A – 9 Latent Cognitive Profiles Reveal Elevated Positive Impression Management in High- and Low-Functioning Groups

Abstract Objective Although heterogeneity in neurocognitive functioning is well recognized, few studies have systematically evaluated cognitive performance patterns in clinical populations. Conceptualizing cognitive concerns as homogenous may hinder accurate diagnosis and intervention. This study aimed to identify cognitive subgroups using Latent Profile Analysis (LPA) in adults referred for neuropsychological evaluation. A secondary aim was to examine the association between profile membership and response style. Method Participants were 421 adults (Mean age = 51.97, SD = 11.17; 60.6% female; 92.8% White, 5.9% Black, and 1.2% Asian) referred for outpatient neuropsychological assessment at an academic medical center. LPA was conducted using z-scores derived from attention, executive functioning, memory, and language tests. Response style was assessed using the Personality Assessment Inventory (PAI). Results Five cognitive profiles were identified, ranging from low to high cognitive scores and unique patterns of strengths and weaknesses (Figure 1). Positive impression management (PIM) significantly differentiated profiles. Higher PIM scores were associated with significantly lower odds of being in P4 compared to P1 (β = -0.013, SE = 0.006, p = .022), and significantly greater odds of being in P5 compared to P4 (β = 0.013, SE = 0.006, p = .022). Conclusion Distinct cognitive profiles were associated with PIM. Elevated PIM in the highest- and lowest-functioning groups relative to an average-to-low functioning profile (P4) may reflect compensatory or self-enhancement strategies. Individuals in P1 may mask cognitive difficulties, while those in P5 may use PIM to align with their cognitive strengths. P4 individuals, showing intact cognitive abilities, may require fewer such strategies.