Clinical signs in functional cognitive disorders: A systematic review and diagnostic meta-analysis 2023 Cabreira, Stone, Carson et al

[Andy]

Highlights

• Functional cognitive symptoms are common in functional somatic disorders.
  
  
• Positive signs allow for an early differentiation between FCD and neurodegeneration.
  
  
• Language and interaction profiles are promising diagnostic markers.
  
  
• Personality traits, effects of ‘thinking’, and comorbidities remain unexplored.
  
  
• This review can inform future diagnostic decision tools and intervention testing.
  

Abstract

Objective
Functional cognitive disorder (FCD) accounts for around a third of patients attending specialized memory clinics. It is also overrepresented in patients with other functional and somatic diagnoses. So far, no long-term diagnostic validity studies were conducted, and a positive diagnostic profile is yet to be identified. We aimed to review the literature on diagnostic signs and symptoms that allow for a discrimination between FCD and neurodegeneration.

Methods
Systematic review of Ovid-Medline®, Embase and PsycINFO databases. Relevant clinical features were extracted including demographics, symptom history, comorbidities, language and interaction profiles and cognitive assessments. Studies with quantifiable diagnostic accuracy data were included in a diagnostic meta-analysis.

Results
Thirty studies (N = 8602) were included. FCD patients were younger, more educated, and more likely to have a family history of older onset dementia, abrupt symptom onset, and higher rates of anxiety, depression and sleep disturbance. Promising language profiles include longer duration of spoken answer, elaborated examples of memory failures, ability to answer compound and personal questions, and demonstration of working memory during interaction. The pooled analysis of clinical accuracy of different signs revealed that attending alone and bringing a handwritten list of problems particularly increase the odds of a FCD diagnosis. Current evidence from neuropsychometric studies in FCD is scarce.

Conclusions
Our systematic review reinforces that positive signs contribute for an early differentiation between FCD and neurodegeneration in patients presenting with memory complaints. It is the first to attain quantitative value to clinical observations. These results will inform future diagnostic decision tools and intervention testing.

Open access, https://www.sciencedirect.com/science/article/pii/S0022399923003045

 

[Andy]

"1. Introduction

The last decade witnessed a global increase in the number of referrals to specialist memory services. Many of the patients attending have a functional cognitive disorder (FCD)(12–56% of the new referrals) [[1], [2], [3], [4], [5], [6], [7]]. A recent audit in England showed that 47% of the patients under 65 years-old attending memory clinics did not have a dementia [7]. FCD is also overrepresented in patients with other functional and somatic diagnoses, including chronic fatigue syndrome, fibromyalgia, and post-traumatic brain injury [6,8,9]. It may present with multiple severities and possibilities of progression [3], but the initial clinical presentation often overlaps with dementia, posing a diagnostic challenge for clinicians [10]."

 

[rvallee]

Yet again complete nonsense that simply takes cases that medicine doesn't know the cause of and lumps them all under some imaginary conversion disorder. There is no sense or reason to any of it, and the claim of up to 1/3 clearly marks it as a category defined by a lack of explanation, the hysteria of the gaps. This is completely antiscience.

For the most part they are describing brain fog, but they don't know what it is, don't acknowledge the common infectious trigger, or how common it is after brain injuries that don't leave obvious marks, so they just make stuff up as usual.

They are clearly labeling freely here. Anything not caused by neurodegeneration is asserted to be functional, in the sense of conversion disorder. There is zero difference to their bigotry and the awfulness of having asserted that homosexuality is a mental illness in the not-so-distant past. This deserves nothing but utter contempt.

 

[Amw66]

They are legacy building. Setting up a field for a new generation to take forward.
It's unsettling how few choose to see through the misdirection.

 

[DokaGirl]

Patients have long been advised to write down their concerns in preparation for a medical consultation. Advice is to be brief, and prioritize.

Now it seems, as noted in this study, those who follow this long held advice, are more likely to be diagnosed with FCD.

Good grief!

 

[Sean]

Yes, they are trying to make it impossible to avoid the diagnosis, in the absence of another diagnosis.

All roads lead to functional something.

 

[bobbler]

Just been reading the following news story: https://www.thetimes.co.uk/article/fears-of-bias-in-low-traffic-neighbourhoods-research-6x3j95mjm

The transport secretary has asked officials to examine how research into low-traffic neighbourhoods and other policies can be “genuinely independent” amid concerns that studies are being conducted by people whose opinions might prejudice their work.

Mark Harper ordered civil servants to act after learning that part of an “independent” review of low-traffic neighbourhoods (LTNs) commissioned by the Department for Transport in 2021 was being conducted by a university department led by an academic who was the trustee of a charity that campaigned for the schemes. Another part of the study is being conducted by a charity that has received contracts from councils for helping to create the schemes, which divert traffic from certain roads.

And all I could think of is this malarkey for FND with the same rotating what trio, quad and their trainees and contacts just churning out manifestos then reviewing them and publishing in journals they are often editors on etc - and here we are, the exact people have done another one

I don't believe for a minute that this isn't just propaganda to try and advertise undermining Nice guidelines and future guidelines and treatment for other conditions as 'conversion disorder'.

Is what this lot do a real subject? No, it is just activist campaigners for bigotry (generally send women with chronic illness off for some mind-retraining) hiding behind a job title that doesn't mean the area/ideology is valid but scarily it also seems to not only not focus on critique of it but is lacking in it.

 

[Sean]

Yes, they are trying to make it impossible to avoid the diagnosis, in the absence of another diagnosis.

Or even with any other diagnosis.