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Altieri M, Maggi G, Giacobbe C, Santangelo G. Psychometric properties and normative data of the Italian version of the Cognitive Function at Work Questionnaire: a screening tool for detecting subjective cognitive complaints at work. Neurol Sci 2024; 45:2593-2603. [PMID: 38155286 DOI: 10.1007/s10072-023-07265-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/12/2023] [Indexed: 12/30/2023]
Abstract
INTRODUCTION Considering the extension of working life due to socioeconomic and political factors, many people may experience cognitive complaints (CC) at their workplace, with severe consequences on their quality of life. The identification of workers reporting significative SCC is crucial to eventually address them to an objective neuropsychological evaluation and implement cognitive interventions to guarantee workers' well-being. Since no Italian questionnaires for detecting CC were designed for occupational settings, the aim of the study was to validate the Italian version of the Cognitive Function at Work Questionnaire (CFWQ) and to provide its normative data. MATERIALS AND METHODS Internal consistency, convergent and divergent validity, and factorial structure of the CFWQ were evaluated. A regression-based procedure served to compute percentiles of CFWQ and its subscales. RESULTS Four hundred twenty-one participants without psychiatric and/or neurological disorders completed the survey. We found that the Italian CFWQ included 26 items, with a good internal consistency (Cronbach's alpha = 0.897) and a six-factor structure (memory, language, processing speed, abstract thinking/behavioral control, behavioral inertia, planning ability). CFWQ score did not correlate with empathy but correlated strongly with memory scores and moderately with anxiety and depression scores. CONCLUSIONS The Italian CFWQ showed good psychometric properties, in analogy with the original English scale. Therefore, it can be successfully employed in organizational contexts to possibly identify workers with CC and therefore with possible co-occurrent psychological, behavioral, and cognitive consequences.
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Affiliation(s)
- Manuela Altieri
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Gianpaolo Maggi
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Chiara Giacobbe
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Gabriella Santangelo
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy.
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2
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Dijkstra N, Mazor M, Fleming SM. Confidence ratings do not distinguish imagination from reality. J Vis 2024; 24:13. [PMID: 38814936 PMCID: PMC11146086 DOI: 10.1167/jov.24.5.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 05/03/2024] [Indexed: 06/01/2024] Open
Abstract
Perceptual reality monitoring refers to the ability to distinguish internally triggered imagination from externally triggered reality. Such monitoring can take place at perceptual or cognitive levels-for example, in lucid dreaming, perceptual experience feels real but is accompanied by a cognitive insight that it is not real. We recently developed a paradigm to reveal perceptual reality monitoring errors during wakefulness in the general population, showing that imagined signals can be erroneously attributed to perception during a perceptual detection task. In the current study, we set out to investigate whether people have insight into perceptual reality monitoring errors by additionally measuring perceptual confidence. We used hierarchical Bayesian modeling of confidence criteria to characterize metacognitive insight into the effects of imagery on detection. Over two experiments, we found that confidence criteria moved in tandem with the decision criterion shift, indicating a failure of reality monitoring not only at a perceptual but also at a metacognitive level. These results further show that such failures have a perceptual rather than a decisional origin. Interestingly, offline queries at the end of the experiment revealed global, task-level insight, which was uncorrelated with local, trial-level insight as measured with confidence ratings. Taken together, our results demonstrate that confidence ratings do not distinguish imagination from reality during perceptual detection. Future research should further explore the different cognitive dimensions of insight into reality judgments and how they are related.
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Affiliation(s)
- Nadine Dijkstra
- Department of Imaging Neuroscience, University College London, London, UK
- https://sites.google.com/view/nadinedijkstra
| | - Matan Mazor
- All Souls College and Department of Experimental Psychology, University of Oxford, Oxford, UK
- matanmazor.github.io
| | - Stephen M Fleming
- Department of Imaging Neuroscience, University College London, London, UK
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, London, UK
- Department of Experimental Psychology, University College London, London, UK
- https://metacoglab.org/
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Kurnaz S, Durmaz O. The relationship between metacognitive processes and cognitive performances in older adults with no significant impairment: a cross-sectional study. Psychogeriatrics 2024; 24:322-328. [PMID: 38247025 DOI: 10.1111/psyg.13077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 11/30/2023] [Accepted: 01/06/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND Metacognitive dysfunctions have been implicated in several neuropsychiatric conditions, while cognitive performances have been evaluated by measuring cognitive domains in older adults. This study investigated a relationship between metacognitive processes and cognitive performances in older adults. METHODS A sociodemographic form, the Standardised Mini-Mental State Examination (SMMSE) and the Metacognitions Questionnaire-30 (MCQ-30) were applied to participants aged >65 years who had no significant cognitive decline defined as normal or with mild cognitive impairment. RESULTS 'Negative beliefs about worry' and 'need to control thoughts' domains of MCQ-30 were related to cognitive performance measured with SMMSE. Increased negative beliefs about worry were a predicting factor for total cognitive performance as a means of contributing to cognitive impairment, whereas an increased need to control thoughts was related to having a less likely cognitive impairment. CONCLUSIONS Metacognitive dysfunctional processes, in particular about worry, might contribute to determining more decent outcomes for cognitive conditions in older adults with no significant cognitive dysfunction.
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Affiliation(s)
- Samet Kurnaz
- Department of Psychiatry, Şehit Prof. Dr. İlhan Varank Sancaktepe Training & Research Hospital, Istanbul, Turkey
| | - Onur Durmaz
- Department of Psychiatry, Erenköy Mental Health and Neurology Training & Research Hospital, Istanbul, Turkey
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Silverberg ND, Rush BK. Neuropsychological evaluation of functional cognitive disorder: A narrative review. Clin Neuropsychol 2024; 38:302-325. [PMID: 37369579 DOI: 10.1080/13854046.2023.2228527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/17/2023] [Indexed: 06/29/2023]
Abstract
Objective: To critically review contemporary theoretical models, diagnostic approaches, clinical features, and assessment findings in Functional Cognitive Disorder (FCD), and make recommendations for neuropsychological evaluation of this condition. Method: Narrative review. Results: FCD is common in neuropsychological practice. It is characterized by cognitive symptoms that are not better explained by another medical or psychiatric disorder. The cognitive symptoms are associated with distress and/or limitations in daily functioning, but are potentially reversible with appropriate identification and treatment. Historically, a variety of diagnostic frameworks have attempted to capture this condition. A contemporary conceptualization of FCD positions it as a subtype of Functional Neurological Disorder, with shared and unique etiological factors. Patients with FCD tend to perform normally on neuropsychological testing or demonstrate relatively weak memory acquisition (e.g. list learning trials) in comparison to strong attention and delayed recall performance. Careful history-taking and behavioral observations are essential to support the diagnosis of FCD. Areas of ongoing controversy include operationalizing "internal inconsistencies" and the role of performance validity testing. Evidence for targeted interventions remains scarce. Conclusions: Neuropsychologists familiar with FCD can uniquely contribute to the care of patients with this condition by improving diagnostic clarity, richening case formulation, communicating effectively with referrers, and leading clinical management. Further research is needed to refine diagnosis, prognosis, and treatment.
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Affiliation(s)
- Noah D Silverberg
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
- Rehabilitation Research Program, Centre for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada
| | - Beth K Rush
- Department of Psychiatry & Psychology, Mayo Clinic, Jacksonville, Florida, USA
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Jungilligens J, Flohr MC, Lange M, Wellmer J, Popkirov S. The relationship of action, affect, and metacognition in functional seizures. J Clin Exp Neuropsychol 2023; 45:1003-1013. [PMID: 38007609 DOI: 10.1080/13803395.2023.2287778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 11/19/2023] [Indexed: 11/27/2023]
Abstract
INTRODUCTION Metacognition provides a lens through which individuals experience, interpret, and respond to their affective states and behavior; it might thus influence complex neuropsychiatric conditions such as functional seizures - events characterized by states of heightened affective arousal and the disinhibition of prepotent behavior. In this pilot study, we aimed to establish a better understanding of the role of metacognition in functional seizures and its relationship to affective arousal and behavioral disinhibition (i.e., problems in suppressing prepared behavior). We hypothesized that affective arousal is related to higher behavioral disinhibition as well as slower reaction times, that affect and action (performing vs. not performing a movement) are related to memory and metacognition, and that metacognition is related to illness characteristics. METHODS We used a combination of an emotional go/no-go and a metacognitive recognition task with affectively valenced and neutral images in 18 patients with functional seizures. We compared markers of behavioral inhibition as well as indices for memory and metacognitive performance between affective (vs. neutral) and action/go (vs. inhibition/no-go) conditions. RESULTS Contrary to our hypothesis, behavioral disinhibition was not different between conditions. However, we found slower reaction times for affectively valenced stimuli. Memory performance and metacognition were better for affectively valenced pictures and for pictures used in go trials (i.e., associated with action/performing the movement). Illness factors (illness duration, seizure frequency, levels of self-reported anxiety) were correlated with aspects of metacognition. CONCLUSIONS This pilot study offers first insights into alterations in metacognition related to action and affect in patients with functional seizures; specifically, that affectively valenced stimuli and active engagement are related to enhanced memory and metacognition. This relationship was also found with respect to illness factors. These results provide insight into potentially underlying pathomechanisms, although the lack of a control group limits evaluating the specificity of these findings.
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Affiliation(s)
- Johannes Jungilligens
- Behavioral Neurology Research Group, Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - Marie-Christin Flohr
- Behavioral Neurology Research Group, Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany
- Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Miriam Lange
- Behavioral Neurology Research Group, Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany
- Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Jörg Wellmer
- Ruhr Epileptology, Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Stoyan Popkirov
- Department of Neurology, University Hospital Essen, Essen, Germany
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Picon EL, Wardell V, Palombo DJ, Todd RM, Aziz B, Bedi S, Silverberg ND. Factors perpetuating functional cognitive symptoms after mild traumatic brain injury. J Clin Exp Neuropsychol 2023; 45:988-1002. [PMID: 37602857 DOI: 10.1080/13803395.2023.2247601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/08/2023] [Indexed: 08/22/2023]
Abstract
INTRODUCTION Self-reported memory difficulties (forgetting familiar names, misplacing objects) often persist long after a mild traumatic brain injury (mTBI), despite normal neuropsychological test performance. This clinical presentation may be a manifestation of a functional cognitive disorder (FCD). Several mechanisms underlying FCD have been proposed, including metacognitive impairment, memory perfectionism, and misdirected attention, as well as depression or anxiety-related explanations. This study aims to explore these candidate perpetuating factors in mTBI, to advance our understanding of why memory symptoms frequently persist following mTBI. METHODS A cross-sectional study of 67 adults (n = 39 with mTBI mean = 25 months ago and n = 28 healthy controls). Participants completed standardized questionnaires (including the Functional Memory Disorder Inventory), a metacognitive task (to quantify discrepancies between their trial-by-trial accuracy and confidence), and a brief neuropsychological test battery. We assessed candidate mechanisms in two ways: (1) between-groups, comparing participants with mTBI to healthy controls, and (2) within-group, examining their associations with functional memory symptom severity (FMDI) in the mTBI group. RESULTS Participants with mTBI performed similarly to controls on objective measures of memory ability but reported experiencing much more frequent memory lapses in daily life. Contrary to expectations, metacognitive efficiency did not differentiate the mTBI and control groups and was not associated with functional memory symptoms. Memory perfectionism was strongly associated with greater functional memory symptoms among participants with mTBI but did not differ between groups when accounting for age. Depression and checking behaviors produced consistent results across between-groups and within-group analyses: these factors were greater in the mTBI group compared to the control group and were associated with greater functional memory symptoms within the mTBI group. CONCLUSIONS This study highlights promising (e.g., depression, checking behaviors) and unlikely (e.g., metacognitive impairment) mechanisms underlying functional memory symptoms after mTBI, to guide future research and treatment.
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Affiliation(s)
- Edwina L Picon
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Victoria Wardell
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Daniela J Palombo
- Department of Psychology, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rebecca M Todd
- Department of Psychology, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bilal Aziz
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Sanjana Bedi
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Noah D Silverberg
- Department of Psychology, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Rehabilitation Research Program, Centre for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, Canada
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Cabreira V, McWhirter L, Carson A. Functional Cognitive Disorder: Diagnosis, Treatment, and Differentiation from Secondary Causes of Cognitive Difficulties. Neurol Clin 2023; 41:619-633. [PMID: 37775194 DOI: 10.1016/j.ncl.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Functional cognitive disorder is an increasingly common cause of referral to the memory clinic. As a substantial source of disability, clinicians involved in the management of patients with cognitive complaints need to familiarize themselves with this important differential diagnosis. Our approach focuses on the identification of positive features of internal inconsistency (historical and clinical clues alongside patterns of performance) instead of an exclusionary approach. Although effective treatments are desperately needed, promising therapies include metacognitive retraining and cognitive-behavioral therapy modalities. Future research should focus on a better understanding of disease trajectories and outcomes as well as the development of evidence-based interventions.
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Affiliation(s)
- Verónica Cabreira
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Laura McWhirter
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
| | - Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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Roivainen E, Peura M, Pätsi J. Cognitive profile in functional disorders. Cogn Neuropsychiatry 2023; 28:424-436. [PMID: 37889124 DOI: 10.1080/13546805.2023.2275336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023]
Abstract
INTRODUCTION Patients with functional disorders (FD) often experience cognitive problems such as forgetfulness and distractibility alongside physical symptoms that cannot be attributed to a known somatic disease. METHOD Test scores of cognitive tests and psychiatric rating scales of 100 outpatients diagnosed with a functional disorder were compared to a control group (n = 300) of patients with other diagnoses and to test norms for the general population. RESULTS Out of the 100 patients with functional disorders, 59 reported significant subjective cognitive symptoms. A moderate difference (d = 0.5-0.7) was found between the FD group mean and the population mean in processing speed tests, as well as in four psychiatric rating scales (depression, anxiety, phobias, somatisation) but there were no statistically significant differences in verbal and nonverbal reasoning or in logical memory. Somatisation and logical verbal memory scores were higher in the FD group compared to the control group. CONCLUSION The findings of the study suggest that a decline in processing speed is a central feature in the cognitive profile of patients with functional disorders.
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Affiliation(s)
- Eka Roivainen
- Department of Medical Rehabilitation, Oulu University Hospital, Oulu, Finland
| | - Maria Peura
- Department of Medical Rehabilitation, Oulu University Hospital, Oulu, Finland
| | - Jukka Pätsi
- Department of Medical Rehabilitation, Oulu University Hospital, Oulu, Finland
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9
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Ball HA, Coulthard E, Fish M, Bayer A, Gallacher J, Ben-Shlomo Y. Predictors and prognosis of population-based subjective cognitive decline: longitudinal evidence from the Caerphilly Prospective Study (CaPS). BMJ Open 2023; 13:e073205. [PMID: 37844990 PMCID: PMC10582873 DOI: 10.1136/bmjopen-2023-073205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 09/11/2023] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVES To understand associations between the subjective experience of cognitive decline and objective cognition. This subjective experience is often conceptualised as an early step towards neurodegeneration, but this has not been scrutinised at the population level. An alternative explanation is poor meta-cognition, the extreme of which is seen in functional cognitive disorder (FCD). DESIGN Prospective cohort (Caerphilly Prospective Study). SETTING Population-based, South Wales, UK. PARTICIPANTS This men-only study began in 1979; 1225 men participated at an average age of 73 in 2002-2004, including assessments of simple subjective cognitive decline (sSCD, defined as a subjective report of worsening memory or concentration). Dementia outcomes were followed up to 2012-2014. Data on non-completers was additionally obtained from death certificates and local health records. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure was incident dementia over 10 years. Secondary outcome measures included prospective change in objective cognition and cross-sectional cognitive internal inconsistency (the existence of a cognitive ability at some times, and its absence at other times, with no intervening explanatory factors except for focus of attention). RESULTS sSCD was common (30%) and only weakly associated with prior objective cognitive decline (sensitivity 36% (95% CI 30 to 42) and specificity 72% (95% CI 68 to 75)). Independent predictors of sSCD were older age, poor sleep quality and higher trait anxiety. Those with sSCD did not have excess cognitive internal inconsistency, but results suggested a mild attentional deficit. sSCD did not predict objective cognitive change (linear regression coefficient -0.01 (95% CI -0.13 to 0.15)) nor dementia (odds ratio 1.35 (0.61 to 2.99)) 10 years later. CONCLUSIONS sSCD is weakly associated with prior objective cognitive decline and does not predict future cognition. Prior sleep difficulties and anxiety were the most robust predictors of sSCD. sSCD in the absence of objective decline appears to be a highly prevalent example of poor meta-cognition (ie, poor self-awareness of cognitive performance), which could be a driver for later FCD.
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Affiliation(s)
- Harriet A Ball
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Elizabeth Coulthard
- Translational Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Mark Fish
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
| | - Antony Bayer
- Institute of Primary Care and Public Health, Cardiff University, Cardiff, Wales, UK
| | - John Gallacher
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol, Bristol, UK
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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.
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Mobile facial affect recognition and real-time social experiences in serious mental illness. Schizophr Res Cogn 2022; 29:100253. [PMID: 35444929 PMCID: PMC9014436 DOI: 10.1016/j.scog.2022.100253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/01/2022] [Accepted: 04/01/2022] [Indexed: 11/22/2022]
Abstract
Background Emotion recognition deficits are linked with social dysfunction in psychosis, as is inaccurate self-assessment of emotion recognition abilities. However, little is known about the link between ER and real-time social appraisals and behavior. Methods In 136 people with psychotic disorders or affective disorder with psychosis we administered a novel ecological momentary cognitive test of emotion recognition which both assesses emotion recognition ability and self-assessed performance in conjunction with ecological momentary assessment of social appraisals, motivation, and time spent alone. Hybrid mixed effects models evaluated emotion recognition's associations with social experiences. Results Better recognition ability was associated with greater pleasure and more positive appraisals of others during interactions, whereas accuracy of self-assessment of emotion recognition ability was associated with more positive appraisals of interactions and social motivation. Overestimation of emotion recognition was linked with concurrent higher social motivation yet greater desire to avoid others. Time alone was unrelated to emotion recognition ability or self-assessment of ability. Discussion Mobile emotion recognition performance was associated with appraisals of recent interactions but not behavior. Self-assessment of social cognitive performance was associated with more positive appraisals and social motivation, and may be a novel target for interventions aimed at social dysfunction.
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Larner AJ. Towards a neural network hypothesis for functional cognitive disorders: an extension of the Overfitted Brain Hypothesis. Cogn Neuropsychiatry 2022; 27:314-321. [PMID: 35306961 DOI: 10.1080/13546805.2022.2054694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Introduction: Whilst the empirical understanding of functional cognitive disorders (FCD) has advanced in recent years, theoretical and conceptual models have evolved more slowly. Existing frameworks for FCD are based on models of other functional neurological disorders or of metacognitive processes and are recognised to lack mechanistic precision.Methods: In this article, a novel application to FCD of Hoel's Overfitted Brain Hypothesis of the evolved function of dreaming is attempted.Results: This posits that the empirically observed sleep disturbance in FCD entails impaired dreaming which causes the brain to be overfitted and hence unable to generalise appropriately, producing mismatch between memory expectations and memory performance.Conclusions: This formulation of FCD is based on considerations derived from the study of neural networks and shares commonalities with Bayesian models of functional neurological disorders. Additionally, it has implications for future hypothesis-driven research in FCD and suggests a pragmatic basis for management strategies.
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Affiliation(s)
- A J Larner
- Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Liverpool, UK
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Larner AJ. Metacognition in functional cognitive disorder: contradictory or convergent experimental results? Brain Commun 2022; 4:fcac138. [PMID: 35706976 PMCID: PMC9189609 DOI: 10.1093/braincomms/fcac138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 03/16/2022] [Accepted: 05/24/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- AJ Larner
- University College London Honorary Senior Research Fellow Department of Brain Repair & Rehabilitation Institute of Neurology WC1B 5EH United Kingdom
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Functional neurological disorder: new subtypes and shared mechanisms. Lancet Neurol 2022; 21:537-550. [PMID: 35430029 PMCID: PMC9107510 DOI: 10.1016/s1474-4422(21)00422-1] [Citation(s) in RCA: 146] [Impact Index Per Article: 73.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 10/14/2021] [Accepted: 11/24/2021] [Indexed: 01/12/2023]
Abstract
Functional neurological disorder is common in neurological practice. A new approach to the positive diagnosis of this disorder focuses on recognisable patterns of genuinely experienced symptoms and signs that show variability within the same task and between different tasks over time. Psychological stressors are common risk factors for functional neurological disorder, but are often absent. Four entities-functional seizures, functional movement disorders, persistent perceptual postural dizziness, and functional cognitive disorder-show similarities in aetiology and pathophysiology and are variants of a disorder at the interface between neurology and psychiatry. All four entities have distinctive features and can be diagnosed with the support of clinical neurophysiological studies and other biomarkers. The pathophysiology of functional neurological disorder includes overactivity of the limbic system, the development of an internal symptom model as part of a predictive coding framework, and dysfunction of brain networks that gives movement the sense of voluntariness. Evidence supports tailored multidisciplinary treatment that can involve physical and psychological therapy approaches.
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Sharma V, Sagar R, Kaloiya G, Mehta M. The Scope of Metacognitive Therapy in the Treatment of Psychiatric Disorders. Cureus 2022; 14:e23424. [PMID: 35475111 PMCID: PMC9030663 DOI: 10.7759/cureus.23424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 03/23/2022] [Indexed: 12/17/2022] Open
Abstract
Metacognitive therapy (MCT) is a novel and promising transdiagnostic psychotherapy intervention based on the Self-Regulatory Executive Function model of conceptualizing emotional disorders. It was developed by Adrian Wells in 2009. Its therapeutic response occurs by reducing dysfunctional metacognitive beliefs regarding worry and rumination, often seen in patients with psychiatric disorders. Since its inception, it has been increasingly applied to a wide spectrum of psychiatric illnesses, but mainly focusing on mood and anxiety disorders. To our knowledge, no study has detailed its existing therapeutic scope in psychiatry. In this comprehensive narrative review, we describe the various psychiatric illnesses in which MCT has been used, the advantages of MCT, and the limitations of the MCT research. In addition, we propose some solutions to systematically examine its place in psychiatry. We encountered its potential role in treating trauma and stress-related disorders, obsessive-compulsive spectrum disorders, personality disorders, psychotic disorders, substance use disorders, and sexual disorders.
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Affiliation(s)
- Vandita Sharma
- Psychiatry, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Rajesh Sagar
- Psychiatry, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | | | - Manju Mehta
- Psychiatry, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
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Bhome R, McWilliams A, Price G, Poole NA, Howard RJ, Fleming SM, Huntley JD. Metacognition in functional cognitive disorder. Brain Commun 2022; 4:fcac041. [PMID: 35243345 PMCID: PMC8889108 DOI: 10.1093/braincomms/fcac041] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 01/16/2022] [Accepted: 02/20/2022] [Indexed: 11/17/2022] Open
Abstract
Functional cognitive disorder is common but underlying mechanisms remain poorly understood. Metacognition, an individual's ability to reflect on and monitor cognitive processes, is likely to be relevant. Local metacognition refers to an ability to estimate confidence in cognitive performance on a moment-to-moment basis, whereas global metacognition refers to long-run self-evaluations of overall performance. Using a novel protocol comprising task-based measures and hierarchical Bayesian modelling, we compared local and global metacognitive performance in individuals with functional cognitive disorder. Eighteen participants with functional cognitive disorder (mean age = 49.2 years, 10 males) were recruited to this cross-sectional study. Participants completed computerized tasks that enabled local metacognitive efficiency for perception and memory to be measured using the hierarchical meta-d' model within a signal detection theory framework. Participants also completed the Multifactorial Memory Questionnaire measuring global metacognition, and questionnaires measuring anxiety and depression. Estimates of local metacognitive efficiency were compared with those estimated from two control groups who had undergone comparable metacognitive tasks. Global metacognition scores were compared with the existing normative data. A hierarchical regression model was used to evaluate associations between global metacognition, depression and anxiety and local metacognitive efficiency, whilst simple linear regressions were used to evaluate whether affective symptomatology and local metacognitive confidence were associated with global metacognition. Participants with functional cognitive disorder had intact local metacognition for perception and memory when compared with controls, with the 95% highest density intervals for metacognitive efficiency overlapping with the two control groups in both cognitive domains. Functional cognitive disorder participants had significantly lower global metacognition scores compared with normative data; Multifactorial Memory Questionnaire-Ability subscale (t = 6.54, P < 0.0001) and Multifactorial Memory Questionnaire-Satisfaction subscale (t = 5.04, P < 0.0001). Mood scores, global metacognitive measures and metacognitive bias were not significantly associated with local metacognitive efficiency. Local metacognitive bias [β = -0.20 (SE = 0.09), q = 0.01] and higher depression scores as measured by the Patient Health Questionnaire-9 [β = -1.40 (SE = 2.56), q = 0.01] were associated with the lower global metacognition scores. We show that local metacognition is intact, whilst global metacognition is impaired, in functional cognitive disorder, suggesting a decoupling between the two metacognitive processes. In a Bayesian model, an aberrant prior (impaired global metacognition), may override bottom-up sensory input (intact local metacognition), giving rise to the subjective experience of abnormal cognitive processing. Future work should further investigate the interplay between local and global metacognition in functional cognitive disorder.
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Affiliation(s)
- Rohan Bhome
- Dementia Research Centre, University College London, 8-11 Queen Square, London, UK
| | - Andrew McWilliams
- Wellcome Centre for Human Neuroimaging, University College London, London, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- UCL Institute of Child Health, Great Ormond Street, London, UK
- Department of Experimental Psychology, University College London, London, UK
| | - Gary Price
- National Hospital for Neurology and Neurosurgery, London, UK
| | - Norman A. Poole
- South West London and St George’s Mental Health NHS Trust, London, UK
| | | | - Stephen M. Fleming
- Wellcome Centre for Human Neuroimaging, University College London, London, UK
- Department of Experimental Psychology, University College London, London, UK
- Max Planck University College London Centre for Computational Psychiatry and Ageing Research, London, UK
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17
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Mollica A, Dey A, Cairncross M, Silverberg N, Burke MJ. Neuropsychiatric Treatment for Mild Traumatic Brain Injury: Nonpharmacological Approaches. Semin Neurol 2022; 42:168-181. [PMID: 35114694 DOI: 10.1055/s-0041-1742143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Postconcussive symptoms following mild traumatic brain injury (mTBI)/concussion are common, disabling, and challenging to manage. Patients can experience a range of symptoms (e.g., mood disturbance, headaches, insomnia, vestibular symptoms, and cognitive dysfunction), and neuropsychiatric management relies heavily on nonpharmacological and multidisciplinary approaches. This article presents an overview of current nonpharmacological strategies for postconcussive symptoms including psychoeducation; psychotherapy; vestibular, visual, and physical therapies; cognitive rehabilitation; as well as more novel approaches, such as neuromodulation. Ultimately, treatment and management of mTBI should begin early with appropriate psychoeducation/counseling, and be tailored based on core symptoms and individual goals.
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Affiliation(s)
- Adriano Mollica
- Neuropsychiatry Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Harquail Centre for Neuromodulation and Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Ayan Dey
- Neuropsychiatry Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Harquail Centre for Neuromodulation and Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Molly Cairncross
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada.,Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Noah Silverberg
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada.,Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Matthew J Burke
- Neuropsychiatry Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Harquail Centre for Neuromodulation and Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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18
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Chutko L, Surushkina S. Functional cognitive disorders. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:43-48. [DOI: 10.17116/jnevro202212202143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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19
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Seow TXF, Rouault M, Gillan CM, Fleming SM. How Local and Global Metacognition Shape Mental Health. Biol Psychiatry 2021; 90:436-446. [PMID: 34334187 DOI: 10.1016/j.biopsych.2021.05.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 05/14/2021] [Accepted: 05/16/2021] [Indexed: 01/22/2023]
Abstract
Metacognition is the ability to reflect on our own cognition and mental states. It is a critical aspect of human subjective experience and operates across many hierarchical levels of abstraction-encompassing local confidence in isolated decisions and global self-beliefs about our abilities and skills. Alterations in metacognition are considered foundational to neurologic and psychiatric disorders, but research has mostly focused on local metacognitive computations, missing out on the role of global aspects of metacognition. Here, we first review current behavioral and neural metrics of local metacognition that lay the foundation for this research. We then address the neurocognitive underpinnings of global metacognition uncovered by recent studies. Finally, we outline a theoretical framework in which higher hierarchical levels of metacognition may help identify the role of maladaptive metacognitive evaluation in mental health conditions, particularly when combined with transdiagnostic methods.
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Affiliation(s)
- Tricia X F Seow
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, London, United Kingdom; Wellcome Centre for Human Neuroimaging, University College London, London, United Kingdom.
| | - Marion Rouault
- Institut Jean Nicod, Département d'études cognitives, PSL Research University, Paris, France; Laboratoire de neurosciences cognitives et computationnelles, Département d'études cognitives, PSL Research University, Paris, France.
| | - Claire M Gillan
- School of Psychology, Trinity College Dublin, Dublin, Ireland; Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland; Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Stephen M Fleming
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, London, United Kingdom; Wellcome Centre for Human Neuroimaging, University College London, London, United Kingdom; Department of Experimental Psychology, University College London, London, United Kingdom
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20
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Functional Cognitive Disorders (FCD): How Is Metacognition Involved? Brain Sci 2021; 11:brainsci11081082. [PMID: 34439701 PMCID: PMC8393342 DOI: 10.3390/brainsci11081082] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 11/17/2022] Open
Abstract
Functional cognitive disorders (FCD) have become a subject of increasing clinical interest in recent years, in part because of their high prevalence amongst patients attending dedicated memory clinics. Empirical understanding of FCD based on observational studies is growing, suggesting a relationship to other functional neurological disorders (FND) based on shared phenomenology. However, understanding of FCD at the theoretical level has been lacking. One suggestion has been that FCD are disorders of metacognition, most usually of metamemory. In this article, a brief overview of these constructs is presented along with existing evidence for their impairment in FCD. Previous adaptations of theoretical models of FND to accommodate FCD are reviewed. A novel application to FCD of Nelson and Narens’ monitoring and control model of metamemory is then attempted, positing an improper setting of the monitoring function, with examples of ecological relevance. Formulation of FCD in light of a metacognitive model of anosognosia is also considered. Although lacking mechanistic and neuroanatomical sophistication, this metacognitive formulation of FCD may give pointers for future hypothesis-driven research and a pragmatic basis for management strategies.
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21
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Differentiating Functional Cognitive Disorder from Early Neurodegeneration: A Clinic-Based Study. Brain Sci 2021; 11:brainsci11060800. [PMID: 34204389 PMCID: PMC8234331 DOI: 10.3390/brainsci11060800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/11/2021] [Accepted: 06/13/2021] [Indexed: 11/22/2022] Open
Abstract
Functional cognitive disorder (FCD) is a relatively common cause of cognitive symptoms, characterised by inconsistency between symptoms and observed or self-reported cognitive functioning. We aimed to improve the clinical characterisation of FCD, in particular its differentiation from early neurodegeneration. Two patient cohorts were recruited from a UK-based tertiary cognitive clinic, diagnosed following clinical assessment, investigation and expert multidisciplinary team review: FCD, (n = 21), and neurodegenerative Mild Cognitive Impairment (nMCI, n = 17). We separately recruited a healthy control group (n = 25). All participants completed an assessment battery including: Hopkins Verbal Learning Test-Revised (HVLT-R), Trail Making Test Part B (TMT-B); Depression Anxiety and Stress Scale (DASS) and Minnesota Multiphasic Personality Inventory (MMPI-2RF). In comparison to healthy controls, the FCD and nMCI groups were equally impaired on trail making, immediate recall, and recognition tasks; had equally elevated mood symptoms; showed similar aberration on a range of personality measures; and had similar difficulties on inbuilt performance validity tests. However, participants with FCD performed significantly better than nMCI on HVLT-R delayed free recall and retention (regression coefficient −10.34, p = 0.01). Mood, personality and certain cognitive abilities were similarly altered across nMCI and FCD groups. However, those with FCD displayed spared delayed recall and retention, in comparison to impaired immediate recall and recognition. This pattern, which is distinct from that seen in prodromal neurodegeneration, is a marker of internal inconsistency. Differentiating FCD from nMCI is challenging, and the identification of positive neuropsychometric features of FCD is an important contribution to this emerging area of cognitive neurology.
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22
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Ricciardi L, Nisticò V, Andrenelli E, Cunha JM, Demartini B, Kirsch LP, Crucianelli L, Yogarajah M, Morgante F, Fotopoulou A, Edwards MJ. Exploring three levels of interoception in people with functional motor disorders. Parkinsonism Relat Disord 2021; 86:15-18. [PMID: 33819899 DOI: 10.1016/j.parkreldis.2021.03.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 03/12/2021] [Accepted: 03/24/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION A three-level model of interoception has recently been defined. We aim to study the interoceptive processing in individuals with functional motor disorder (FMD). METHODS Twenty-two patients with FMD were compared to 23 healthy controls. They underwent a protocol measuring different levels of interoception including: accuracy (a heart-beat tracking task), awareness (participant's confidence level) and sensibility (the Body Awareness Questionnaire-BAQ). Depression, anxiety and alexithymia were assessed by means of validated clinical scales. RESULTS The FMD group showed a lower cardiac interoceptive accuracy and sensibility than healthy controls but they did not differ in terms of awareness (p = 0.03 and 0.005 respectively). They were aware of their poor performance in the accuracy task. Cardiac interoceptive accuracy positively correlated with the BAQ sub-scales "Predict Body Reaction" (r = 0.49, p = 0.001) and "Sleep-Wake Cycle" (r = 0.52, p < 0.001). A mediation analysis showed a significant indirect effect of group on cardiac interoceptive accuracy through BAQ "Predict Body Reaction" (b = -2.95, 95% BCa CI[-7.2;-0.2]). The direct effect of group on "Predict Body Reaction" was still significant (b = - 6.95, p = 0.02, 95% CI[-13.18;-0.73]). CONCLUSIONS People with FMD have impaired cardiac interoceptive accuracy and sensibility but no difference in metacognitive interoception compared to healthy controls.
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Affiliation(s)
- Lucia Ricciardi
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK; MRC Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, Oxford, UK.
| | - Veronica Nisticò
- Dipartimento di Scienze Della Salute, Università Degli Studi di Milano, Milano, Italy; "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, Università Degli Studi di Milano, Milano, Italy
| | - Elisa Andrenelli
- Department of Experimental and Clinical Medicine, Neurorehabilitation Clinic, "Politecnica Delle Marche" University of Ancona, Ancona, Italy
| | - Joana Macedo Cunha
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Benedetta Demartini
- Dipartimento di Scienze Della Salute, Università Degli Studi di Milano, Milano, Italy; "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, Università Degli Studi di Milano, Milano, Italy; Unità di Psichiatria II, A.O. San Paolo, ASST Santi Paolo e Carlo, Milano, Italy
| | - Louise P Kirsch
- Institut des Systèmes Intelligents et de Robotique (ISIR), Sorbonne Université, Paris, France
| | - Laura Crucianelli
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden; Research Department of Clinical, Educational and Health Psychology, University College London, United Kingdom
| | - Mahinda Yogarajah
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Francesca Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Aikaterini Fotopoulou
- Research Department of Clinical, Educational and Health Psychology, University College London, United Kingdom
| | - Mark J Edwards
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
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23
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Birle C, Slavoaca D, Balea M, Livint Popa L, Muresanu I, Stefanescu E, Vacaras V, Dina C, Strilciuc S, Popescu BO, Muresanu DF. Cognitive function: holarchy or holacracy? Neurol Sci 2020; 42:89-99. [PMID: 33070201 DOI: 10.1007/s10072-020-04737-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/17/2020] [Indexed: 12/24/2022]
Abstract
Cognition is the most complex function of the brain. When exploring the inner workings of cognitive processes, it is crucial to understand the complexity of the brain's dynamics. This paper aims to describe the integrated framework of the cognitive function, seen as the result of organization and interactions between several systems and subsystems. We briefly describe several organizational concepts, spanning from the reductionist hierarchical approach, up to the more dynamic theory of open complex systems. The homeostatic regulation of the mechanisms responsible for cognitive processes is showcased as a dynamic interplay between several anticorrelated mechanisms, which can be found at every level of the brain's organization, from molecular and cellular level to large-scale networks (e.g., excitation-inhibition, long-term plasticity-long-term depression, synchronization-desynchronization, segregation-integration, order-chaos). We support the hypothesis that cognitive function is the consequence of multiple network interactions, integrating intricate relationships between several systems, in addition to neural circuits.
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Affiliation(s)
- Codruta Birle
- Department of Neurosciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, No. 37 Mircea Eliade Street, 400486, Cluj-Napoca, Romania.,"RoNeuro" Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Dana Slavoaca
- Department of Neurosciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, No. 37 Mircea Eliade Street, 400486, Cluj-Napoca, Romania. .,"RoNeuro" Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania.
| | - Maria Balea
- Department of Neurosciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, No. 37 Mircea Eliade Street, 400486, Cluj-Napoca, Romania.,"RoNeuro" Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Livia Livint Popa
- Department of Neurosciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, No. 37 Mircea Eliade Street, 400486, Cluj-Napoca, Romania.,"RoNeuro" Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Ioana Muresanu
- Department of Neurosciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, No. 37 Mircea Eliade Street, 400486, Cluj-Napoca, Romania.,"RoNeuro" Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Emanuel Stefanescu
- "RoNeuro" Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Vitalie Vacaras
- Department of Neurosciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, No. 37 Mircea Eliade Street, 400486, Cluj-Napoca, Romania.,"RoNeuro" Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Constantin Dina
- Department of Clinical Neurosciences, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Stefan Strilciuc
- Department of Neurosciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, No. 37 Mircea Eliade Street, 400486, Cluj-Napoca, Romania.,"RoNeuro" Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Bogdan Ovidiu Popescu
- Department of Radiology, Faculty of Medicine, "Ovidius" University, Constanta, Romania
| | - Dafin F Muresanu
- Department of Neurosciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, No. 37 Mircea Eliade Street, 400486, Cluj-Napoca, Romania.,"RoNeuro" Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
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24
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Ball HA, McWhirter L, Ballard C, Bhome R, Blackburn DJ, Edwards MJ, Fleming SM, Fox NC, Howard R, Huntley J, Isaacs JD, Larner AJ, Nicholson TR, Pennington CM, Poole N, Price G, Price JP, Reuber M, Ritchie C, Rossor MN, Schott JM, Teodoro T, Venneri A, Stone J, Carson AJ. Functional cognitive disorder: dementia's blind spot. Brain 2020; 143:2895-2903. [PMID: 32791521 PMCID: PMC7586080 DOI: 10.1093/brain/awaa224] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/06/2020] [Accepted: 05/21/2020] [Indexed: 12/25/2022] Open
Abstract
An increasing proportion of cognitive difficulties are recognized to have a functional cause, the chief clinical indicator of which is internal inconsistency. When these symptoms are impairing or distressing, and not better explained by other disorders, this can be conceptualized as a cognitive variant of functional neurological disorder, termed functional cognitive disorder (FCD). FCD is likely very common in clinical practice but may be under-diagnosed. Clinicians in many settings make liberal use of the descriptive term mild cognitive impairment (MCI) for those with cognitive difficulties not impairing enough to qualify as dementia. However, MCI is an aetiology-neutral description, which therefore includes patients with a wide range of underlying causes. Consequently, a proportion of MCI cases are due to non-neurodegenerative processes, including FCD. Indeed, significant numbers of patients diagnosed with MCI do not 'convert' to dementia. The lack of diagnostic specificity for MCI 'non-progressors' is a weakness inherent in framing MCI primarily within a deterministic neurodegenerative pathway. It is recognized that depression, anxiety and behavioural changes can represent a prodrome to neurodegeneration; empirical data are required to explore whether the same might hold for subsets of individuals with FCD. Clinicians and researchers can improve study efficacy and patient outcomes by viewing MCI as a descriptive term with a wide differential diagnosis, including potentially reversible components such as FCD. We present a preliminary definition of functional neurological disorder-cognitive subtype, explain its position in relation to other cognitive diagnoses and emerging biomarkers, highlight clinical features that can lead to positive diagnosis (as opposed to a diagnosis of exclusion), and red flags that should prompt consideration of alternative diagnoses. In the research setting, positive identifiers of FCD will enhance our recognition of individuals who are not in a neurodegenerative prodrome, while greater use of this diagnosis in clinical practice will facilitate personalized interventions.
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Affiliation(s)
- Harriet A Ball
- Population Health Sciences, University of Bristol, BS8 1QU, UK
| | - Laura McWhirter
- Centre for Clinical Brain Sciences, The University of Edinburgh, EH16 4SB, UK
| | - Clive Ballard
- College of Medicine and Health, University of Exeter, EX1 2LU, UK
| | - Rohan Bhome
- Division of Psychiatry, University College London, W1T 7NF, UK
| | - Daniel J Blackburn
- Department of Neuroscience, Medical School, The University of Sheffield, S10 2TN, UK
| | - Mark J Edwards
- Neuroscience Research Centre, St George's, University of London, SW17 0RE, UK
| | - Stephen M Fleming
- Wellcome Centre for Human Neuroimaging, University College London, WC1N 3AR, UK
| | - Nick C Fox
- Dementia Research Centre, Department of Neurodegenerative Diseases, UCL Queen Square Institute of Neurology, WC1E 6BT, UK
| | - Robert Howard
- Division of Psychiatry, University College London, W1T 7NF, UK
| | | | - Jeremy D Isaacs
- Neuroscience Research Centre, St George's, University of London, SW17 0RE, UK.,Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, SW17 0QT, UK
| | - Andrew J Larner
- Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Liverpool, L9 7LJ, UK
| | - Timothy R Nicholson
- Institute of Psychiatry Psychology and Neuroscience, King's College London, SE5 8AF, UK
| | | | - Norman Poole
- Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, SW17 0QT, UK
| | - Gary Price
- University College London Hospitals NHS Foundation Trust, NW1 2BU, UK
| | - Jason P Price
- Department of Neuropsychology, South Tees Hospitals NHS Foundation Trust, TS4 3BW, UK
| | - Markus Reuber
- Department of Neuroscience, Medical School, The University of Sheffield, S10 2TN, UK
| | - Craig Ritchie
- Centre for Clinical Brain Sciences, The University of Edinburgh, EH16 4SB, UK
| | - Martin N Rossor
- Dementia Research Centre, Department of Neurodegenerative Diseases, UCL Queen Square Institute of Neurology, WC1E 6BT, UK
| | - Jonathan M Schott
- Dementia Research Centre, Department of Neurodegenerative Diseases, UCL Queen Square Institute of Neurology, WC1E 6BT, UK
| | - Tiago Teodoro
- Neuroscience Research Centre, St George's, University of London, SW17 0RE, UK.,Instituto de Medicina Molecular, Universidade de Lisbon, 1649-028 Lisboa, Portugal
| | - Annalena Venneri
- Department of Neuroscience, Medical School, The University of Sheffield, S10 2TN, UK
| | - Jon Stone
- Centre for Clinical Brain Sciences, The University of Edinburgh, EH16 4SB, UK
| | - Alan J Carson
- Centre for Clinical Brain Sciences, The University of Edinburgh, EH16 4SB, UK
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25
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Pick S, Rojas-Aguiluz M, Butler M, Mulrenan H, Nicholson TR, Goldstein LH. Dissociation and interoception in functional neurological disorder. Cogn Neuropsychiatry 2020; 25:294-311. [PMID: 32635804 DOI: 10.1080/13546805.2020.1791061] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Introduction: We aimed to examine susceptibility to dissociation and the impact of dissociation on interoceptive processing in individuals with functional neurological disorder (FND). We hypothesised that dissociative states would be elevated and interoceptive accuracy and awareness impaired at baseline in people with FND, and that such differences would be exacerbated following acute dissociation. Methods: Nineteen adults with FND were compared to 20 healthy controls. A modified heart-beat tracking task measured interoceptive accuracy and awareness (confidence) before and after a validated dissociation induction procedure. An exteroceptive processing control task was included. Mann-Whitney tests and r-values (effect size) were computed for between-group comparisons. Results: The FND group displayed elevated dissociation at baseline (p = 0.001, r = 0.528) compared to controls which increased following dissociation-induction (p < 0.001, r = 0.663). Interoceptive accuracy did not differ between groups at baseline (p = 0.967, r = 0.009); however, the FND group had lower accuracy scores post-induction (p = 0.021, r = 0.379). A negative correlation (trend) between change scores for dissociation and interoceptive accuracy was noted (rs = -0.411, p = 0.057). Confidence ratings on interoceptive and exteroceptive processing tasks were lower in the FND group (p-values < 0.05 or <0.01, r-values 0.331-0.489). Conclusions: Individuals with FND experienced greater susceptibility to dissociation, metacognitive deficits and impaired interoceptive accuracy than controls after acute dissociation.
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Affiliation(s)
- Susannah Pick
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Maya Rojas-Aguiluz
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Morgan Butler
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Heather Mulrenan
- GKT School of Medical Education, King's College London, London, UK
| | - Timothy R Nicholson
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Laura H Goldstein
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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26
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Larner AJ. Functional cognitive disorders: update on diagnostic status. Neurodegener Dis Manag 2020; 10:67-72. [DOI: 10.2217/nmt-2019-0038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Many patients referred to cognitive disorders clinics are not found to have evidence of any neurological disorder(s) to account for their symptoms. Many demonstrate incongruence between their subjective cognitive symptoms and preserved social and occupational functions. The term ‘functional cognitive disorders’ (FCD) has been used to denote this diagnostic category. This article aims to review the current state of knowledge regarding FCD. Studies of FCD are in their infancy, but available evidence suggests positive diagnosis may be made based on typical clinical profiles, including language discourse and simple clinical signs. Concurrent mood disorder and sleep disturbance are common, as well as other functional disorders. Pathogenesis is yet to be determined, but a disorder of metamemory has been suggested.
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Affiliation(s)
- AJ Larner
- Cognitive Function Clinic, Walton Centre for Neurology & Neurosurgery, Liverpool, UK
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