Cognitive Complaints in Motor Functional Neurological (Conversion) Disorders: A Focused Review and Clinical Perspective, 2020, Perez et al

Andy

Andy

Retired committee member
Functional neurological (conversion) disorder (FND) is a neuropsychiatric condition characterized by sensorimotor symptoms exhibiting features incompatible with other neurologic diseases. Individuals with motor FND (mFND) typically present with limb weakness, nonepileptic seizures, and/or abnormal movements. However, this population also frequently reports clouded thinking, inattention, and memory difficulties. Cognitive complaints in individuals with mFND are important to evaluate as they may negatively impact quality of life and impede treatment engagement.

We provide a narrative review of the neuropsychological testing literature detailing neurocognitive profiles of individuals with mFND. We also present three illustrative clinical cases at the intersection of mFND and cognitive concerns. Several studies and our case examples highlight that generally normal cognitive performance can be observed concurrently with subjective cognitive complaints in some individuals with mFND; this mismatch may be a possible “rule-in” sign of functional cognitive symptoms. Other studies have reported impairments in attention, memory, language, visuospatial, and executive functioning in individuals with mFND. These impairments could be related to medical-psychiatric comorbidities, psychotropic medication side effects, and intrinsic disease mechanisms. When evaluating individuals with mFND and their cognitive complaints, clinicians can use performance validity test and psychopathology findings to help them interpret the neuropsychological test results. Perceptual mismatches between intact objective cognitive performance and subjective cognitive complaints may reflect a negative attentional bias for cognitive abilities that can be targeted with cognitive retraining and cognitive behavioral therapy. Neuropsychological evaluations may provide a useful adjunctive tool clinicians can use to help assess individuals with mFND and cognitive concerns.
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Paywall, https://journals.lww.com/cogbehavne...gnitive_Complaints_in_Motor_Functional.1.aspx
Not available via Sci hub at time of posting.
 
Several studies and our case examples highlight that generally normal cognitive performance can be observed concurrently with subjective cognitive complaints in some individuals with mFND; this mismatch may be a possible “rule-in” sign of functional cognitive symptoms. Other studies have reported impairments in attention, memory, language, visuospatial, and executive functioning in individuals with mFND.
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Oh, for goodness sake. To paraphrase:

'Several studies' and our three carefully chosen and perhaps not even real 'illustrative clinical cases' found no cognitive dysfunction, even though patients report it. Other studies did find impairments, but let's ignore those.

Let's ignore the possibility that someone now functioning at an average level might still have suffered a major loss of function; they may have been above-average before. Let's ignore that as it's not really possible to rule it out.

Let's ignore the possibility that our particular tests might not be measuring the same thing as the patient has a problem with.

Let's ignore the possibility that the dysfunction might only occur under certain circumstances, such as after physical and mental exertion, or, in the case of cognitive dysfunction caused by psychotropic medicine, at certain times of the dosing schedule.

Let's ignore all of those things and go ahead and test a patient. And, if they report cognitive dysfunction and we don't find it with our particular test at that particular time, then let's slap a label of hypochondria or hysteria or liar on them. And treat them accordingly.
 
We provide a narrative review
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But. Why? This is not a game. There are actual human lives at stake, millions of them. This requires science, not stories from people with no perspective on the matter. Our own narratives are ignored, why would the narratives of people with no personal experience be of any use when they explicitly reject, without reliable evidence or reason, the patients' narratives as being delusional?

Take this seriously or don't take it at all. Especially from an imaginary basis like conversion disorder, which to this day has no evidence whatsoever to support. Leave the story telling to people with a valid perspective and either do actual science or do nothing at all, please. For millions of people's sake.
 
I havnt read this, but if dynorod take their time to attend a blocked drain I might get there later today.

Out of interest, how many were female?
 
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