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. 2025 Sep 15:476:123618.
doi: 10.1016/j.jns.2025.123618. Epub 2025 Jul 14.

Functional cognitive disorder in Alzheimer's disease

Verónica Cabreira  1 , Martin Zeidler  2 , Laura McWhirter  3 , Suvankar Pal  4 , Jon Stone  3 , Alan Carson  3
Affiliations
Free article

Functional cognitive disorder in Alzheimer's disease

Verónica Cabreira et al. J Neurol Sci. .
Free article

Abstract

Objectives: To conduct a preliminary exploration of functional cognitive disorders (FCD) in the context of Alzheimer's disease (AD), and potential shared mechanisms.

Methods: Retrospective analysis of a convenience sample of FCD patients with an overlapping diagnosis of AD evaluated in two outpatient services in the United Kingdom, between 2010 and 2023. Demographics, latency until AD diagnosis, detailed description of FCD and AD, comorbidities, family history, imaging and fluid biomarkers, cognitive testing, symptom trajectory, and employment status were collected from hospital records. Possible clues for AD among FCD patients were explored by comparing FCD-AD cases against a sample of insidious onset FCD-only patients matched for age at symptom onset.

Results: Twelve FCD-AD cases were identified (eight female). All patients had FCD symptoms before or simultaneously with an AD diagnosis (median latency of 2.5 years). Low cognitive scores at baseline, sleep disturbance and/or mood and anxiety disorders were more common in the FCD-AD cases, in comparison with the FCD-only group. Informants' concern, executive, language and/or praxis difficulties, and an increase in repetitions may point to underlying AD. No cases appeared to be a misdiagnosis. Initial relative symptom stability or transient improvement, stressful life events around symptom onset and a family history of cognitive difficulties did not differentiate between FCD patients with or without AD.

Discussion: FCD may be a prodromal or presenting feature of AD. We discuss potential links between the two, and the clinical relevance of these findings for prognostication and management of FCD patients, including its implications for clinical trials.

Keywords: Alzheimer's disease; Biomarkers; Clinical neurology history; Conversion disorders; Functional cognitive disorder.

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Conflict of interest statement

Declaration of competing interest 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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