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Cabreira V, Alty J, Antic S, Araújo R, Aybek S, Ball HA, Baslet G, Bhome R, Coebergh J, Dubois B, Edwards M, Filipović SR, Frederiksen KS, Harbo T, Hayhow B, Howard R, Huntley J, Isaacs J, LaFrance WC, Larner AJ, Di Lorenzo F, Main J, Mallam E, Marra C, Massano J, McGrath ER, McWhirter L, Moreira IP, Nobili F, Pennington C, Tábuas-Pereira M, Perez DL, Popkirov S, Rayment D, Rossor M, Russo M, Santana I, Schott J, Scott EP, Taipa R, Tinazzi M, Tomic S, Toniolo S, Tørring CW, Wilkinson T, Frostholm L, Stone J, Carson A. Perspectives on the diagnosis and management of functional cognitive disorder: An international Delphi study. Eur J Neurol 2024:e16318. [PMID: 38700361 DOI: 10.1111/ene.16318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/18/2024] [Accepted: 04/11/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Current proposed criteria for functional cognitive disorder (FCD) have not been externally validated. We sought to analyse the current perspectives of cognitive specialists in the diagnosis and management of FCD in comparison with neurodegenerative conditions. METHODS International experts in cognitive disorders were invited to assess seven illustrative clinical vignettes containing history and bedside characteristics alone. Participants assigned a probable diagnosis and selected the appropriate investigation and treatment. Qualitative, quantitative and inter-rater agreement analyses were undertaken. RESULTS Eighteen diagnostic terminologies were assigned by 45 cognitive experts from 12 countries with a median of 13 years of experience, across the seven scenarios. Accurate discrimination between FCD and neurodegeneration was observed, independently of background and years of experience: 100% of the neurodegenerative vignettes were correctly classified and 75%-88% of the FCD diagnoses were attributed to non-neurodegenerative causes. There was <50% agreement in the terminology used for FCD, in comparison with 87%-92% agreement for neurodegenerative syndromes. Blood tests and neuropsychological evaluation were the leading diagnostic modalities for FCD. Diagnostic communication, psychotherapy and psychiatry referral were the main suggested management strategies in FCD. CONCLUSIONS Our study demonstrates the feasibility of distinguishing between FCD and neurodegeneration based on relevant patient characteristics and history details. These characteristics need further validation and operationalisation. Heterogeneous labelling and framing pose clinical and research challenges reflecting a lack of agreement in the field. Careful consideration of FCD diagnosis is advised, particularly in the presence of comorbidities. This study informs future research on diagnostic tools and evidence-based interventions.
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Affiliation(s)
- Verónica Cabreira
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Jane Alty
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
| | - Sonja Antic
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Rui Araújo
- Department of Neurology, Centro Hospitalar Universitário São João, Porto, Portugal
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine University of Porto, Porto, Portugal
| | - Selma Aybek
- Neurology, Faculty of Sciences and Medicine, Fribourg University, Fribourg, Switzerland
| | - Harriet A Ball
- Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Gaston Baslet
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rohan Bhome
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
- Centre for Medical Image Computing, University College London, London, UK
| | - Jan Coebergh
- Department of Neurology, St George's University of London, London, UK
| | - Bruno Dubois
- Department of Neurology, Institut de la mémoire et de la maladie d'Alzheimer (IM2A), AP-HP, Brain Institute, Sorbonne University, Paris, France
| | - Mark Edwards
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry Psychology and Neurosciences, Kings College London, London, UK
| | - Saša R Filipović
- University of Belgrade Institute for Medical Research, Belgrade, Serbia
| | - Kristian Steen Frederiksen
- Clinical Trial Unit, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Harbo
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Bradleigh Hayhow
- Department of Neurology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- School of Medicine, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Robert Howard
- Division of Psychiatry, University College London, London, UK
| | - Jonathan Huntley
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Jeremy Isaacs
- Department of Neurology, St George's University of London, London, UK
| | - William Curt LaFrance
- Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Neuropsychiatry and Behavioral Neurology, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Andrew J Larner
- Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - Francesco Di Lorenzo
- Department of Clinical and Behavioural Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | - James Main
- Bristol Dementia Wellbeing Service, Devon Partnership NHS Trust, Bristol, UK
| | | | - Camillo Marra
- Department of Neuroscience, Catholic University of the Sacred Heart, Memory Clinic - Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy
| | - João Massano
- Department of Neurology, Centro Hospitalar Universitário São João, Porto, Portugal
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine University of Porto, Porto, Portugal
| | - Emer R McGrath
- School of Medicine, University of Galway, Galway, Ireland
| | - Laura McWhirter
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Isabel Portela Moreira
- Neurology Department, Private Hospital of Gaia of the Trofa Saúde Group, Vila Nova de Gaia, Portugal
| | - Flavio Nobili
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Catherine Pennington
- Clinical Lecturer, University of Edinburgh, Edinburgh, UK
- Neurology Department, NHS Forth Valley, Larbert, UK
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
| | - Miguel Tábuas-Pereira
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal
| | - David L Perez
- Department of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Stoyan Popkirov
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Dane Rayment
- Rosa Burden Centre for Neuropsychiatry, Southmead Hospital, Bristol, UK
| | - Martin Rossor
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Mirella Russo
- Department of Neuroscience, Imaging and Clinical Sciences G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Isabel Santana
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal
| | - Jonathan Schott
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Emmi P Scott
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ricardo Taipa
- Neuropathology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Michele Tinazzi
- Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Svetlana Tomic
- Department of Neurology, University Hospital Center Osijek, Medical School on University of Osijek, Osijek, Croatia
| | - Sofia Toniolo
- Cognitive Disorder Clinic, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - Tim Wilkinson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Lisbeth Frostholm
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Jon Stone
- 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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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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Van Patten R, Bellone JA. The neuropsychology of functional neurological disorders. J Clin Exp Neuropsychol 2023; 45:957-969. [PMID: 38441076 DOI: 10.1080/13803395.2024.2322798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Affiliation(s)
- Ryan Van Patten
- VA Providence Healthcare System, Center for Neurorestoration & Neurotechnology, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - John A Bellone
- Department of Behavioral Health, Kaiser Permanente, San Bernardino, CA, USA
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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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6
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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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Millman LSM, Short E, Stanton B, Winston JS, Nicholson TR, Mehta MA, Reinders AATS, Edwards MJ, Goldstein LH, David AS, Hotopf M, Chalder T, Pick S. Interoception in functional motor symptoms and functional seizures: Preliminary evidence of intact accuracy alongside reduced insight and altered sensibility. Behav Res Ther 2023; 168:104379. [PMID: 37516011 PMCID: PMC10788481 DOI: 10.1016/j.brat.2023.104379] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/14/2023] [Accepted: 07/23/2023] [Indexed: 07/31/2023]
Abstract
Altered interoception may be a pathophysiological mechanism in functional neurological disorder (FND). However, findings have been inconsistent across interoceptive dimensions in FND including functional motor symptoms (FMS) and seizures (FS). Here, individuals with FMS/FS (n = 17) and healthy controls (HC, n = 17) completed measures of interoceptive accuracy and insight (adapted heartbeat tracking task [HTT] with confidence ratings), a time estimation control task (TET) and the Multidimensional Assessment of Interoceptive Awareness-2 (MAIA-2) to assess interoceptive sensibility. The groups did not differ in interoceptive accuracy (p = 1.00, g = 0.00) or confidence (p = .99, g = 0.004), although the FMS/FS group displayed lower scores on the "Not-Distracting" (p < .001, g = 1.42) and "Trusting" (p = .005, g = 1.17) MAIA-2 subscales, relative to HCs. The groups did not differ in TET performance (p = .82, g = 0.08). There was a positive relationship between HTT accuracy and confidence (insight) in HCs (r = .61, p = .016) but not in FMS/FS (r = 0.11, p = .69). HTT confidence was positively correlated with MAIA-2 "Self-Regulation" (r = 0.77, p = .002) and negatively correlated with FND symptom severity (r = -0.84, p < .001) and impact (r = -0.86, p < .001) in FMS/FS. Impaired interoceptive accuracy may not be a core feature in FMS/FS, but reduced insight and altered sensibility may be relevant. Reduced certainty in self-evaluations of bodily experiences may contribute to the pathogenesis of FND symptoms.
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Affiliation(s)
- L S Merritt Millman
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Eleanor Short
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Biba Stanton
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Joel S Winston
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Timothy R Nicholson
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Mitul A Mehta
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Antje A T S Reinders
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Mark J Edwards
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Laura H Goldstein
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | | | - Matthew Hotopf
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Trudie Chalder
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Susannah Pick
- Institute of Psychiatry, Psychology, and Neuroscience, King's College 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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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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10
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Rioux M, Wardell V, Palombo DJ, Picon EL, Le ML, Silverberg ND. Memory for forgetting in adults with persistent symptoms following concussion. J Clin Exp Neuropsychol 2022; 44:19-30. [PMID: 35536243 DOI: 10.1080/13803395.2022.2067326] [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: 10/18/2022]
Abstract
INTRODUCTION Persistent memory complaints following concussion often do not coincide with evidence of objective memory impairment. To the extent this clinical presentation represents Functional Cognitive Disorder (FCD), we would expect preservation or even enhancement of memory for instances of forgetting, based on two lines of prior evidence. First, emotional arousal enhances autobiographical memory. People who experience memory lapses as worrisome may better remember them. Second, individuals with FCD can paradoxically provide detailed accounts of memory lapses compared to patients with neurodegenerative disease, who tend to provide vague examples. The current study aimed to better characterize the recall of forgetting events in people with subjective memory problems following concussion. METHODS The study sample consisted of adults with chronic post-concussion symptoms (N = 37, M = 42.7 years old; 70.27% women; M = 24.9 months post-injury) and normal-range performance on conventional neuropsychological tests. Participants completed a measure of memory complaint severity and the Autobiographical Interview (AI). The AI was used to quantify the richness of narrative recollections of recent instances when they forgot something and (control) personal events that did not involve forgetting. Linear regression modeling assessed the relationship between memory complaint severity and AI variables, including narrative details, valence, arousal, and rehearsal of memories. RESULTS There was no association between memory complaint severity and memory for forgetting vs. control events. We further found no association between memory complaint severity and AI performance overall (collapsing across forgetting and control events). Participants with greater memory complaints experienced past memory lapses as more negative than control memories, but did not consistently differ on other AI phenomenological variables. CONCLUSION Autobiographical recall of memory lapses appears preserved but not selectively heightened in people who report experiencing severe memory problems long after concussion. This inconsistency supports conceptualization of persistent memory complaints after concussion as FCD.
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Affiliation(s)
- Mathilde Rioux
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Victoria Wardell
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Daniela J Palombo
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Edwina L Picon
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - M Lindy Le
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Noah D Silverberg
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
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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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12
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Picon EL, Todorova EV, Palombo DJ, Perez DL, Howard AK, Silverberg ND. OUP accepted manuscript. Arch Clin Neuropsychol 2022; 37:1177-1184. [PMID: 35443277 PMCID: PMC9396453 DOI: 10.1093/arclin/acac021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The etiology of persistent memory complaints after concussion is poorly understood. Memory perfectionism (highly valuing memory ability and intolerance of minor memory lapses) may help explain why some people report persistent subjective memory problems in the absence of corresponding objective memory impairment. This study investigated the relationship between memory perfectionism and persistent memory complaints after concussion. METHODS Secondary analysis of baseline data from a randomized controlled trial. Adults (N = 77; 61% women) with persistent symptoms following concussion were recruited from outpatient specialty clinics. Participants completed the National Institutes of Health Toolbox Cognition Battery, Test of Memory Malingering-Trial 1, and questionnaires measuring memory perfectionism (Metamemory in Adulthood-Achievement subscale), forgetfulness and other postconcussion symptoms (Rivermead Postconcussion Symptoms Questionnaire; RPQ), and depression (Patient Health Questionnaire-2) at M = 17.8 weeks postinjury. Patients with versus without severe memory complaints (based on the RPQ) were compared. RESULTS Memory perfectionism was associated cross-sectionally with severe memory complaint, after controlling for objective memory ability, overall cognitive ability, and depression (95% confidence interval for odds ratio = 1.11-1.40). Sensitivity analyses showed that this relationship did not depend on use of specific objective memory tests nor on inclusion of participants who failed performance validity testing. In a control comparison to test the specificity of identified relationships, memory perfectionism was not associated with severe fatigue (95% confidence interval for odds ratio = 0.91-1.07). CONCLUSIONS Memory perfectionism may be a risk factor for persistent memory symptoms after concussion, with potential relevance to the spectrum of functional cognitive disorders more broadly.
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Affiliation(s)
- Edwina L Picon
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Evgenia V Todorova
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Psychiatry, British Columbia Neuropsychiatry Program Vancouver, British Columbia, Canada
| | - Daniela J Palombo
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
| | - David L Perez
- Department of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrew K Howard
- Department of Psychiatry, British Columbia Neuropsychiatry Program Vancouver, British Columbia, Canada
- British Columbia Neuropsychiatry Program Vancouver, British Columbia, Canada
| | - Noah D Silverberg
- Corresponding author at: Department of Psychology, University of British Columbia, 3505-2136 West Mall, Vancouver, British Columbia V6T 1Z4, Canada. Tel.: 604-734-1313 ext. 2316; Fax: 604-714-4168E-mail address: (N.D. Silverberg)
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Larner AJ. Wittgenstein, neurology, and neuroscience. Brain 2021; 145:3-6. [PMID: 35021192 DOI: 10.1093/brain/awab418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 10/28/2021] [Accepted: 11/04/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Andrew J Larner
- Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Liverpool, UK
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