Functional cognitive disorder in Alzheimer's disease

To conduct a preliminary exploration of functional cognitive disorders (FCD) in the context of Alzheimer's disease (AD), and potential shared mechanisms.

Retrospective analysis of a convenience sample of FCD patients with an overlapping diagnosis of AD evaluated in two outpatient services in the United Kingdom, between 2010 and 2023. Demographics, latency until AD diagnosis, detailed description of FCD and AD, comorbidities, family history, imaging and fluid biomarkers, cognitive testing, symptom trajectory, and employment status were collected from hospital records. Possible clues for AD among FCD patients were explored by comparing FCD-AD cases against a sample of insidious onset FCD-only patients matched for age at symptom onset.

Twelve FCD-AD cases were identified (eight female). All patients had FCD symptoms before or simultaneously with an AD diagnosis (median latency of 2.5 years). Low cognitive scores at baseline, sleep disturbance and/or mood and anxiety disorders were more common in the FCD-AD cases, in comparison with the FCD-only group. Informants' concern, executive, language and/or praxis difficulties, and an increase in repetitions may point to underlying AD. No cases appeared to be a misdiagnosis. Initial relative symptom stability or transient improvement, stressful life events around symptom onset and a family history of cognitive difficulties did not differentiate between FCD patients with or without AD.

FCD may be a prodromal or presenting feature of AD. We discuss potential links between the two, and the clinical relevance of these findings for prognostication and management of FCD patients, including its implications for clinical trials.