments people make about their own cognitive abilities vary greatly from one person to another
these judgments about the self are also systematically biased relative to the judgments made by others about us CITATION
we often regard ourselves as more competent than others CITATION and better than what is justified by our actual performance CITATION
discouraging as these observations might be  people can learn and improve at most cognitive tasks
the learning occurs not only at the task levelwe can get better at playing the pianobut also at the meta-levelwe become more attuned to judging just how good we are at playing the piano
these examples illustrate several aspects of what is known in the cognitive and developmental literatures as metacognition or the knowledge people possess about their own cognitive abilities  including beliefs about their own performance in specific tasks
some psychologists have argued that metacognitive judgment is secondary to actual performance CITATION
according to this view  the knowledge and skills required to perform tasks in a certain domain are also required for judging one's ability in that domain
one corollary of this view is that metacognitive judgment is domain-specific  a person who is good at remembering things and bad at understanding how others feel will be relatively aware of his good memory skills but relatively unaware of his poor empathy skills
despite its intuitive appeal  this view has been challenged as confounding metacognitive judgment with level of performance
because subjective estimates of performance are never perfectly correlated with actual performance  judgments of performance will regress toward the mean  participants who perform worst in a given domain will tend to overestimate their ability in that domain  while those performing best will tend to underestimate
in other words  the relation between actual performance and subjective judgment may reflect a statistical artifact rather than a genuine relation between cognitive and meta-cognitive levels CITATION
although biased beliefs about one's own skills are the norm  such biases are often exacerbated in psychiatric and neurological disorders CITATION
denial of deficit  reduced self-awareness  loss of insight  and anosognosia are all clinical terms that broadly refer to the same phenomenon  a patient's distorted assessment of her own skills
these patient populations provide an excellent opportunity to test the domain-specificity of metacognitive judgment  as certain abilities become severely affected by the disease while others remain relatively unaffected
thus  it is possible to ask whether metacognitive judgments become distorted only in the affected domains or the distortion generalizes to judgments in spared domains
the answer to this question so far has been mixed
consistent with the domain-specificity hypothesis  some studies have reported cases of patients with hemiplegia who deny their paralysis but acknowledge limitations in other domains CITATION
there is also evidence that failures of awareness cluster around symptoms
for example  in a study of denial in dementia of alzheimer's type dat  a factor analysis of questionnaire data revealed two independent factors  a  cognitive denial  related to length of disease and severity of cognitive deficits  and a  behavioral denial  related to behavioral disinhibition and inappropriate emotional displays CITATION
in contrast  other studies have reported findings consistent with a domain-general deficit  showing that metacognitive errors extend beyond the specific domain of impairment
for example  patients with probable dat have been reported to overestimate their performance not only in memory but also in visuo-spatial tasks CITATION
furthermore  denial in dat seems to correlate more strongly with frontal lobe deficit than with memory problems  despite the latter being more typical of dat CITATION
although denial of deficit is prevalent in the clinical setting and may help us understand over-optimism in healthy adults  until not long ago research on denial of deficit had proceeded independently from the experimentally based literature on metacognitive judgment
recently  the clinical and experimental traditions have become better integrated and clinical researchers have begun to rely more heavily on experimental paradigms CITATION
such experimental designs are useful for comparing patients' judgments of their performance to their actual performance on the task
furthermore  by asking the patient to predict performance before the task and to estimate it after the task  it is possible to assess metacognitive monitoring i e   whether metacognitive judgment improves after experiencing the task
experimental designs can be applied to domains other than the one of primary clinical concern
this feature becomes important when testing the domain generality of metacognitive judgment
the patient populations in our study consisted of patients with a behavioral variant of frontotemporal dementia ftd-b and patients with early dementia of alzheimer type dat
although ftd-b has an insidious onset and a gradual progression  its clinical presentation bears close resemblance to cases of orbitofrontal damage caused by traumatic brain injury  such as the famous case of phineas gage CITATION
ftd-b patients are often described by their spouses as unable or unwilling to take other people's feelings into account when deciding how to act
they often exhibit inappropriate social behavior  changes in personality and poor decision making CITATION
at early stages of the disease  many ftd-b patients deny having difficulties or seem unconcerned about them CITATION
such a denial has been documented in the social and emotional domains but needs to be explored further in domains of relatively spared performance
in contrast to ftd-b  patients in early stages of dat have their social skills relatively spared
the deficit in dat is primarily of episodic memory CITATION
at early stages  dat patients tend to be aware of their deficit  but this awareness declines as the disease progresses CITATION
after describing ftd-b's denial of deficit in semi-structured interviews  we report two experiments that examined whether ftd-b patients overestimate their performance relative to dat patients and healthy adults
pre- and post-test judgments of performance were obtained for an attention task experiment  NUMBER   stroop task and a perception task experiment  NUMBER   change blindness task
by testing metacognition in two different domains attention  perception  neither of which is prototypically impaired in early dementia  we were able to test the domain-generality of metacognitive judgments
