Functional Cognitive Disorder: Differential Diagnosis of Common Clinical Presentations, 2022, Kemp et al

Abstract

Background
Cognitive symptoms in the absence of neurological disease are common. Functional cognitive disorder (FCD) has been conceptualized as a cognitive subtype of functional neurological disorder. Although FCD is understood as different from exaggerated or feigned cognitive complaints, previous accounts have provided little practical advice on how FCD can be separated from factitious or malingered cognitive complaints. Also, the distinction of FCD from other medical or mental health disorders that impact on cognition is an area of ongoing study and debate. Diagnostic precision is important to prevent iatrogenesis and for the development of needed treatment protocols.

Method
We summarize the current literature and present seven anonymized case vignettes to characterize the challenges in this area and develop proposals for solutions.

Results/Conclusions
Recognizing the limitations of categorical diagnostic systems, we position FCD as distinct from feigning and cognitive symptoms of psychiatric disorders, although with overlapping features. We set out typical clinical features and neuropsychological profiles for each category of cognitive disorder and a statistical method to analyze performance validity tests/effort tests to assist in determining feigned or invalid responding.

Paywall, https://academic.oup.com/acn/advance-article-abstract/doi/10.1093/arclin/acac020/6575419

 

The thing that bothers me the most about this is that I can't for the life of me process what these people imagine are the benefits of feigning, consciously or not. As specialists they obviously know that there are no benefits, that even if someone, somehow, gets recognized as being cognitively impaired, that's basically all there is to it. It gets written down somewhere, no one cares.

It's not covered by private or public insurance programs, there are no accommodations for it, literally nothing happens if someone, somehow, manages to fool several healthcare professionals into feigning cognitive impairment. Unless there is a cause that is accepted, such as a head injury, but even then that is limited in time and scope, and also poorly recognized.

So what is it that they are imagining is happening here? You generally see the same thing in everything "MUS". With us the complaint is that they can't tell the difference with depression, which only emphasizes that they obviously understand neither enough to confirm or deny. It's not even about the patients, everything is about their own perception and how they handle this in a clinical setting. It turns the focus completely away from the patient and onto the professional. It's highly unprofessional for professionals to make themselves the center of their whole work.

Symptoms are isolated, detached from their context, then analyzed as a single entity in their own right. We can even see it with the creep of BPS into things like TBIs, where some effect will be acknowledged, but, somehow, there is always place for a "functional overlay", all because, by their own admission, they can't tell the difference, mostly by ignoring context, which is what gives useful clues.

It seems like the obsession is all over "no one is going to fool me", as if the worst failure a physician can do is fall for a malingerer, worth neglecting dozens, nay hundreds, of actually ill people. But there is literally no reason why anyone would go through the trouble of feigning this, there is literally no upside. It makes as much sense as accusing someone of running a criminal enterprise, for something that literally cannot turn a profit and has no other possible benefit.

It's genuinely rare to hit a more perfect ratio of all downside, zero upside. We can see the same things with welfare programs, about which some people are obsessed with the idea of cheaters, even though we have decades of data showing it's minimal, precisely because it's not even worth it. So in a way they are basically calling us stupid for chasing something with no possible gain. All because they don't get it, because we don't understand the bizarre rationalizations they invented in their minds.