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We examined cognitive awareness in PwMS, its change after undergoing neuropsychological assessment, and its association with mood, fatigue, and objective cognitive functioning.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>PwMS were recruited as part of an observational study (Don\u2019t be late!). Participants estimated their performance on the Minimal Assessment of Cognitive Function in MS (MACFIMS) battery before and after the assessment, relative to a demographically matched peer group. Participants were classified as overestimators, accurate estimators, or underestimators, based on discrepancies between subjective and objective percentile scores. Symptoms of mood and fatigue were assessed with the Hospital Anxiety and Depression Scale and the Modified Fatigue Impact Scale.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The sample included 228 PwMS (mean age\u2009=\u200948.39\u2009\u00b1\u200911.15\u00a0years; 70.2% female). Prior assessment, 123 participants (54%) overestimated, 70 (31%) accurately estimated, and 35 (15%) underestimated their cognitive performance. After assessment, fewer participants overestimated their performance (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200989; 39%), while more accurately estimated (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200989; 39%) or underestimated (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200950; 22%) their performance. Fatigue and objective cognitive functioning predicted cognitive awareness at both time points (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.005); depression only before testing (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.040), and anxiety was not a significant predictor (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.417).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>About half of PwMS overestimate their cognitive performance before neuropsychological assessment. While task experience generally improves estimation accuracy, it also leads to increased underestimation in some PwMS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00415-025-13486-2","type":"journal-article","created":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T09:55:59Z","timestamp":1762336559000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Cognitive awareness in people with multiple sclerosis before and after neuropsychological assessment"],"prefix":"10.1007","volume":"272","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4226-7446","authenticated-orcid":false,"given":"P. T.","family":"Waskowiak","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B. A.","family":"de Jong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B. M. 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T. Waskowiak (PW): is a PhD candidate on the Don\u2019t be late! project, funded by the Dutch Research Council (NWO). She has received speaker honoraria from Biogen and Sanofi Genzyme. B. A. de Jong (BdJ): reported receiving grants from Dutch MS Research Foundation, National MS Foundation, Dutch Multiple Sclerosis Association, and Zorgverzekeraars Nederland (i.e. umbrella organization of health insurers in the Netherlands). B.A. de Jong is member of the medical advisory board of the Dutch MS Society, member of the scientific board of the Dutch MS Research Foundation, chair of the committee for the revision of the guideline on disease modifying therapy and MS for the Netherlands Society of Neurology, and chair of the committee of the Dutch National MS registration of the Netherlands Society of Neurology. B. M. J. Uitdehaag (BU): has received consultancy fees from Immunic Therapeutics. nothing to disclose. H. E. Hulst (HH): is a board member of the Multiple Sclerosis Journal, receives research support from the Dutch MS Research Foundation and the Dutch Research Council. She has served as a consultant for or received research support from Atara Biotherapeutics, Biogen, Novartis, Celgene\/Bristol Meyers Squibb, Sanofi Genzyme, MedDay and Merck BV. A. Myronenko (AM), and M. Klein (MK): declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}},{"value":"The study was conducted according to the principles of the Declaration of Helsinki (2013) and in accordance with the Dutch Medical Research Involving Human Subjects Act (WMO). The Medical Ethical Committee of the Amsterdam UMC, Vrije Universiteit Amsterdam has reviewed and approved this study (METC 2021.0707, protocol version 2, 4 May 2022). 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