Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland, United Kingdom.
CNS Spectr. 2022 Dec;27(6):754-763. doi: 10.1017/S1092852921000845. Epub 2021 Sep 17.
Functional cognitive disorders (FCD) are an important differential diagnosis of neurodegenerative disease. The utility of suggested diagnostic features has not been prospectively explored in "real world" clinical populations. This study aimed to identify positive clinical markers of FCD.
Adults with cognitive complaints but not dementia were recruited from memory, neurology, and neuropsychiatry clinics. Participants underwent structured interview, Mini International Neuropsychiatric Interview, Montreal Cognitive Assessment, Luria 3-step, interlocking fingers, digit span and Medical Symptom Validity Test, Patient Health Questionnaire 15, Hospital Anxiety and Depression Scale, Multifactorial Memory Questionnaire, and Pittsburgh Sleep Quality Inventory. Potential diagnostic variables were tested against expert consensus diagnosis using logistic regression.
FCD were identified in 31/49 participants. Participants with FCD were younger, spoke for longer when prompted "Tell me about the problems you've been having," and had more anxiety and depression symptoms and psychiatric diagnoses than those without FCD. There were no significant differences in sex, education, or cognitive scores. Younger age and longer spoken response predicted FCD diagnosis in a model which explained 74% of diagnostic variability and had an area under the curve (AUC) of 94%.
A detailed description of cognitive failure is a sensitive and specific positive feature of FCD, demonstrating internal inconsistency between experienced and observed function. Cognitive and performance validity tests appear less helpful in FCD diagnosis. People with FCD are not "worried well" but often perform poorly on tests, and have more anxiety, depression, and physical symptoms than people with other cognitive disorders. Identifying diagnostic profiles is an important step toward parity of esteem for FCDs, as differential diagnoses of neurodegenerative disease and an independent target for clinical trials.
功能性认知障碍（FCD）是神经退行性疾病的一个重要鉴别诊断。尚未前瞻性地在“真实世界”临床人群中探索建议的诊断特征的实用性。本研究旨在确定 FCD 的阳性临床标志物。
从记忆、神经病学和神经精神病学诊所招募有认知主诉但无痴呆的成年人。参与者接受了结构化访谈、Mini 国际神经精神访谈、蒙特利尔认知评估、Luria 三步、手指交错、数字跨度和医学症状有效性测试、患者健康问卷 15、医院焦虑和抑郁量表、多因素记忆问卷和匹兹堡睡眠质量指数。使用逻辑回归对潜在诊断变量进行了测试，以确定与专家共识诊断的关系。
在 49 名参与者中发现了 31 名 FCD。与没有 FCD 的参与者相比，患有 FCD 的参与者更年轻，当被提示“告诉我您遇到的问题”时，他们的回答时间更长，焦虑和抑郁症状以及精神科诊断更多。参与者在性别、教育程度或认知评分方面没有显著差异。在一个解释 74%诊断变异性且曲线下面积（AUC）为 94%的模型中，年龄较小和较长的口语反应预测了 FCD 诊断。
对认知失败的详细描述是 FCD 的一个敏感且特异的阳性特征，表现为体验到的和观察到的功能之间的内在不一致。认知和表现有效性测试在 FCD 诊断中似乎帮助不大。患有 FCD 的人并不是“担心得好”，而是在测试中表现不佳，并且比患有其他认知障碍的人有更多的焦虑、抑郁和身体症状。确定诊断特征是 FCD 获得同等尊重的重要一步，因为 FCD 的鉴别诊断是神经退行性疾病的独立临床试验目标。
