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Ball HA, McWhirter L, Ballard C, Bhome R, Blackburn DJ, Edwards MJ, 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, Venneri A, Stone J, Carson AJ. Reply: Functional cognitive disorder: dementia's blind spot. Brain 2021; 144:e73. [PMID: 34398190 DOI: 10.1093/brain/awab305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Harriet A Ball
- Clinical Neurosciences, University of Bristol, BS10 5NB, 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, University of Sheffield, S10 2TN, UK
| | - Mark J Edwards
- Neuroscience research Centre, St George's, University of London, SW17 0RE, 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
| | - A J Larner
- Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Liverpool, L9 7LJ, UK
| | - Timothy R Nicholson
- Institute of Psychiatry Psychology & Neuroscience, King's College London, SE5 8AF, UK
| | | | - Norman Poole
- Neuropsychiatry Dept, St George's Hospital, London SW17 0QT, UK
| | - Gary Price
- Department of Neuropsychiatry, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, WC1N 3BG, UK
| | - J P Price
- Department of Neuropsychology, South Tees Hospitals NHS Foundation Trust, James Cook University Hospital, Middlesbrough, TS4 3BW, UK
| | - Markus Reuber
- Department of Neuroscience, Medical School, University of Sheffield, S10 2TN, UK
| | - Craig Ritchie
- Centre for Dementia Prevention, The University of Edinburgh, EH16 4UX, 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
| | - Annalena Venneri
- Department of Life Sciences, Brunel University London, UB8 3PH, 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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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: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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