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Functional cognitive disorder: dementia's blind spot.

Ball, HA; McWhirter, L; Ballard, C; Bhome, R; Blackburn, DJ; Edwards, MJ; Fleming, SM; Fox, NC; Howard, R; Huntley, J; et al. Ball, HA; McWhirter, L; Ballard, C; Bhome, R; Blackburn, DJ; Edwards, MJ; Fleming, SM; Fox, NC; Howard, R; Huntley, J; Isaacs, JD; Larner, AJ; Nicholson, TR; Pennington, CM; Poole, N; Price, G; Price, JP; Reuber, M; Ritchie, C; Rossor, MN; Schott, JM; Teodoro, T; Venneri, A; Stone, J; Carson, AJ (2020) Functional cognitive disorder: dementia's blind spot. Brain, 143 (10). pp. 2895-2903. ISSN 1460-2156 https://doi.org/10.1093/brain/awaa224
SGUL Authors: Edwards, Mark John James Isaacs, Jeremy

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Abstract

An increasing proportion of cognitive difficulties are recognized to have a functional cause, the chief clinical indicator of which is internal inconsistency. When these symptoms are impairing or distressing, and not better explained by other disorders, this can be conceptualized as a cognitive variant of functional neurological disorder, termed functional cognitive disorder (FCD). FCD is likely very common in clinical practice but may be under-diagnosed. Clinicians in many settings make liberal use of the descriptive term mild cognitive impairment (MCI) for those with cognitive difficulties not impairing enough to qualify as dementia. However, MCI is an aetiology-neutral description, which therefore includes patients with a wide range of underlying causes. Consequently, a proportion of MCI cases are due to non-neurodegenerative processes, including FCD. Indeed, significant numbers of patients diagnosed with MCI do not 'convert' to dementia. The lack of diagnostic specificity for MCI 'non-progressors' is a weakness inherent in framing MCI primarily within a deterministic neurodegenerative pathway. It is recognized that depression, anxiety and behavioural changes can represent a prodrome to neurodegeneration; empirical data are required to explore whether the same might hold for subsets of individuals with FCD. Clinicians and researchers can improve study efficacy and patient outcomes by viewing MCI as a descriptive term with a wide differential diagnosis, including potentially reversible components such as FCD. We present a preliminary definition of functional neurological disorder-cognitive subtype, explain its position in relation to other cognitive diagnoses and emerging biomarkers, highlight clinical features that can lead to positive diagnosis (as opposed to a diagnosis of exclusion), and red flags that should prompt consideration of alternative diagnoses. In the research setting, positive identifiers of FCD will enhance our recognition of individuals who are not in a neurodegenerative prodrome, while greater use of this diagnosis in clinical practice will facilitate personalised interventions.

Item Type: Article
Additional Information: This is a pre-copyedited, author-produced version of an article accepted for publication in Brain following peer review. The version of record Harriet A Ball, Laura McWhirter, Clive Ballard, Rohan Bhome, Daniel J Blackburn, Mark J Edwards, Stephen M Fleming, Nick C Fox, Robert Howard, Jonathan Huntley, Jeremy D Isaacs, Andrew J Larner, Timothy R Nicholson, Catherine M Pennington, Norman Poole, Gary Price, Jason P Price, Markus Reuber, Craig Ritchie, Martin N Rossor, Jonathan M Schott, Tiago Teodoro, Annalena Venneri, Jon Stone, Alan J Carson, Functional cognitive disorder: dementia’s blind spot, Brain, Volume 143, Issue 10, October 2020, Pages 2895–2903 is available online at: https://doi.org/10.1093/brain/awz224
Keywords: cognition, dementia, functional cognitive disorder, functional neurological disorder, mild cognitive impairment, cognition, dementia, functional cognitive disorder, functional neurological disorder, mild cognitive impairment, 11 Medical and Health Sciences, 17 Psychology and Cognitive Sciences, Neurology & Neurosurgery
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Brain
ISSN: 1460-2156
Language: eng
Dates:
DateEvent
October 2020Published
13 August 2020Published Online
21 May 2020Accepted
Publisher License: Publisher's own licence
PubMed ID: 32791521
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/112394
Publisher's version: https://doi.org/10.1093/brain/awaa224

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