Identifying functional cognitive disorder: a proposed diagnostic risk model
- 17 September 2021
- journal article
- research article
- Published by Cambridge University Press (CUP) in CNS Spectrums
- Vol. 27 (6), 754-763
- https://doi.org/10.1017/s1092852921000845
Abstract
Background 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. Methods 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. Results 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%. Conclusions 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.Keywords
This publication has 21 references indexed in Scilit:
- Linguistic Features Identify Alzheimer’s Disease in Narrative SpeechJournal of Alzheimer's Disease, 2015
- Functional (Psychogenic) Cognitive Disorders: A Perspective from the Neurology ClinicJournal of Alzheimer's Disease, 2015
- Conversational assessment in memory clinic encounters: interactional profiling for differentiating dementia from functional memory disordersAging & Mental Health, 2015
- A diagnosis for £55: what is the cost of government initiatives in dementia case findingAge and Ageing, 2015
- Screening Utility of the “Attended Alone” Sign for Subjective Memory ImpairmentAlzheimer Disease & Associated Disorders, 2014
- Late-life depression and risk of vascular dementia and Alzheimer's disease: systematic review and meta-analysis of community-based cohort studiesThe British Journal of Psychiatry, 2013
- Subjective memory complaints, vascular risk factors and psychological distress in the middle-aged: a cross-sectional studyBMC Psychiatry, 2011
- The diagnosis of dementia due to Alzheimer's disease: Recommendations from the National Institute on Aging‐Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's diseaseAlzheimer's & Dementia, 2011
- Use of cognitive screening instruments in primary care: the impact of national dementia directives (NICE/SCIE, National Dementia Strategy)Family Practice, 2010
- Interlocking finger test: a bedside screen for parietal lobe dysfunctionJournal of Neurology, Neurosurgery & Psychiatry, 2003