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Neuropsychological assessment in functional cognitive disorder: a scoping review
Anna Mammì1, Markus Reuber2, Angelo Pascarella1
1Department of Medical and Surgical Sciences, "Magna Græcia" University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy.
Background:
Functional cognitive disorder (FCD) involves potentially reversible cognitive complaints characterized by internal inconsistency, where subjective cognitive difficulties exceed or are incompatible with observed performance and cannot be explained by other neurological or psychiatric disorders. Although some patients perform below expected levels on formal tests, the role of neuropsychological assessment in FCD diagnosis remains unclear.
Objectives:
This review aimed to synthesize evidence on formal neuropsychological assessment in FCD and provide guidance for practitioners involved in its diagnosis. We investigated whether: 1) a typical pattern of cognitive performance can be identified in this condition; and 2) clinically relevant features may emerge during comprehensive neuropsychological evaluation.
Methods:
MEDLINE, Scopus, and PsycINFO were searched for English-language empirical studies on FCD up to January 9th, 2025. Quality appraisal was conducted using JBI tools. A narrative synthesis was performed analysing cognitive outcomes, clinical and behavioural features identified during neuropsychological evaluation.
Results:
Of 226 screened articles, 23 met inclusion criteria; quality was mixed. Cognitive performance in FCD is heterogeneous, and standalone tests have limited diagnostic utility. Key clinical features include mid-life onset, psychiatric comorbidities, and links to stress or adverse life events. Distinctive communicative and behavioural features may support diagnosis, though not diagnostic alone.
Conclusion:
The diagnosis of FCD requires a multidimensional approach integrating cognitive, behavioural, linguistic, and contextual observations. Neuropsychological evaluation can identify positive signs and internal inconsistencies through a combination of standardized cognitive testing, behavioural and linguistic observation, psychodiagnostics measures. Further research is urgently needed to validate potential cognitive markers and refine assessment strategies.
