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Identifying functional cognitive disorder: a proposed diagnostic risk model

Published online by Cambridge University Press:  17 September 2021

Laura McWhirter Open the ORCID record for Laura McWhirter [Opens in a new window] ,
Craig Ritchie ,
Jon Stone  and
Alan Carson
Laura McWhirter*
Affiliation:
Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland, United Kingdom
Craig Ritchie
Affiliation:
Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland, United Kingdom
Jon Stone
Affiliation:
Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland, United Kingdom
Alan Carson
Affiliation:
Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland, United Kingdom
*
*Author for correspondence: L. McWhirter Email: laura.mcwhirter@ed.ac.uk
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Abstract

Background

Functional cognitive disorders (FCD) are an important differential diagnosis of neurodegenerative disease. The utility of suggested diagnostic features has not been prospectively explored in “real world” clinical populations. This study aimed to identify positive clinical markers of FCD.

Methods

Adults with cognitive complaints but not dementia were recruited from memory, neurology, and neuropsychiatry clinics. Participants underwent structured interview, Mini International Neuropsychiatric Interview, Montreal Cognitive Assessment, Luria 3-step, interlocking fingers, digit span and Medical Symptom Validity Test, Patient Health Questionnaire 15, Hospital Anxiety and Depression Scale, Multifactorial Memory Questionnaire, and Pittsburgh Sleep Quality Inventory. Potential diagnostic variables were tested against expert consensus diagnosis using logistic regression.

Results

FCD were identified in 31/49 participants. Participants with FCD were younger, spoke for longer when prompted “Tell me about the problems you’ve been having,” and had more anxiety and depression symptoms and psychiatric diagnoses than those without FCD. There were no significant differences in sex, education, or cognitive scores. Younger age and longer spoken response predicted FCD diagnosis in a model which explained 74% of diagnostic variability and had an area under the curve (AUC) of 94%.

Conclusions

A detailed description of cognitive failure is a sensitive and specific positive feature of FCD, demonstrating internal inconsistency between experienced and observed function. Cognitive and performance validity tests appear less helpful in FCD diagnosis. People with FCD are not “worried well” but often perform poorly on tests, and have more anxiety, depression, and physical symptoms than people with other cognitive disorders. Identifying diagnostic profiles is an important step toward parity of esteem for FCDs, as differential diagnoses of neurodegenerative disease and an independent target for clinical trials.

Keywords

cognitive disordersdiagnosisfunctional neurological disordersneurodegenerative diseasemild cognitive impairmentsubjective cognitive decline
Type
Original Research
Information
CNS Spectrums , Volume 27 , Issue 6 , December 2022 , pp. 754 - 763
Copyright
© The Author(s), 2021. Published by Cambridge University Press

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