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Functional cognitive disorders: identification and management

  • Norman A. Poole (a1), Sarah R. Cope (a2), Cate Bailey (a3) and Jeremy D. Isaacs (a4)

Summary

We 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 OBJECTIVES

After 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.

DECLARATION OF INTEREST

None.

Copyright

Corresponding author

Correspondence Dr Norman A. Poole, Department of Neuropsychiatry, South West London & St George's Mental Health NHS Trust, St George's Hospital, Blackshaw Road, London SW17 0QT, UK. Email: Norman.poole@swlstg.nhs.uk

References

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American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders (5th edn) (DSM-5). American Psychiatric Publishing.
Bailey, C, Bell, SM, Blackburn, DM (2017) How the UK describes functional memory symptoms. Psychogeriatrics, 17: 336–7.
Bailey, C, Poole, NA, Blackburn, DJ (2018) Identifying patterns of communication in patients attending memory clinics: a systematic review of observations and signs with potential diagnostic utility. British Journal of General Practice, 68: e12338.
Berrios, GE (1996) The History of Mental Symptoms: Descriptive Psychopathology since the Nineteenth Century. Cambridge University Press.
Berrios, GE, Marková, IS, Girala, N, et al. (2000) Functional memory complaints: hypochondria and disorganization. In Memory Disorders in Psychiatric Practice (eds Berrios, GE, Hodges, JR): 384–99. Cambridge University Press.
Bhome, R, Berry, AJ, Huntley, JD, et al. (2018) Interventions for subjective cognitive decline: systematic review and meta-analysis. BMJ Open, 8: e021610.
Burmester, B, Leathem, J, Merrick, P (2016) Subjective cognitive complaints and objective cognitive function in aging: a systematic review and meta-analysis of recent cross-sectional findings. Neuropsychology Review, 26: 376–93.
Delis, DC, Wetter, SR (2007) Cogniform disorder and cogniform condition: proposed diagnoses for excessive cognitive symptoms. Archives of Clinical Neuropsychology, 22: 589604.
Devenney, E, Swinn, T, Mioshi, E, et al. (2018) The behavioural variant frontotemporal dementia phenocopy syndrome is a distinct entity – evidence from a longitudinal study. BMC Neurology, 18(1): 56.
Gambogi, LB, Guimarães, HC, de Souza, LC, et al. (2018) Long-term severe mental disorders preceding behavioral variant frontotemporal dementia: frequency and clinical correlates in an outpatient sample. Journal of Alzheimer's Disease, 66: 1577–85.
Harrison, NA, Johnston, K, Corno, F, et al. (2017) Psychogenic amnesia: syndromes, outcome, and patterns of retrograde amnesia. Brain, 140: 2498–510.
Hasselbalch, BJ, Knorr, U, Kessing, LV (2011) Cognitive impairment in the remitted state of unipolar depressive disorder: a systematic review. Journal of Affective Disorders, 134: 2031.
Heintz, CE, van Tricht, MJ, van der Salm, SM, et al. (2013) Neuropsychological profile of psychogenic jerky movement disorders: importance of evaluating non-credible cognitive performance and psychopathology. Journal of Neurology, Neurosurgery & Psychiatry, 84: 862–7.
Hessen, E, Eckerstrom, M, Nordlund, A, et al. (2017) Subjective cognitive impairment is a predominantly benign condition in memory clinic patients followed for 6 years: the Gothenburg-Oslo MCI Study. Dementia and Geriatric Cognitive Disorders Extra, 7: 114.
Kessler, E-M, Bowen, CE, Baer, M, et al. (2012) Dementia worry: a psychological examination of an unexplored phenomenon. European Journal of Ageing, 9: 275–84.
Kipps, CM, Hodges, JR, Fryer, TD, et al. (2009) Combined magnetic resonance imaging and positron emission tomography brain imaging in behavioural variant frontotemporal degeneration: refining the clinical phenotype. Brain, 132: 2566–78.
Koedam, EL, Lauffer, V, van der Vlies, AE, et al. (2010) Early- versus late-onset Alzheimer's disease: more than age alone. Journal of Alzheimer's Disease, 19: 1401–8.
Kopelman, MD (2000) Focal retrograde amnesia and the attribution of causality: an exceptionally critical review. Cognitive Neuropsychology, 17: 585621.
Larner, AJ (2014) Impact of the National Dementia Strategy in a neurology-led memory clinic: 5-year data. Clinical Medicine, 14: 216.
Lishman, WA (1978) Organic Psychiatry: The Psychological Consequences of Cerebral Disorder. Blackwell Scientific Publications.
McIntyre, RS, Soczynska, JZ, Woldeyohannes, HO, et al. (2015) The impact of cognitive impairment on perceived workforce performance: results from the International Mood Disorders Collaborative Project. Comprehensive Psychiatry, 56: 279–82.
McIntyre, R, Harrison, J, Loft, H, et al. (2016) The effects of vortioxetine on cognitive function in patients with major depressive disorder: a meta-analysis of three randomized controlled trials. International Journal of Neuropsychopharmacology, Jun 15: doi 10.1093/ijnp/pyw055 [Epub ahead of print].
Metternich, B, Schmidtke, K, Dykierek, P, et al. (2008) A pilot group therapy for functional memory disorder. Psychotherapy and Psychosomatics, 77: 259–60.
Metternich, B, Kosch, D, Kriston, L, et al. (2010) The effects of nonpharmacological interventions on subjective memory complaints: a systematic review and meta-analysis. Psychotherapy and Psychosomatics, 79: 619.
Mitchell, AJ, Beaumont, H, Ferguson, D, et al. (2014) Risk of dementia and mild cognitive impairment in older people with subjective memory complaints: meta-analysis. Acta Psychiatrica Scandinavica, 130: 439–51.
Neisser, U, Harsh, N (1992) Phantom flashbulbs: false recollection of hearing the news about Challenger. In Affect and Accuracy in Recall: Studies of “Flashbulb” Memories (eds Winograd, E, Neisser, U): 931. Cambridge University Press.
Pennington, C, Hayre, A, Newson, M, et al. (2015) Functional cognitive disorder: a common cause of subjective cognitive symptoms. Journal of Alzheimer's Disease, 48(suppl 1): S1924.
Reuber, M, Blackburn, DJ, Elsey, C, et al. (2018) An interactional profile to assist the differential diagnosis of neurodegenerative and functional memory disorders. Alzheimer Disease & Associated Disorders, 32: 197206.
Rock, PL, Roiser, JP, Riedel, WJ, et al. (2014) Cognitive impairment in depression: a systematic review and meta-analysis. Psychological Medicine, 44: 2029–40.
Sachdev, P, Reutens, S (2003) The nondepressive pseudodementias. In Dementia: Presentations, Differential Diagnosis, and Nosology (eds Emery, VOB, Oxman, TE): 418. JHU Press.
Saez-Fonseca, JA, Lee, L, Walker, Z (2007) Long-term outcome of depressive pseudodementia in the elderly. Journal of Affective Disorders, 101: 123–9.
Schmidtke, K, Pohlmann, S, Metternich, B (2008) The syndrome of functional memory disorder: definition, etiology, and natural course. American Journal of Geriatric Psychiatry, 16: 981–8.
Stone, J, Carson, A (2011) Functional neurologic symptoms: assessment and management. Neurologic Clinics, 29: 118.
Stone, J, Pal, S, Blackburn, D, et al. (2015) Functional (psychogenic) cognitive disorders: a perspective from the neurology clinic. Journal of Alzheimer's Disease, 49(suppl 1): S517.
Teodoro, T, Edwards, MJ, Isaacs, JD (2018) A unifying theory for cognitive abnormalities in functional neurological disorders, fibromyalgia and chronic fatigue syndrome: systematic review. Journal of Neurology, Neurosurgery, and Psychiatry, 89: 1308–19.
Vestberg, S, Passant, U, Elfgren, C (2010) Stability in the clinical characteristics of patients with memory complaints. Archives of Gerontology and Geriatrics, 50: e2630.
Wakefield, SJ, Blackburn, DJ, Harkness, K, et al. (2018) Distinctive neuropsychological profiles differentiate patients with functional memory disorder from patients with amnestic-mild cognitive impairment. Acta Neuropsychiatrica, 30: 90–6.
Wells, CE (1979) Pseudodementia. American Journal of Psychiatry, 136: 895900.
Wessely, S, Nimnuan, C, Sharpe, M (1999) Functional somatic syndromes: one or many? Lancet, 354: 936–9.
Wilson, RS, Boyle, PA, Yu, L, et al. (2015) Temporal course and pathologic basis of unawareness of memory loss in dementia. Neurology, 85: 984–91.
World Health Organization (1992) The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. WHO.
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BJPsych Advances
  • ISSN: 2056-4678
  • EISSN: 2056-4686
  • URL: /core/journals/bjpsych-advances
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Functional cognitive disorders: identification and management

  • Norman A. Poole (a1), Sarah R. Cope (a2), Cate Bailey (a3) and Jeremy D. Isaacs (a4)
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