Patients’ accounts of memory lapses in interactions between neurologists and patients with functional memory disorders

Abstract

One of the most commonly made diagnoses in secondary care memory services is functional memory disorder (FMD). FMD is non-progressive and characterised by persistent worries about memory failures without objective evidence of cognitive impairment. This study explores how patients with FMD present their memory concerns. Utilizing video recordings of consultations between patients and neurologists in a memory clinic, we show that FMD patients account for their memory deficits as significant disruptions to their daily lives. Resonating with research which identified a dissonance between self-reports of memory functioning by FMD patients and the outcome of neuropsychological assessments, we demonstrate that, in giving a detailed account of their perceived memory problems, patients provide objective conversational evidence of their cognitive and memory capacity, implicitly undermining the claim of an objective problem. Using conversation analysis, we examine three of the more prominent interactional practices FMD patients draw on when attempting to communicate memory deficits to the doctor - they are (i) contrasts with a standard of 'normal'; (ii) third-party observations; and (iii) direct reported speech. These interactional features are recurrent devices for displaying memory concerns as legitimate problems, embedded within patients' accounts of their day-to-day lives.

Metacognitive Performance on Memory and Visuospatial Tasks in Functional Cognitive Disorder

“…We hypothesised that people with FCD would show impaired mnestic metacognition, with a tendency to under-rate their performance, whilst those with neurodegenerative MCI (nMCI) would over-rate their abilities. This hypothesis is based on the inconsistency between self-reported cognitive functioning and performance in FCD [4,9]. This is similar to the discrepancies seen in other functional neurological disorders-people with functional tremor over-report the presence of tremor, as measured by wearable actigraphy [10].…”

Differentiating Functional Cognitive Disorder from Early Neurodegeneration: A Clinic-Based Study

“…Markers of cognitive internal inconsistency include: patient recognition that cognitive performance fluctuates under different circumstances; informant reports of cognitive ability being more favourable than self-report, or a higher level of concern in the subject than their informant (the opposite scenario to that seen in people with neurodegeneration); and performance in clinical interview. For example, providing a fluent, richly illustrated personal history, and/or informant reports of normal cognition [ 9 ], is internally inconsistent with self-reported enduring severe cognitive symptoms.…”

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

“…Empirically, the key clinical feature of FCD, as in other FND, is a discrepancy or internal inconsistency between subjective reports and objective measures, specifically in this instance of cognitive performance, most frequently memory performance. This is perhaps best encapsulated by the observation that patients are often able, during the history-taking component of clinical assessment, to remember what they claim to have forgotten and hence are able to give an account, often detailed, of these memory lapses [7]. The contrast with an erstwhile excellent or brilliant memory function is often complained of.…”

“…An increasing number of observational studies of FCD have been published (e.g., [7,[10][11][12][13][14][15][16][17]; see [18][19][20] for reviews). These suggest that FCD are commonly encountered in dedicated memory and cognitive disorders clinics, sometimes accounting for more than half of the patients seen, typically in individuals younger than those with dementia and mild cognitive impairment (MCI).…”