Functional Cognitive Disorders (FCD): How Is Metacognition Involved?

Abstract

Functional cognitive disorders (FCD) have become a subject of increasing clinical interest in recent years, in part because of their high prevalence amongst patients attending dedicated memory clinics. Empirical understanding of FCD based on observational studies is growing, suggesting a relationship to other functional neurological disorders (FND) based on shared phenomenology. However, understanding of FCD at the theoretical level has been lacking. One suggestion has been that FCD are disorders of metacognition, most usually of metamemory. In this article, a brief overview of these constructs is presented along with existing evidence for their impairment in FCD. Previous adaptations of theoretical models of FND to accommodate FCD are reviewed. A novel application to FCD of Nelson and Narens’ monitoring and control model of metamemory is then attempted, positing an improper setting of the monitoring function, with examples of ecological relevance. Formulation of FCD in light of a metacognitive model of anosognosia is also considered. Although lacking mechanistic and neuroanatomical sophistication, this metacognitive formulation of FCD may give pointers for future hypothesis-driven research and a pragmatic basis for management strategies.

Towards a Neural Network Hypothesis for Functional (Dissociative) Amnesia: Catastrophic Forgetting

“…To use Hughlings Jackson's pathophysiological framework, the negative features of functional amnesia may reflect non-functioning rather than destroyed tissue. Apparent recovery of "lost" memories might also suggest lack of metacognition plays a role in at least some instances of functional amnesia, as has previously been suggested in other forms of FCD [20][21][22][23][24].…”

“…The hypothesis as proposed obviously lacks neuroanatomical and mechanistic precision, a complaint frequently levelled against hypothetical models of functional disorders [22,25]. Ideally studies of hippocampal and neocortical networks pertinent to memory are required in functional amnesia patients.…”

Ageing 2023: Proceedings of 6th Gerontological Interdisciplinary Conference

“…PP je charak-terizovaný kombináciou vysoko hodnotenej dôležitosti pamäťových schopností a intolerancie miernych pamäťových výkyvov (Teodoro, Edwards & Isaacs, 2018). PP podporuje seba-monitorovanie, všímavosť voči pamäťovým zlyhaniam a katastrofické interpretácie benígnych omylov a obavy s nimi súvisiace (Teodoro, Edwards & Isaacs, 2018;Larner, 2021). PP koreluje so závažnosťou SCD v oblasti pamäti v klinickej populácii aj v komunite (Metternich, Schmidtke & Hüll, 2009).…”

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“…Additionally, by designing this software, we wanted to lay a foundation for future research on one of the hottest areas in cognitive neuroscience: the relationship between metacognition and functional cognitive impairments (Larner, 2021).…”