(PS7-8) Changes in Perception of Cognition Throughout a Home-based Intervention for Hoarding Disorder

Abstract Text: Impairment in cognitive function may be linked with the development of hoarding disorder (HD). More specifically, increased deficits in working memory and attention, executive functioning, visuospatial learning and memory are often reported among those with hoarding disorder (Woody et al., 2014). Deficits in these areas coincide with difficulties related to sustained attention to sorting tasks, challenges with planning and executing tasks related to discarding items, and potential difficulties with recalling available space. In addition to objective impairment in cognitive function, those with HD tend to self-report memory impairment, increased distractibility and inattention (Tolin et al., 2018). While deficits reported in subjective and objective assessment of cognition are reported among those with HD, there does not tend to be a relation between these variables (Zakrzewski et al., 2022). Those with hoarding disorder may have difficulty accurately assessing their cognitive function (i.e., belief their memory is worse than it is objectively) which leads to keeping items as a compensatory mechanism (Hartl et al., 2004). Psychotherapeutic interventions aimed towards improving hoarding symptoms may indirectly influence perceptions of cognitive ability. Twenty-three rural-dwelling older adults (Mage= 69 yrs; 75% women; 73% White) were enrolled in Project RECLAIM (Reduce Clutter and Increase Meaning), a home-based treatment using sorting practice and motivational interviewing to treat hoarding disorder. Participants were assessed prior to treatment, at 4 weeks, and 8 weeks into treatment on measures including PROMIS Cognitive Function (a self-reported measure), NIH Toolbox Cognition Battery (generating an objective Total Cognition Composite), and self-reported hoarding disorder symptoms (clutter, acquisition, and difficulty discarding) on the Saving Inventory-Revised. Subjective cognition was associated with clutter (r = -.59, p = .004), and not with objective global cognitive ability (r = -.23, p = .311). Participants tended to report nonsignificant increases in subjective cognitive ability from baseline to week 4 of intervention (M = 43 vs. 46; t(11) = -1.62, p = .067) and from baseline to week 8 of intervention (M = 43 vs. 48; t(9) = -.39, p = .098). For individuals with HD, perception of cognition may not relate to objective cognition scores and may actually be more linked to the disorganization of the household. As the clutter level decreases over the course of intervention, HD patients may experience an increase in subjective cognitive functioning. Further study is required to determine a potential causal relationship between subjective cognition and clutter, and mechanisms affecting subjective cognition within HD intervention.