Precipitating Factors for Functional Cognitive Disorder 2025 Cabreira, McWhirter, Stone and Carson

Andy

Andy

Retired committee member
ABSTRACT

Background
The underlying mechanisms of functional cognitive disorder (FCD) are still poorly understood. This hinders diagnostic identification and establishment of personalised and effective treatments. We aimed to describe the precipitating factors for new-onset FCD and explore differences between the acute and gradual onset FCD groups.

Methods
Retrospective analysis of a consecutive sample of FCD patients seen in three dedicated clinics in the United Kingdom between September 2023 and March 2024. Only patients with at least one-year symptom duration were included. We extracted mode of onset and precipitating factors, demographics, comorbidities, family history of cognitive symptoms, personal exposure to dementia, symptom duration and trajectory, as well as cognitive testing when available.

Results
Ninety-three patients were included, of which 45 had an acute onset of functional cognitive symptoms (48% of total). Of the acute onset group, 51% were female; mean age of symptom onset was 44 years (± 12). In the acute onset group, COVID-19 (n = 18, 40%), head injury (n = 16, 36%) and migraine (n = 16, 36%) were the most common precipitating factors for symptom onset, followed by cardiovascular/vasovagal events, dissociative episodes, panic, medication change, medical procedure under sedation and acute vertigo. The acute onset group was younger, most commonly had a fluctuating course of symptoms, and more headache and fatigue than the gradual onset group.

Conclusions
Functional cognitive disorder often begins acutely. The circumstances around onset may have treatment and prognostic implications. Similar to other functional disorders, the experience of abnormal cognition from an acute pathophysiological event can act as powerful precipitating factors for functional cognitive disorder.

Open access
 
"Functional cognitive disorder (FCD) is the cognitive subtype of functional neurological disorder (FND) [1]. The term is used to describe cognitive symptoms that are persistent and distressing and whose distinguishing feature is the presence of internal inconsistency [2]. FCD accounts for up to a quarter of patients attending memory services [3] and is also common in other medical conditions such as chronic fatigue syndrome, fibromyalgia and irritable bowel syndrome [4]."

Ref 4 is for A unifying theory for cognitive abnormalities in functional neurological disorders, Fibromyalgia and CFS (2018), Mark J Edwards et al.
 
The paper said:
the experience of abnormal cognition from an acute pathophysiological event can act as powerful precipitating factors for functional cognitive disorder
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Magical bootstrapping explanation where the cause is the cause of the cause through some magical process that only exists to account for not understanding what's happening. The fact that it's possible to publish something as ridiculous as "powerful precipitating factors" in an academic paper is completely farcical. It reads like a parody of science and it beclowns the entire profession.
Migrainous cognitive symptoms, and likely alarming acute pain, may also alter brain predictions in a way that makes cognitive symptoms persistent
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They're just going out there making stuff up and no one cares that this is all a sick joke. They put stuff like "alarming acute pain" like it's a religious "This is the way" type mantra.
The findings of the present study fit a model whereby the expectation and/or experience of abnormal cognition following different types of pathophysiological event, work through a range of potential common mechanisms to lead to symptom persistence including attentional dysregulation
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Oh, they "fit a model", through "a range of potential common mechanisms to lead to symptom persistence", uh? A whole range of diffuse, possible, conceptual maybes? And they are in the room with you right now, these "potential common mechanisms"?
Cognitive symptoms with an acute onset more often followed a fluctuating course (89% vs. 67% in the gradual onset group, p = 0.021). In 94% of our cohort, symptoms remained stable or somewhat improved since the onset, while the remaining patients continued to worsen after the initial event; there was no difference between groups, although the absence of improvement was numerically more common in the gradual onset group and driven by comorbid PTSD in the acute onset group (Table 1).
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Good grief where even to begin with this? The numbers don't even bother to match up, both 'types' have a supermajority of fluctuating patterns, but the next sentences contradict each other in a quite fluctuating and inconsistent manner, while the last sentence is completely speculative nonsense based on circular reasoning and asking overlapping questions.

This isn't just speculative nonsense, it's completely unserious dereliction of duty:
Acute triggers, and their associated potential direct effects, update a ‘symptom internal model’ with new salient information that is interpreted as the ‘new normal’ [32, 33]. When the direct effects have improved, for example after traumatic brain injury or post-COVID infection, the internal model is not updated back to a more normal state and continues to respond as if the acute trigger is still present (Figure 2). In other words, there is a failure of habituation to the acute trigger. The symptoms are typically amplified through self-monitoring, hypervigilance, anticipatory and performance anxiety [34], which in turn further reduce the amount of attentional resources available for information processing and task performance [4, 32, 35]. Other potential perpetuating factors include repeated investigations, time off work and litigation [15, 32-34].
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See, button soup is soup you make out of a single button. Just water and a button. Nothing else. Well, OK, also a range of potential common ingredients, such as bones, meat, herbs, spices, vegetables and probably some fat. But without the button, it's just not button soup. You only need the single button, with the "range of potential common ingredients" merely acting to perpetuate the delusion of tasting anything but hot water.
In conclusion, this study may provide further insight into the mechanisms underlying FCD and open future avenues for better disease management and personalised treatment strategies
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