Review Neuropsychological evaluation of functional cognitive disorder: a narrative review 2023 Silverberg and Rush

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.

Paywall, https://www.tandfonline.com/doi/full/10.1080/13854046.2023.2228527

 

I take it FCD is some new name for brain fog.

 

I'm afraid so.

 

The immediate response would be: "not sure how that's internal inconsistency if someone external is doing the counter-claiming." But they discuss this next (though again with the "promising") —

Also —

Speaking of internal inconsistency —

which is later followed with —

 

A brief moment of good news —

Although I might develop concussion from all the face-palming with these next snippets. It's like they haven't read any biological science about what goes on in the brain or body at all —

Oh and you betcha it can co-exist —

A-ight, now we're entering tiger country —

Note for @dave30th —

And then this distinction —

That last bit sounds like you can't form new memories over any given day, but then you wake up and you find you do have the memories? However the reference seems to relate to Case E in which case it's the opposite: "She gave an emotional account of normal memory for the course of 1 day, but waking-up each morning with no recall of the previous day."

Isn't the whole point that short term memory is consolidated during sleep with new neural connections in the hippocampus? Any possibility that could relate to interference with processes that should normally occur during sleep? You did state that FCD was strongly associated with sleep disturbance after all. Maybe it's time-varying brain dysfunction, such as - oh I don't know - metabolism? What's that, oh you haven't looked because "Opinion leaders recommend that a diagnosis of FCD should be established on the basis of internal inconsistencies". Gotcha.

Worth having a read through the referenced: Functional Cognitive Disorder: Differential Diagnosis of Common Clinical Presentations (2022, Archives of Clinical Neuropsychology) although it too is pay-walled. (This specialty doesn't seem overly keen on just anyone being able to read their publications.)

There's more including the obligatory hardware/software explanation, which they seem to indicate is nonsense for patient consumption.

 

Treatments —

No doubt both are "promising".

The conclusion wouldn't go amiss in r/self-awarewolves —

 

So basically, don't bother to test anything, we can just tell. Just like the claim that Hoover's sign is 100% specific for FND leg weakness when the studies are shit.

 

Yup. Don't look, trust us, we're experts.

 

This is very concerning to read.

 

From what ibhave read and tried to understand most of these tests and diagnosises are in the mind of the physician. So what we get is mostly biased diagnosis and lots of missed conditions. So the whole construct is rubish