Bhome Rohan, McWilliams Andrew, Huntley Jonathan D, Fleming Stephen M, Howard Robert J
Division of Psychiatry, University College London , London , UK.
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London , London , UK.
Cogn Neuropsychiatry. 2019 Sep;24(5):311-321. doi: 10.1080/13546805.2019.1651708. Epub 2019 Aug 7.
Functional Cognitive Disorder (FCD) is common. Despite this, there is no evidence-based consensus on how to treat FCD. Poor metacognitive ability has been suggested as a key mechanism underlying the disorder. This paper evaluates the proposal that strategies which improve metacognition could provide a mechanistically plausible translational therapy. We reviewed the existing literature relating to metacognition in FCD, previous strategies to improve metacognitive ability in FCD and whether metacognitive performance can be modulated. Though limited, there is evidence to suggest that metacognition is impaired in FCD. Converging evidence from neuroimaging studies suggests that metacognitive performance can be modulated. The effectiveness of existing strategies to improve metacognition including cognitive training, psychoeducation and lifestyle interventions have been equivocal. Recently, a potential treatment option has emerged in the form of a computer-based metacognitive training paradigm. There is an urgent need for effective treatments in FCD. Impaired metacognition may be a plausible therapeutic target but, in the first instance, further research is required to demonstrate deficits in "local" metacognitive ability in FCD patients when measured objectively. If so, clinical trials of interventions, such as computerised metacognitive training, are required to evaluate their effectiveness in improving FCD symptoms.
功能性认知障碍（FCD）很常见。尽管如此，对于如何治疗FCD，尚无基于证据的共识。元认知能力差被认为是该障碍的关键潜在机制。本文评估了这样一种提议，即改善元认知的策略可能提供一种在机制上合理的转化治疗方法。我们回顾了与FCD中的元认知相关的现有文献、以往提高FCD中元认知能力的策略以及元认知表现是否可以被调节。虽然证据有限，但有证据表明FCD中的元认知受损。神经影像学研究的一致证据表明元认知表现可以被调节。包括认知训练、心理教育和生活方式干预在内的现有改善元认知策略的有效性一直存在争议。最近，一种基于计算机的元认知训练范式形式的潜在治疗选择出现了。FCD迫切需要有效的治疗方法。元认知受损可能是一个合理的治疗靶点，但首先，需要进一步研究以客观测量FCD患者“局部”元认知能力的缺陷。如果是这样，就需要进行干预措施的临床试验，如计算机化元认知训练，以评估其改善FCD症状的有效性。
