Abstract
Neurocognitive symptoms are common in individuals with somatic symptom and related disorders (SSRD), but little is known about the specific impairments in neurocognitive domains in patients with conversion disorder (CD)/functional neurological disorder (FND). This study examines neurocognitive functioning in patients with CD/FND compared to patients with other SSRD. The sample consisted of 318 patients. Twenty‐nine patients were diagnosed with CD/FND, mean age 42.4, standard deviation (SD) = 13.8 years, 79.3% women, and 289 patients had other SSRD (mean age 42.1, SD = 13.3, 60.2% women). Patients completed a neuropsychological test battery that addressed a broad range of neurocognitive domains, including information processing speed, attention and executive functioning. Patients with CD/FND had clinically significant neurocognitive deficits in all neurocognitive domains based on normative data comparison. Patients with CD/FND also performed significantly worse than patients with other SSRD on information processing speed (Digit Symbol Substitution Test (V = .115, p = .035), Stroop Color–Word Test (SCWT) card 1 (V = .190, p = .006), and SCWT card 2 (V = .244, p < .001). No CD/FND vs. other SSRD differences were observed in other neurocognitive domains. These findings indicate the patients with CD/FND perform worse on information processing speed tests compared to patients with other SSRD.
Highlights
We expect that neurocognitive functioning in patients with CD/FND will be poorer compared to patients with other symptom and related disorders (SSRD) and that these differences are not accounted for by potential confounders
A total of 29 patients were diagnosed with CD/FND of which 6 patients presented with psychogenic non-epileptic attacks, seven patients suffered from periods of unresponsiveness and 16 patients showed either weakness/paralysis or loss of sensation in extremities
Regarding the 289 patients with other SSRD, two patients were diagnosed with factitious disorder, two with unspecified psychological disorder by a somatic disease, 23 patients were diagnosed with an illness anxiety disorder, and 262 patients were diagnosed with a somatic symptom disorder
Summary
The prevalence of CD/FND is approximately 0.7–5.0% (Uijen & Bischoff, 2011) and is more common among women than men (Feinstein, 2011; Krem, 2004; Uijen & Bischoff, 2011) with a typical onset between the ages of 10–35 (Uijen & Bischoff, 2011). Research on neurocognitive impairment in patients with CD/FND has typically used normative data or non-psychiatric (healthy) comparison groups without taking concurrent physical complaints into consideration. It is not known whether the nature and severity of these impairments differ from neurocognitive functioning in patients with. A recent study concluded that neurocognitive function in patients with SSRD is substantially reduced across a broad array of cognitive domains (De Vroege et al, 2018) These investigations indicate that individuals with SSRD-alike symptoms and SSRD are characterized by a wide range of neurocognitive impairments and it is not established whether the neurocognitive problems in CD/FND are more profound than in patients with other SSRD. We expect that neurocognitive functioning in patients with CD/FND will be poorer compared to patients with other SSRD and that these differences are not accounted for by potential confounders (i.e., age, sex, level of education, depression, and anxiety)
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