Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom.
Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
J Psychosom Res. 2023 Oct;173:111447. doi: 10.1016/j.jpsychores.2023.111447. Epub 2023 Aug 5.
Functional cognitive disorder (FCD) accounts for around a third of patients attending specialized memory clinics. It is also overrepresented in patients with other functional and somatic diagnoses. So far, no long-term diagnostic validity studies were conducted, and a positive diagnostic profile is yet to be identified. We aimed to review the literature on diagnostic signs and symptoms that allow for a discrimination between FCD and neurodegeneration.
Systematic review of Ovid-Medline®, Embase and PsycINFO databases. Relevant clinical features were extracted including demographics, symptom history, comorbidities, language and interaction profiles and cognitive assessments. Studies with quantifiable diagnostic accuracy data were included in a diagnostic meta-analysis.
Thirty studies (N = 8602) were included. FCD patients were younger, more educated, and more likely to have a family history of older onset dementia, abrupt symptom onset, and higher rates of anxiety, depression and sleep disturbance. Promising language profiles include longer duration of spoken answer, elaborated examples of memory failures, ability to answer compound and personal questions, and demonstration of working memory during interaction. The pooled analysis of clinical accuracy of different signs revealed that attending alone and bringing a handwritten list of problems particularly increase the odds of a FCD diagnosis. Current evidence from neuropsychometric studies in FCD is scarce.
Our systematic review reinforces that positive signs contribute for an early differentiation between FCD and neurodegeneration in patients presenting with memory complaints. It is the first to attain quantitative value to clinical observations. These results will inform future diagnostic decision tools and intervention testing.
功能性认知障碍（FCD）约占专门记忆诊所就诊患者的三分之一。它在其他功能性和躯体性诊断患者中也更为常见。到目前为止，还没有进行长期的诊断有效性研究，也尚未确定明确的阳性诊断特征。我们旨在回顾关于有助于区分 FCD 和神经退行性变的诊断体征和症状的文献。
对 Ovid-Medline®、Embase 和 PsycINFO 数据库进行系统综述。提取了相关的临床特征，包括人口统计学、症状史、合并症、语言和互动特征以及认知评估。纳入了具有可量化诊断准确性数据的研究进行诊断荟萃分析。
共纳入 30 项研究（N=8602）。FCD 患者年龄较小、受教育程度较高，且更有可能有家族性老年发病痴呆史、症状突然发作、焦虑、抑郁和睡眠障碍的发生率较高。有希望的语言特征包括回答持续时间较长、记忆失败的详细例子、回答复合和个人问题的能力，以及在互动过程中展示工作记忆。不同体征的临床准确性的汇总分析表明，单独就诊和携带手写问题清单特别增加了 FCD 诊断的可能性。目前 FCD 神经心理测量研究的证据有限。
我们的系统综述强化了这样一种观点，即积极的体征有助于在出现记忆问题的患者中早期区分 FCD 和神经退行性变。这是首次对临床观察获得定量价值。这些结果将为未来的诊断决策工具和干预测试提供信息。
