Functional Cognitive Disorders Research Articles

Features of internal inconsistency in functional and organic cognitive disorders

AbstractBackgroundMemory complaints are common in elderly and have various etiologies, including functional cognitive disorder (FCD). Diagnosis of FCD is supported by clinical evidence of incongruity with a neurodegenerative disorder and/or evidence of internal inconsistency ‐ the ability to perform a task well at certain times, but with impaired ability at other times. The prevalence of features suggesting FCD in organic disorders is unclear. We assessed the presence of clinical features of internal inconsistency and other possible discriminators of FCD from organic causes in patients with mild cognitive impairment (MCI) and subjective cognitive impairment (SCI).MethodPatients attending our tertiary memory clinic in a period of one year with SCI or MCI were included. Exclusion criteria were toxic or metabolic causes of cognitive decline, major psychiatric disorders, co‐morbid neurological conditions that could affect cognition, and uncertainty of diagnosis of organic disorder or FCD. Medical records were reviewed for evidence of internal inconsistency and other suggested discriminators between functional and organic etiology. Demographic, cognitive and clinical data were compared between groups.ResultWe evaluated 39 patients with FCD and 57 with organic disorders. MCI was more common in patients with organic disorders. However, most patients with FCD also had MCI. Patients with FCD were younger and performed better on cognitive assessments, but with significant overlap between groups (Table 1). While patients with FCD more commonly attended the appointment alone and reported greater concern about their symptoms than their supporters, these features were unspecific (Table 2). Patients with FCD reported symptoms that could represent normal experiences and provided detailed descriptions of memory lapses more commonly. While less sensitive, memory perfectionism and symptoms occurring only in specific situations were highly specific for FCD.ConclusionDifferentiation between functional and organic cognitive disorders based on history and examination can be challenging. Features suggesting internal inconsistency and incongruity with neurodegeneration may also appear in organic causes of SCI and MCI. Their varying specificity and sensitivity for FCD need to be taken into account when considering the diagnosis. Improving the identification of FCD could in turn improve identification of patients with prodromal neurodegeneration.

Functional Cognitive Disorders in the Emergency Department

Functional Cognitive Disorders in the Emergency Department

Neurobehavioral and inflammatory responses following traumatic brain injury in male and female mice

Traumatic brain injury (TBI) is a leading cause of mortality and is associated with a high rate of functional comorbidities, including motor, cognitive, anxiety, depression, and emotional disorders. TBI pathophysiology and recovery are complicated and involve several mechanistic pathways that control neurobehavioral outcomes. In this study, male and female C57Bl/6 J mice were subjected to a controlled cortical impact model of TBI or sham injury and evaluated for different neurobehavioral and inflammatory outcomes over a month. We demonstrate that TBI mice have increased motor dysfunction at early and late time points following the injury as compared to the sham group. Anxiety-like symptoms were time- and task-dependent, with both sexes having increased anxiety-like behavior 2 weeks post-injury. Cognitive functions measured by T-maze presented greater deficits in TBI mice, while there was no sex or injury-related difference in depressive-like behaviors. Notably, a significant effect of sex was found in empathy-like behavior, with females showing more allogrooming and freezing behavior in the consoling and fear observational tests, respectively. Evaluating the impact of the injury-induced brain damage demonstrated a greater injury volume and neuronal degeneration in males compared to females one month after TBI. Moreover, male mice showed higher peripheral inflammatory responses, as represented by elevated serum levels of peripheral leukocytes and inflammatory markers. These results will have significant implications for understanding TBI's long-term consequences on neurobehavioral and inflammatory responses, which are sex-specific and can be considered for individualized therapeutic strategies in treating TBI.

The role of digital art in treating students with functional cognitive disorders

BackgroundFunctional Cognitive disorders are a common neurodevelopmental disorder that negatively affects students’ learning and social skills. Digital art as an innovative therapeutic approach has aroused wide interest in the field of psychology, but its therapeutic effect in identifying functional cognitive disorders is still unclear.Subjects and MethodsThe subjects of this study were 60 middle school students diagnosed with functional cognitive disorders. They were randomly divided into two groups. One group received digital art communication therapy, and the other group received regular rehabilitation training as a control group. The treatment period was 12 weeks, three times a week. SPSS23.0 was used for data analysis, including descriptive statistics and correlation analysis before and after treatment.ResultsResults showed that students in the Digital Arts Communication group showed significant improvement in identifying functional cognitive disorders. After treatment, the average recognition accuracy of the digital art group increased from 60% before treatment to 80% after treatment. Correlation analysis results showed that there was a significant positive correlation between digital art communication and cognitive ability (r = 0.70, P< 0.05).ConclusionsThrough statistical analysis with SPSS23.0, this study identified the effectiveness of digital art communication as a therapeutic tool for improving students’ identification of functional cognitive disorders. Digital art communication therapy can enhance students’ cognitive ability and have a positive impact on the development of emotional regulation and social skills. Therefore, digital art communication has potential in the treatment of identifying functional cognitive disorders.

Rural tourism combined with psychological intervention on functional cognitive disorders

BackgroundFunctional cognitive impairment, also known as cognitive impairment, can lead to severe loss of daily or social communication abilities and diagnosis of dementia. The treatment methods for functional cognitive impairment include medication, psychological training, and so on.Subjects and MethodsThe study conducted an experiment on 88 patients with functional cognitive impairment, dividing them into a control group, a psychological group, and an experimental group. The control group only received prescription medication provided by the doctor, the psychological group received social psychological intervention treatment on the basis of the control group, and the experimental group received comprehensive treatment of rural tourism projects on the basis of the psychological group. The study used the MATRICS Consensus Cognitive Battery (MCCB) and Positive and Negative Symptom Scale (PANSS) to evaluate the condition of three groups of patients after treatment, in order to analyze the therapeutic effects of different treatment plans on the patient’s condition.ResultsAs the treatment duration increases, the patient’s MCCB score gradually increases and the PANSS score gradually decreases, indicating that all three treatment regimens can improve the patient’s cognitive impairment. The MCCB and PANSS scores of the experimental group were better than those of the control group and the psychological group.ConclusionsThe effect of simple drug therapy is unclear and the treatment course is long. Combining medication with social psychology intervention training can improve the treatment effect of patients. Rural tourism projects combined with social psychological intervention present the best treatment effect.AcknowledgementThe Year of 2021 Vocational Education Teaching Reform Research Project of Shandong Province (No.2021120).

Systematic Review: The Impact Of Pandemic Post-Covid-19 On The Mental Health Of The Elderly

This study aims to investigate how MSMEs in Cilacap capacity to compete and perfome well in the marketing arena are
 The elderly are those who spend a lot of time at home to gather with their families and grandchildren, which is normal. This systematic review aims to look at the impact of the COVID-19 pandemic on the post-pandemic mental health of the elderly. based on research journal articles published from January 2022 to April 2022 on the elderly. Five research articles were obtained from three international publishers. The five journals were tested for due diligence using six PRISMA (Preferred Reporting Items for Systematic Review and Meta-analyses) assessment protocols which included abstracts and titles, introduction and objectives, methods and data, sample selection strategy, data analysis, and research findings. The results obtained based on a systematic study conducted in depth regarding the impact of Covid-19 on the health of the elderly are; (1) Psychological disorders, namely: anxiety, stress, overdose, and trauma. (2) Disorders of happiness, namely quality of life, perceptions of health and well-being (3) and Physical Disorders, namely functional disorders, dyspenia, and cognitive disorders. This finding represents the impact that the elderly have felt during the 4 months of the pandemic in 2022, even though it has been more than two years of the COVID-19 pandemic, the elderly are still feeling the negative impact of the pandemic. The third finding of the impact of the pandemic on the elderly can be used as reference material and a source of reference for in-depth research by linking variables that can increase positive emotions in individuals.

Functional cognitive impairment: A new concept in neuropsychiatry

Due to the high prevalence of different levels of memory disorders and amnesia, many psychiatry and psychology referrals are due to the fear of diseases that cause dementia, including Alzheimer's disease. However, many of these disorders have internal causes and can be classified as functional cognitive disorders. Although the diagnosis of cognitive disorder is made by ruling out organic causes, it is difficult to diagnose functional disorders, thus most of these disorders are not diagnosed. It has been determined that depression, anxiety and behavioral disorders can be precursors of mild cognitive impairment, but it has not been determined whether functional cognitive impairment can also be a trigger or precursor for organic cognitive disorders related to dementia. The typical form of functional cognitive disorder overlaps with the components of attention and concentration. The coexistence of these disorders with depression can make the diagnosis of functional cognitive disorders more difficult. Therefore, it is important to rule out pseudodementia due to depression before making such a diagnosis. Since functional cognitive impairment occur in the midlife period, these disorders are differentially diagnosed with early-onset neurodegenerative disorders. Regardless of the research conducted in the field of diagnosing functional cognitive disorders, no definitive diagnostic criteria have been determined for these disorders, and the long-term prognosis of these disorders is also unknown.

Diagnostic Challenges of Functional Cognitive Disorders

IntroductionFunctional cognitive disorders (FCD) denotes a complaint about memory function or, less commonly, another cognitive process, in the absence of relevant neuropathology and with evidence of inconsistency between symptoms reported and signs identified at assessment.Increasing numbers of people with FCD are being identified.Most are discharged back to primary care without a diagnosis or are given the label of mild cognitive impairment, which is not a synonym for FCD.ObjectivesThere is a multitude of terms in the clinic and in the research to describe this kind of complaints. Some terms seem to minimize and normalize the state, whereas others posit an underlying cause.Given this lack of order, it is a challenge to diagnose it and give it the proper clinical guidance.This literature-based review aims to fill this gap.MethodsData was obtained through an internet-based literature search, using the databases PubMed, Cochrane Library and NCBI. The World Health Organization was also utilized. Nine articles from the last two years were included.ResultsIt is listed a nosology in six categories and a selection of clinical features which may help with the discrimination of functional and neurological disease causes of memory disorders.ConclusionsPatients presenting with complaints about memory function require standard psychiatric and neurological history and examination.It should be emphasized that these conditions are not diagnoses of exclusion but have positive symptoms and signs that should become well-known.Nevertheless, we remain uncertain about prognosis and treatments, both psychological and pharmacological. Its development would reduce the burden of patients in the healthcare systems.Disclosure of InterestNone Declared

Memory Perfectionism is Associated with Persistent Memory Complaints after Concussion.

The etiology of persistent memory complaints after concussion is poorly understood. Memory perfectionism (highly valuing memory ability and intolerance of minor memory lapses) may help explain why some people report persistent subjective memory problems in the absence of corresponding objective memory impairment. This study investigated the relationship between memory perfectionism and persistent memory complaints after concussion. Secondary analysis of baseline data from a randomized controlled trial. Adults (N = 77; 61% women) with persistent symptoms following concussion were recruited from outpatient specialty clinics. Participants completed the National Institutes of Health Toolbox Cognition Battery, Test of Memory Malingering-Trial 1, and questionnaires measuring memory perfectionism (Metamemory in Adulthood-Achievement subscale), forgetfulness and other postconcussion symptoms (Rivermead Postconcussion Symptoms Questionnaire; RPQ), and depression (Patient Health Questionnaire-2) at M = 17.8weeks postinjury. Patients with versus without severe memory complaints (based on the RPQ) were compared. Memory perfectionism was associated cross-sectionally with severe memory complaint, after controlling for objective memory ability, overall cognitive ability, and depression (95% confidence interval for odds ratio = 1.11-1.40). Sensitivity analyses showed that this relationship did not depend on use of specific objective memory tests nor on inclusion of participants who failed performance validity testing. In a control comparison to test the specificity of identified relationships, memory perfectionism was not associated with severe fatigue (95% confidence interval for odds ratio = 0.91-1.07). Memory perfectionism may be a risk factor for persistent memory symptoms after concussion, with potential relevance to the spectrum of functional cognitive disorders more broadly.

Towards a neural network hypothesis for functional cognitive disorders: an extension of the Overfitted Brain Hypothesis

ABSTRACT Introduction: Whilst the empirical understanding of functional cognitive disorders (FCD) has advanced in recent years, theoretical and conceptual models have evolved more slowly. Existing frameworks for FCD are based on models of other functional neurological disorders or of metacognitive processes and are recognised to lack mechanistic precision. Methods: In this article, a novel application to FCD of Hoel’s Overfitted Brain Hypothesis of the evolved function of dreaming is attempted. Results: This posits that the empirically observed sleep disturbance in FCD entails impaired dreaming which causes the brain to be overfitted and hence unable to generalise appropriately, producing mismatch between memory expectations and memory performance. Conclusions: This formulation of FCD is based on considerations derived from the study of neural networks and shares commonalities with Bayesian models of functional neurological disorders. Additionally, it has implications for future hypothesis-driven research in FCD and suggests a pragmatic basis for management strategies.

Functional cognitive disorders

The article provides an overview of scientific publications devoted to the study of the problem of functional cognitive disorders (FCD), which are one of the variants of functional neurological disorders (FND). The authors provide data on the frequency of occurrence of this pathology, the differences between the concepts of FCD and «subjective cognitive disorders» (dissociative (conversion) disorders - F44). The authors show the traditional views on the study of this pathology in the mainstream of hysterical disorders. The modern concepts of information processing disorders as a mechanism of FCD development are considered. Special attention is paid to the role of executive dysfunction in the genesis of FCD. The descriptions of the main clinical manifestations of FCD are given. The basic principles of diagnostic examination of patients with FCD are considered. The article presents modern approaches to the therapy of FCD, with special attention paid to psychotherapeutic correction in this pathology.

Brain damage in sleep-disordered breathing: the role of glia (clinical aspects)

Sleep-disordered breathing (SDB) is one of the most frequent sleep-wake disorders. SDB is associated with brain damage that manifests as structural (atrophy of amygdala, hippocampus, insula) and functional (cognitive and emotional dysfunction) disorders. In this review, we summarize the results of clinical and experimental studies investigating the approach for the decreasing brain damage in SDB via glial modulation. In conclusion, we suggest the strategies for future research aimed at optimizing diagnostics and treatment of brain damage in SDB.

Identifying functional cognitive disorder: a proposed diagnostic risk model.

Functional cognitive disorders (FCD) are an important differential diagnosis of neurodegenerative disease. The utility of suggested diagnostic features has not been prospectively explored in "real world" clinical populations. This study aimed to identify positive clinical markers of FCD. Adults with cognitive complaints but not dementia were recruited from memory, neurology, and neuropsychiatry clinics. Participants underwent structured interview, Mini International Neuropsychiatric Interview, Montreal Cognitive Assessment, Luria 3-step, interlocking fingers, digit span and Medical Symptom Validity Test, Patient Health Questionnaire 15, Hospital Anxiety and Depression Scale, Multifactorial Memory Questionnaire, and Pittsburgh Sleep Quality Inventory. Potential diagnostic variables were tested against expert consensus diagnosis using logistic regression. FCD were identified in 31/49 participants. Participants with FCD were younger, spoke for longer when prompted "Tell me about the problems you've been having," and had more anxiety and depression symptoms and psychiatric diagnoses than those without FCD. There were no significant differences in sex, education, or cognitive scores. Younger age and longer spoken response predicted FCD diagnosis in a model which explained 74% of diagnostic variability and had an area under the curve (AUC) of 94%. A detailed description of cognitive failure is a sensitive and specific positive feature of FCD, demonstrating internal inconsistency between experienced and observed function. Cognitive and performance validity tests appear less helpful in FCD diagnosis. People with FCD are not "worried well" but often perform poorly on tests, and have more anxiety, depression, and physical symptoms than people with other cognitive disorders. Identifying diagnostic profiles is an important step toward parity of esteem for FCDs, as differential diagnoses of neurodegenerative disease and an independent target for clinical trials.

Functional Cognitive Disorders (FCD): How Is Metacognition Involved?

Functional cognitive disorders (FCD) have become a subject of increasing clinical interest in recent years, in part because of their high prevalence amongst patients attending dedicated memory clinics. Empirical understanding of FCD based on observational studies is growing, suggesting a relationship to other functional neurological disorders (FND) based on shared phenomenology. However, understanding of FCD at the theoretical level has been lacking. One suggestion has been that FCD are disorders of metacognition, most usually of metamemory. In this article, a brief overview of these constructs is presented along with existing evidence for their impairment in FCD. Previous adaptations of theoretical models of FND to accommodate FCD are reviewed. A novel application to FCD of Nelson and Narens’ monitoring and control model of metamemory is then attempted, positing an improper setting of the monitoring function, with examples of ecological relevance. Formulation of FCD in light of a metacognitive model of anosognosia is also considered. Although lacking mechanistic and neuroanatomical sophistication, this metacognitive formulation of FCD may give pointers for future hypothesis-driven research and a pragmatic basis for management strategies.

Use and understanding of functional cognitive disorder terminology in United Kingdom clinical practice - a survey

AimsThis study aimed to explore the terms used by old-age psychiatrists and psychologists to describe subjective and mild cognitive impairment and functional cognitive disorders (FCD) in clinical practice.MethodParticipants were selected from across the United Kingdom based on their clinical involvement in the assessment of cognitive complaints. 9 old-age psychiatrists and 4 psychologists were interviewed about their use of terminology in clinical practice and their awareness and understanding of FCD terminology via semi-structured interview questions and case vignettes. Interviews were conducted between December 2020 and February 2021 using online platforms Zoom and Microsoft Teams. Participants were recruited by email and Twitter. All questions were asked verbally; however, the four case vignettes were displayed via screen-share. All discussions and answers were transcribed and transcripts were coded manually using the exploratory case study methodology in order to identify themes in participants’ responses.ResultThis study has highlighted the variable use of terms used to describe and diagnose patients presenting with symptoms of cognitive disorders. The terms ‘mild cognitive impairment’, ‘subjective cognitive decline’ and ‘functional cognitive disorder’ were used most commonly amongst participants, though the terms ‘subjective cognitive impairment’ and ‘pseudodementia’ were also presented. This theme of language discontinuity is underscored by participants’ varying use of terminology when describing or presenting their diagnoses for the case vignettes. The data also reveals a sub-theme of variability in application of the term FCD. Whilst all participants gave similar definitions for this term, the application of FCD as a diagnosis in practice was inconsistent. Six participants described FCD as associated with or secondary to other functional or psychiatric conditions, four participants viewed FCD as an isolated diagnosis, and one participant considered FCD to be either part of another illness or a separate diagnosis. Two participants neither used nor recognised the term FCD.ConclusionIt is evident that there is varied use of terms describing or diagnosing forms of cognitive symptoms. The findings of this study highlight the need for a clear, adoptable definition of FCD in practice as well as implementable management plans for FCD patients. This is critical in order to avoid misdiagnosis and mismanagement, which may have harmful effects on patients living with debilitating cognitive symptoms.

Authors’ reply to A. Winston, A. Cotter, M. Gisslen, P. W. G. Mallon and P. Cinque

Authors’ reply to A. Winston, A. Cotter, M. Gisslen, P. W. G. Mallon and P. Cinque

Functional cognitive disorders: update on diagnostic status.

Many patients referred to cognitive disorders clinics are not found to have evidence of any neurological disorder(s) to account for their symptoms. Many demonstrate incongruence between their subjective cognitive symptoms and preserved social and occupational functions. The term 'functional cognitive disorders' (FCD) has been used to denote this diagnostic category. This article aims to review the current state of knowledge regarding FCD. Studies of FCD are in their infancy, but available evidence suggests positive diagnosis may be made based on typical clinical profiles, including language discourse and simple clinical signs. Concurrent mood disorder and sleep disturbance are common, as well as other functional disorders. Pathogenesis is yet to be determined, but a disorder of metamemory has been suggested.

I think, therefore I forget - using experimental simulation of dementia to understand functional cognitive disorders.

Symptoms of functional neurological disorder have traditionally been thought to depend, in part, on patients' ideas about symptoms rather than on the rules of pathophysiology. The possibility that functional cognitive symptoms might similarly reflect ideas of dementia has not been explored. We aimed to assess beliefs, through performance, about symptoms of dementia in healthy non-medical adults with the intention of identifying potential markers of functional cognitive disorders. Healthy volunteers were asked to simulate symptoms of mild dementia during testing with the Montreal Cognitive Assessment (MoCA), coin-in-hand forced-choice test, short digit span trials, Luria 3-step test and interlocking finger test. Family history of dementia was recorded. In 50 participants aged 18-27, simulating dementia, mean MoCA score was 16 (SD 5.5, range 5-26). Delayed recall was the most frequently failed item (100%) and cube drawing least frequently failed (42%). Twenty-six percent failed forward three-digit span and 36% failed reverse two-digit span. On the coin-in-hand test, 32% scored at or below chance level. Inconsistent response patterns were common. Cognitively healthy young adults simulating mild dementia perform similarly to older adults with mild dementia, demonstrating beliefs that dementia is associated with significant global impairment, including attention, motor function, and letter vigilance, but preservation of cube drawing. Inconsistent response patterns were common. Contrary to expectation, family history of dementia did not influence performance. Two and three digit span showed particular promise as a bedside test for simulation. Further investigation will establish whether similar patterns of results are produced in individuals with functional cognitive symptoms.

Dutch guideline for preventing nosocomial transmission of highly-resistant micro-organisms (HRMO) in long-term care facilities (LTCFs)

In 2012, the Dutch Working Party for Infection Control (WIP) issued the first Guideline for prevention of transmission of highly-resistant micro-organisms (HRMO) in Hospitals. The next step was to focus on long-term care facilities (LTCFs) both for nursing homes as for small-scale living facilities with nursing home care. These facilities providing care for residents with functional disabilities, chronical illnesses and cognitive disorders, such as dementia. The objective was to adapt the Guideline for prevention of transmission of HRMO in hospitals to LTCFs with a strong accent on living conditions and social interactions.Residents of LTCFs may be carriers of HRMO over a long period of time and most of the residents of the LTCF stay for extended periods of time. To respect individual living circumstances and to prevent unnecessary limitations in the social life of the residents due to the use of isolation measures, the WIP has chosen to describe infection control precautions per individual micro-organism instead of a ‘one size fits all’ method. The term “isolation” was therefore replaced by the term “additional” precautions. This guideline describes the screening policies for residents in LTCFs, definition and detection of HRMO carriage, standard and additional infection control precautions for HRMO positive residents, documentation and communication of HRMO carriage and discontinuation of additional infection control precautions. It also describes contact tracing of HRMO, environmental control/investigation, surveillance of HRMO and what is important when there is an outbreak.

Functional cognitive disorders: identification and management

SUMMARYWe review the various functional cognitive disorders (FCDs) – complaints about memory function or another cognitive process in the absence of relevant neuropathology. These are increasingly coming to the attention of psychiatrists and neurologists and FCD encompasses some newly recognised conditions in addition to classic types such as pseudodementia and psychogenic amnesia. The clinical features, neuropsychological findings and treatment are presented and discussed.LEARNING OBJECTIVESAfter reading this article you will be able to: •describe clinical features of FCD and how it differs from neurodegenerative causes of cognitive impairment•be able to subclassify cases of FCD using the proposed nosology•understand how to discuss the diagnosis with the patient and explain how the symptoms arise.