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Gasquoine PG. Self-reported anterograde memory loss in older persons that is not validated on neuropsychological assessment: Considerations for a dissociative diagnosis. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-6. [PMID: 38615907 DOI: 10.1080/23279095.2024.2341801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
The past decade has witnessed amplified public awareness of age-related dementias. This has resulted in a dramatic rise in the number of older persons referred to memory clinics with a primary complaint of self-reported memory loss without an antecedent neurological event (e.g., stroke) who produce neuropsychological test profiles that lack evidence of such impairment. Since the latter part of the 19th century, a confusing array of changing terminology, criteria, and perceived causation have been ascribed to patients with unverified medical symptoms to implicate psychological causation. Such terms are often misperceived by laypersons as reflecting character flaws or malingering. Of import for clinical neuropsychologists, the 11th edition of the International Classification of Diseases added cognitive to symptoms eligible for a diagnosis of the modern formulation, dissociative neurological symptom disorder. One dissociative option for referrals with self-reported neurocognitive symptoms not validated on neuropsychological testing is functional memory disorder, conceived as a psychological disorder where emotional distress is plausibly related to the perceived memory loss but is of less severity than would warrant a major depressive or anxiety diagnosis. If evidence of psychological distress or behavioral impairment is not present the referral likely reflects the increased public awareness of age-related dementias interacting with the high base rate of self-perceived memory loss in the general population. In such cases, a dissociative diagnosis should be avoided as there is evidence of neither a medical nor a psychological disorder. A summary statement of not dementia or similar is likely sufficient to help the patient.
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Affiliation(s)
- Philip Gerard Gasquoine
- Department of Psychological Science, University of Texas Rio Grande Valley, Edinburg, TX, USA
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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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Poole N, Cope S, Vanzan S, Duffus A, Mantovani N, Smith J, Barrett BM, Tokley M, Scicluna M, Beardmore S, Turner K, Edwards M, Howard R. Feasibility randomised controlled trial of online group Acceptance and Commitment Therapy for Functional Cognitive Disorder (ACT4FCD). BMJ Open 2023; 13:e072366. [PMID: 37169496 DOI: 10.1136/bmjopen-2023-072366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
INTRODUCTION Functional cognitive disorder (FCD) is seen increasingly in clinics commissioned to assess cognitive disorders. Patients report frequent cognitive, especially memory, failures. The diagnosis can be made clinically, and unnecessary investigations avoided. While there is some evidence that psychological treatments can be helpful, they are not routinely available. Therefore, we have developed a brief psychological intervention using the principles of acceptance and commitment therapy (ACT) that can be delivered in groups and online. We are conducting a feasibility study to assess whether the intervention can be delivered within a randomised controlled trial. We aim to study the feasibility of recruitment, willingness to be randomised to intervention or control condition, adherence to the intervention, completion of outcome measures and acceptability of treatment. METHODS AND ANALYSIS We aim to recruit 48 participants randomised 50:50 to either the ACT intervention and treatment as usual (TAU), or TAU alone. ACT will be provided to participants in the treatment arm following completion of baseline outcome measures. Completion of these outcome measures will be repeated at 8, 16 and 26 weeks. The measures will assess several domains including psychological flexibility, subjective cognitive symptoms, mood and anxiety, health-related quality of life and functioning, healthcare utilisation, and satisfaction with care and participant-rated improvement. Fifteen participants will be selected for in-depth qualitative interviews about their experiences of living with FCD and of the ACT intervention. ETHICS AND DISSEMINATION The study received a favourable opinion from the South East Scotland Research Ethics Committee 02 on 30 September 2022 (REC reference: 22/SS/0059). HRA approval was received on 1 November 2022 (IRAS 313730). The results will be published in full in an open-access journal. TRIAL REGISTRATION NUMBER ISRCTN12939037.
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Affiliation(s)
- Norman Poole
- Deptartment of Neuropsychiatry, South West London and Saint George's Mental Health NHS Trust, London, UK
- St George's University of London, London, UK
| | - Sarah Cope
- Deptartment of Neuropsychiatry, South West London and Saint George's Mental Health NHS Trust, London, UK
| | - Serena Vanzan
- Reseach and Development Deptartment, South West London and St George's NHS Mental Health Trust, London, UK
| | - Aimee Duffus
- Reseach and Development Deptartment, South West London and St George's NHS Mental Health Trust, London, UK
| | - Nadia Mantovani
- St George's University of London, London, UK
- Reseach and Development Deptartment, South West London and St George's NHS Mental Health Trust, London, UK
| | - Jared Smith
- St George's University of London, London, UK
- Reseach and Development Deptartment, South West London and St George's NHS Mental Health Trust, London, UK
| | | | - Melanie Tokley
- Eastern Community Mental Health Centre, Adelaide, South Australia, Australia
| | - Martin Scicluna
- Reseach and Development Deptartment, South West London and St George's NHS Mental Health Trust, London, UK
| | - Sarah Beardmore
- Reseach and Development Deptartment, South West London and St George's NHS Mental Health Trust, London, UK
| | - Kati Turner
- St George's University of London, London, UK
- Reseach and Development Deptartment, South West London and St George's NHS Mental Health Trust, London, UK
| | - Mark Edwards
- Department of Neuroscience, Institute of Psychiatry, Psychology, and Neuroscience (IOPPN), London, UK
| | - Robert Howard
- University College London Division of Psychiatry, London, UK
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Cook LD, Souris H, Isaacs JD. Differences in care between younger and older patients in the 2019 English national memory service audit. BJPsych Bull 2022; 46:315-321. [PMID: 34782030 PMCID: PMC9813762 DOI: 10.1192/bjb.2021.104] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
AIMS AND METHOD This paper analyses how practice varied between patients aged <65 and ≥65 years in the 2019 UK national memory service audit. RESULTS Data on 3959 patients were analysed. Those aged <65 (7% of the sample) were less likely than those aged ≥65 to be diagnosed with dementia (23 v. 67%) and more likely to receive a functional, psychiatric or no diagnosis. Younger patients were more likely to have magnetic resonance imaging; use of dementia biomarkers was low in both groups. Frontotemporal dementia and functional cognitive disorder were diagnosed infrequently. Use of dementia navigators/advisors and carer psychoeducation was similar between groups; younger patients were less likely to be offered but more likely to accept cognitive stimulation therapy. CLINICAL IMPLICATIONS Memory services seeing younger people need expertise in functional cognitive disorder, alongside clinical skills and technologies to diagnose rarer forms of dementia. Further work is needed to understand why cognitive stimulation therapy is less frequently offered to younger people.
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Affiliation(s)
- Laura D Cook
- NHS England/NHS Improvement (London) Dementia Clinical Network, London, UK
| | - Helen Souris
- NHS England/NHS Improvement (London) Dementia Clinical Network, London, UK
| | - Jeremy D Isaacs
- NHS England/NHS Improvement (London) Dementia Clinical Network, London, UK.,St George's University Hospitals NHS Foundation Trust, London, UK
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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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Abdullah S, Critchfield M, Maltby J, Mukaetova-Ladinska EB. Improving Diagnosis of Functional Cognitive Impairment in Younger Adults in Primary Care: Validation of Cognitive Screening Tools and the 4-Item Geriatric Depression Scale. J Alzheimers Dis 2022; 86:1797-1804. [DOI: 10.3233/jad-215552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Cognitive decline is classically attributed to organic causes such as dementia; however, depression can play a role in cognitive decline. Objective: To evaluate cognitive screening tools and the 4-item Geriatric Depression Scale (GDS-4) for use in primary care to distinguish cognitive decline secondary to depression. Method: Clinical data collected over 2.5 years for assessed patients in a secondary clinical service for younger adults. Cognitive screening tools (General Practitioner Assessment of Cognition, Addenbrooke’s Cognitive Examination-III, Rowland Universal Dementia Assessment Scale, Salzburg Dementia Test Prediction) and GDS-4 were analyzed for their accuracy to differentiate patients with cognitive decline due to depression from those with subjective cognitive complaints. Results: 180 young adults seen in a memory clinic setting (< 65 years) were included. These individuals either had a diagnosis of depression (n = 46) or no cognitive impairment on assessment (n = 134) despite having subjective cognitive complaints. All used cognitive tools had poor accuracy in differentiating cognitive decline secondary to depression from subjective cognitive complaints. The GDS-4 alone, however, was able to differentiate with high accuracy (AUC = 0.818) individuals who had cognitive problems secondary to depression. Conclusion: Cognitive screening tools used alone are ineffective in discriminating cognitive decline secondary to depression. Incorporating the GDS-4 into the screening process by primary practitioners could facilitate early identification and treatment of depression in younger people, avoiding unnecessary referrals memory services.
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Affiliation(s)
- Shahbaz Abdullah
- The Evington Centre, Leicestershire Partnership NHS Trust, Leicester, UK
- Leicestershire, Northamptonshire & Rutland (LNR) Foundation School, Leicester, UK
| | | | - John Maltby
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Elizabeta B. Mukaetova-Ladinska
- The Evington Centre, Leicestershire Partnership NHS Trust, Leicester, UK
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
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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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OUP accepted manuscript. Arch Clin Neuropsychol 2022; 37:1158-1176. [DOI: 10.1093/arclin/acac020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 11/14/2022] Open
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