Functional Cognitive Disorder: A Common Cause of Subjective Cognitive Symptoms

Abstract

Patients frequently present to the memory clinic with self-reported cognitive symptoms that cannot be attributed to structural, toxic, or metabolic causes, and are out of keeping with their performance on neuropsychological assessment. This can be considered to be Functional (psychosomatic) Cognitive Disorder, which results in significant patient distress and often has a major impact on social functioning and employment. We performed a retrospective analysis of the Bristol ReMemBr group cognitive clinic database to ascertain the prevalence of Functional Cognitive Disorder, review the patient characteristics, and develop new guidelines for diagnosis and management. 196 patients were screened of whom 23 were diagnosed with Functional Cognitive Disorder; the oldest patient with this diagnosis was aged 60 years at symptom onset. When considering only those presenting below the age of 60 years (total no. held on database = 69), a third were diagnosed with Functional Cognitive Disorder. On neuropsychological testing, 47% had an atypical (invalid) pattern of results, or failed tests of performance validity. Of those with valid neuropsychological results, 80% scored in the normal range. Depression and anxiety were common but did not appear to be the primary cause of cognitive symptoms. Particular characteristics seen were excessively low self-rating of memory ability, and discrepancies between perceived and actual cognitive performance. The rate of unemployment was high, often due to the cognitive symptomatology. This is an important disorder to address, being common in working adults, and carrying a risk of misdiagnosis as early neurodegeneration, with subsequent inappropriate treatment and inclusion in clinical trials.

Functional cognitive disorders: memory clinic study

“…The observed frequency is higher than that reported in a retrospective database study from a memory clinic. 8 This study involved a single clinic over a limited time frame. Inevitably this will entail biases in the population studied (selection bias, referral bias), although no age criteria for referrals operate in this clinic.…”

“…One retrospective memory clinic database study diagnosed one third of patients presenting with cognitive complaints below the age of 60 years with FCD. 8 Previous experience in our dedicated cognitive disorders clinic based in a secondary care (neurosciences centre) setting has shown that more than 50% of patients referred are not diagnosed with dementia or mild cognitive impairment and that this has been a consistent observation over a number of years (Table 1, Figure 1). 9 It seems possible that many of these hitherto undiagnosed patients, previously labelled pragmatically in the clinic as having 'subjective memory complaint', may in fact qualify for a positive diagnosis of FCD as defined by Stone et al 7 We undertook a study with the following objectives: firstly to measure the frequency with which a diagnosis of FCD was made in patients attending a dedicated Functional cognitive disorders: memory clinic study Viraj Bharambe BM, BSc, MRCP, Andrew J Larner MD, PhD 'Functional cognitive disorders' (FCD) is a terminology suggested to denote patients who present with memory complaints but in whom no underlying cognitive disorder is found.…”

Functional (Psychogenic) Cognitive Disorders: A Perspective from the Neurology Clinic

“…[7]. Functional memory disorder was diagnosed twice as often in women as men and 9/19 patients were thought to have invalid neuropsychological results on the basis of effort testing.…”

Sodium tanshinone IIA sulfonate protects against Aβ‐induced cell toxicity through regulating Aβ process

“…Alzheimer's disease (AD) is increasingly severe in this century . The clinical characteristics of AD are deficiencies in cognition . AD pathology is mainly characterized by excessive accumulation of toxic forms of amyloid‐β (Aβ), abnormally hyperphosphorylated tau and neurofibrillary tangles .…”