功能性认知障碍的诊断与管理视角：一项国际德尔菲研究。
Perspectives on the diagnosis and management of functional cognitive disorder: An international Delphi study.
作者信息
Cabreira Verónica, Alty Jane, Antic Sonja, Araújo Rui, Aybek Selma, Ball Harriet A, Baslet Gaston, Bhome Rohan, Coebergh Jan, Dubois Bruno, Edwards Mark, Filipović Saša R, Frederiksen Kristian Steen, Harbo Thomas, Hayhow Bradleigh, Howard Robert, Huntley Jonathan, Isaacs Jeremy, LaFrance William Curt, Larner Andrew J, Di Lorenzo Francesco, Main James, Mallam Elizabeth, Marra Camillo, Massano João, McGrath Emer R, McWhirter Laura, Moreira Isabel Portela, Nobili Flavio, Pennington Catherine, Tábuas-Pereira Miguel, Perez David L, Popkirov Stoyan, Rayment Dane, Rossor Martin, Russo Mirella, Santana Isabel, Schott Jonathan, Scott Emmi P, Taipa Ricardo, Tinazzi Michele, Tomic Svetlana, Toniolo Sofia, Tørring Caroline Winther, Wilkinson Tim, Frostholm Lisbeth, Stone Jon, Carson Alan
机构信息
Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia.
出版信息
Eur J Neurol. 2025 Jan;32(1):e16318. doi: 10.1111/ene.16318. Epub 2024 May 3.
BACKGROUND
Current proposed criteria for functional cognitive disorder (FCD) have not been externally validated. We sought to analyse the current perspectives of cognitive specialists in the diagnosis and management of FCD in comparison with neurodegenerative conditions.
METHODS
International experts in cognitive disorders were invited to assess seven illustrative clinical vignettes containing history and bedside characteristics alone. Participants assigned a probable diagnosis and selected the appropriate investigation and treatment. Qualitative, quantitative and inter-rater agreement analyses were undertaken.
RESULTS
Eighteen diagnostic terminologies were assigned by 45 cognitive experts from 12 countries with a median of 13 years of experience, across the seven scenarios. Accurate discrimination between FCD and neurodegeneration was observed, independently of background and years of experience: 100% of the neurodegenerative vignettes were correctly classified and 75%-88% of the FCD diagnoses were attributed to non-neurodegenerative causes. There was <50% agreement in the terminology used for FCD, in comparison with 87%-92% agreement for neurodegenerative syndromes. Blood tests and neuropsychological evaluation were the leading diagnostic modalities for FCD. Diagnostic communication, psychotherapy and psychiatry referral were the main suggested management strategies in FCD.
CONCLUSIONS
Our study demonstrates the feasibility of distinguishing between FCD and neurodegeneration based on relevant patient characteristics and history details. These characteristics need further validation and operationalisation. Heterogeneous labelling and framing pose clinical and research challenges reflecting a lack of agreement in the field. Careful consideration of FCD diagnosis is advised, particularly in the presence of comorbidities. This study informs future research on diagnostic tools and evidence-based interventions.
背景
目前提出的功能性认知障碍（FCD）标准尚未经过外部验证。我们试图分析认知专家目前在FCD诊断和管理方面与神经退行性疾病相比的观点。
方法
邀请国际认知障碍专家评估七个仅包含病史和床边特征的说明性临床病例。参与者给出可能的诊断，并选择适当的检查和治疗方法。进行了定性、定量和评分者间一致性分析。
结果
来自12个国家的45名认知专家对七个病例给出了18种诊断术语，他们的平均经验年限为13年。观察到FCD和神经退行性疾病之间的准确区分，与背景和经验年限无关：100%的神经退行性病例被正确分类，75%-88%的FCD诊断归因于非神经退行性原因。与神经退行性综合征87%-92%的一致性相比，FCD所用术语的一致性<50%。血液检查和神经心理评估是FCD的主要诊断方式。诊断沟通、心理治疗和精神科转诊是FCD中主要建议的管理策略。
结论
我们的研究证明了根据相关患者特征和病史细节区分FCD和神经退行性疾病的可行性。这些特征需要进一步验证和实施。异质性的标签和框架带来了临床和研究挑战，反映出该领域缺乏一致性。建议仔细考虑FCD诊断，尤其是在存在合并症的情况下。本研究为未来诊断工具和循证干预措施的研究提供了信息。
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