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Identifying functional cognitive disorder: a proposed diagnostic risk model.

Laura McWhirter1, Craig Ritchie1, Jon Stone1

  • 1Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland, United Kingdom.

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|September 17, 2021
PubMed
Summary

Functional cognitive disorders (FCD) are often misdiagnosed. Younger age and detailed patient descriptions of cognitive issues are key diagnostic markers, improving accuracy in real-world clinical settings.

Keywords:
cognitive disordersdiagnosisfunctional neurological disordersmild cognitive impairmentneurodegenerative diseasesubjective cognitive decline

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Area of Science:

  • Neurology
  • Neuropsychiatry
  • Cognitive Science

Background:

  • Functional cognitive disorders (FCD) present a diagnostic challenge, often mimicking neurodegenerative diseases.
  • Prospective validation of diagnostic markers in real-world clinical settings is lacking.
  • This study sought to identify reliable clinical indicators for FCD.

Purpose of the Study:

  • To identify positive clinical markers for functional cognitive disorders (FCD).
  • To differentiate FCD from other cognitive complaints in a clinical population.
  • To improve diagnostic accuracy and clinical management of FCD.

Main Methods:

  • Recruited adults with cognitive complaints (excluding dementia) from specialized clinics.
  • Administered a comprehensive battery of assessments including interviews, cognitive tests, and symptom/validity measures.
  • Utilized logistic regression to test potential diagnostic variables against expert consensus FCD diagnosis.

Main Results:

  • Functional cognitive disorders (FCD) were diagnosed in 31/49 participants.
  • Younger age, longer spoken responses detailing cognitive problems, and higher rates of anxiety/depression predicted FCD.
  • A predictive model incorporating age and spoken response duration achieved 74% diagnostic variability and 94% AUC.

Conclusions:

  • Detailed patient descriptions of cognitive failure serve as sensitive and specific positive markers for FCD.
  • Cognitive and performance validity tests were less informative for FCD diagnosis.
  • FCD patients exhibit significant anxiety, depression, and physical symptoms, challenging the 'worried well' stereotype and highlighting the need for diagnostic parity.