Abstract
Functional cognitive disorder describes patients with persistent, troublesome subjective cognitive complaints that are inconsistent with a recognized disease process, and where significant discrepancies are found between subjective and objectively observed cognitive functioning. The etiology is heterogeneous and potentially related to underlying psychological factors. Making a diagnosis of functional cognitive disorder can be challenging and there is the potential for misdiagnosis of early-stage neurodegeneration. We compared neuropsychological findings in three groups: functional cognitive disorder (FCD), mild cognitive impairment (MCI), and healthy controls. Participants were recruited from the ReMemBr Group Clinic, North Bristol NHS Trust, and via Join Dementia Research. Both the FCD and MCI groups showed elevated prospective and retrospective memory symptom scores. Performance on the Montreal cognitive assessment was equivalent in the FCD and MCI groups, both being impaired compared with the controls. The FCD group was younger than those with MCI. We discuss challenges and controversies in the diagnosis of functional cognitive disorder, alongside illustrative cases and proposals for areas of research priority.
Highlights
Functional cognitive disorder (FCD) describes patients presenting with significant subjective cognitive symptoms that are out of keeping with their observed level of cognitive functioning and not compatible with a recognizable neurodegenerative, psychiatric, or systemic primary cause [1]
We report data and illustrative cases from a recent study of FCD and mild cognitive impairment (MCI) patients drawn from a specialist cognitive clinic
One patient in the FCD group did not attend for subsequent clinical follow-up, and one MCI participant was recruited from Join
Summary
Functional cognitive disorder (FCD) describes patients presenting with significant subjective cognitive symptoms that are out of keeping with their observed level of cognitive functioning and not compatible with a recognizable neurodegenerative, psychiatric, or systemic primary cause [1]. In order to make a diagnosis of FCD, a marked discrepancy between self-reported cognitive symptomatology and observed or reported cognitive functioning must be present. This internal inconsistency in symptoms is evident on comparison of symptom severity with performance on neuropsychological testing or everyday “real world’ cognitive ability. FCD is distinguished from SCD by the presence of significant inconsistency between subjective and objectively observed cognitive functioning, a greater severity of self-reported symptomatology, and resistance to reassurance that observed cognitive functioning is intact. The optimal diagnostic criteria and management strategies for Diagnostics 2019, 9, 131; doi:10.3390/diagnostics9040131 www.mdpi.com/journal/diagnostics
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