Clinical signs in functional cognitive disorders: A systematic review and diagnostic meta-analysis
- PMID: 37567095
- DOI: 10.1016/j.jpsychores.2023.111447
Clinical signs in functional cognitive disorders: A systematic review and diagnostic meta-analysis
Abstract
Objective: Functional cognitive disorder (FCD) accounts for around a third of patients attending specialized memory clinics. It is also overrepresented in patients with other functional and somatic diagnoses. So far, no long-term diagnostic validity studies were conducted, and a positive diagnostic profile is yet to be identified. We aimed to review the literature on diagnostic signs and symptoms that allow for a discrimination between FCD and neurodegeneration.
Methods: Systematic review of Ovid-Medline®, Embase and PsycINFO databases. Relevant clinical features were extracted including demographics, symptom history, comorbidities, language and interaction profiles and cognitive assessments. Studies with quantifiable diagnostic accuracy data were included in a diagnostic meta-analysis.
Results: Thirty studies (N = 8602) were included. FCD patients were younger, more educated, and more likely to have a family history of older onset dementia, abrupt symptom onset, and higher rates of anxiety, depression and sleep disturbance. Promising language profiles include longer duration of spoken answer, elaborated examples of memory failures, ability to answer compound and personal questions, and demonstration of working memory during interaction. The pooled analysis of clinical accuracy of different signs revealed that attending alone and bringing a handwritten list of problems particularly increase the odds of a FCD diagnosis. Current evidence from neuropsychometric studies in FCD is scarce.
Conclusions: Our systematic review reinforces that positive signs contribute for an early differentiation between FCD and neurodegeneration in patients presenting with memory complaints. It is the first to attain quantitative value to clinical observations. These results will inform future diagnostic decision tools and intervention testing.
Keywords: Cognition; Dementia; Diagnosis; Functional cognitive disorder; Systematic review; meta-analysis.
Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.
Conflict of interest statement
Declaration of Competing Interest VC has received funding from the European Union's Horizon 2020 research and innovation program under the Marie Skłodowska-Curie grant agreement No 956673. This article reflects only the author's view, the Agency is not responsible for any use that may be made of the information it contains. L. McWhirter receives funding from the Scottish Government Chief Scientist Office. L. McWhirter provides independent medical testimony in court cases regarding patients with functional disorders, is secretary of the British Neuropsychiatry Association, and receives research funding from the Scottish Government Chief Scientist Office. JS reports personal fees from UptoDate, outside the submitted work, runs a self-help website for patients with functional neurological symptoms (www. neurosymptoms.org) which is free and has no advertising, provides independent medical testimony in personal injury and negligence cases regarding patients with functional disorders, and is secretary of the International Functional Neurological Disorder Society. He is a Chief Scientists Office NHS Research Scotland Career Researcher. AJC is a director of a limited personal services company that provides independent medical testimony in court cases on a range of neuropsychiatric topics on a 50% pursuer 50% defender basis, a paid associate editor of the Journal of Neurology Neurosurgery and Psychiatry, and unpaid president elect of the International Functional Neurological Disorder Society.
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