Clinical signs in functional cognitive disorders: A systematic review and diagnostic meta-analysis
Open accessAbstract
OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
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Despite recent research efforts, it has been difficult to identify clear positive signs of FCD similar to the Hoover's sign in functional movement disorders.
“Despite recent research efforts (6), it has been difficult to identify clear positive signs of FCD similar to the Hoover's sign in functional movement disorders.”
From A qualitative analysis of patients' day-to-day living with functional cognitive disorder (FCD). (2025) · cites this paper as [6]
Despite some recent exceptions, FCD lags behind in this regard and too many clinicians in memory clinics are wary of the diagnosis and its plethora of confusing synonyms, which can hinder research.
“However, despite some recent exceptions (6, 33, 37) FCD lags behind in this regard and too many clinicians in memory clinics are wary of the diagnosis and its plethora of confusing synonyms (8), which can hinder research (4).”
From A qualitative analysis of patients' day-to-day living with functional cognitive disorder (FCD). (2025) · cites this paper as [6]
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“Other validated questionnaires are detailed in Section 7.4 (Cabreira et al., 2023a; Schmidtke and Metternich, 2009; Mascherek et al., 2011).”
InfluentialPrecipitating Factors for Functional Cognitive Disorder
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“Considering these limitations, we advocate for a patient-centred clinical evaluation rooted in a detailed history and positive clinical characteristics to identify FCD and/or AD among at-risk populations, instead of relying on investigations and diagnosis of exclusion [25,26].”
Self-citationFunctional cognitive disorder: Beyond pseudodementia
Marín‐Medina, D. S., Arenas-Vargas, P. A., Velásquez-Duque, M. D. P., & Bagnati, P. (2024) · Neurology Perspectives · doi:10.1016/j.neurop.2024.100179 · Cited by 6 · see citing works
Mavroudis, I. A., Franekova, K., Petridis, F., Ciobica, A. S., Papagiannopoulos, S., & Kazis, D. A. (2025) · Brain Sciences · doi:10.3390/brainsci15090997 · Cited by 5 · see citing works
“Up to 16% of new neurology referrals and over 40% of patients in specialist memory clinics present with symptoms ultimately diagnosed as functional in origin [2,11].”
InfluentialMcWhirter, L. (2024) · Practical Neurology · doi:10.1136/pn-2024-004112 · Cited by 5 · see citing works
Self-citationFeasibility trial of a self-help digital intervention for functional cognitive disorder
Cabreira, V., Frostholm, L., Stone, J., & Carson, A. J. (2025) · Brain Communications · doi:10.1093/braincomms/fcaf248 · Cited by 4 · see citing works
Self-citationSaccadic eye movements differentiate functional cognitive disorder from mild cognitive impairment
Wilcockson, T. D. W., Roy, S., & Crawford, T. J. (2025) · Perception · doi:10.1177/03010066251359215 · Cited by 3 · see citing works
“Currently, the knowledge of speci fi c diagnostic tools available to screen FCD is lacking (Cabreira et al., 2023).”
Aubignat, M., & Cervellera, P. A. (2024) · La Revue de Médecine Interne · doi:10.1016/j.revmed.2024.11.006 · Cited by 3 · see citing works
Brain health clinics – An evolving clinical pathway?
Butters, A. F., Blackman, J., Farouk, H., Meky, S., Newson, M., Lemke, T., Rosewell, N., Selwood, J., Turner, N. L., Coulthard, E. J., et al. (2025) · The Journal of Prevention of Alzheimer s Disease · doi:10.1016/j.tjpad.2024.100051 · Cited by 3 · see citing works
“FCD is also often prevalent in younger patients with more psychiatric and sleep disturbances [ 40 ], possibly explaining its relatively high prevalence in our sample.”
Overvliet, G. M., van Haandel, Z. P., Hage, S. A. L., van Engelen, M. E., Pijnenburg, Y. A. L., & Krudop, W. A. (2025) · International Review of Psychiatry · doi:10.1080/09540261.2025.2577802 · Cited by 3 · see citing works
“We hypothesized that context dependent variability in symptomatology, family context, quality of life and coping style play some role in phFTD, based on previous literature and the described overlap with functional cognitive complaints (Cabreira et al., 2023; Gossink et al., 2016).”
A qualitative analysis of patients' day-to-day living with functional cognitive disorder (FCD).
Mantovani, N., Poole, N., Cope, S., Vanzan, S., Duffus, A., Williams, T., Smith, J. G., Barrett, B., Scicluna, M., Beardmore, S., et al. (2025) · Disability and Rehabilitation · doi:10.1080/09638288.2025.2460725 · Cited by 2 · see citing works
“Despite recent research efforts [6], it has been difficult to identify clear positive signs of FCD similar to the Hoover’s sign in functional movement disorders.”
InfluentialSleep in Functional Motor Disorders: A Case–Control Polysomnographic Study
Nepožitek, J., Dostálová, S., Jirásek, M., Chaloupková, G., Forejtová, Z., Nováková, L., Rottová, V., Konvičná, V., Šonka, K., Edwards, M. J., et al. (2025) · Journal of Sleep Research · doi:10.1111/jsr.70163 · Cited by 2 · see citing works
“Self-reported sleep disturbance is highly prevalent in functional cognitive disorder and serves as a distinguishing diagnostic feature from neurodegenerative causes; however, there is a lack of PSG studies in this area (Cabreira et al. 2023).”
Westlin, C., Rioux, M., Lee, J., Panenka, W. J., Palombo, D. J., Todd, R. M., Silverberg, N. D., & Perez, D. L. (2025) · NeuroImage Clinical · doi:10.1016/j.nicl.2025.103936 · Cited by 2 · see citing works
“…cognitive symptoms, (2) evidence of internal inconsistency, (3) symptoms not better explained by another medical disorder, and (4) symptoms that cause clinically significant distress or impairment, or warrant medical evaluation (Ball et al., 2020; Cabreira et al., 2023a; McWhirter et al., 2020).”
García‐Roldán, E., Almodóvar‐Sierra, Á., Luque‐Tirado, A., Cabañas, A. M. M., Sánchez‐Arjona, M. B., & Macías, E. F. (2025) · European Journal of Neurology · doi:10.1111/ene.70383 · Cited by 1 · see citing works
“…a recent systematic review and diagnostic meta-analysis synthesized the clinical signs of FCD, identifying signs such as frequent checking, elaborated examples of memory failures, longer duration of spoken answer, and unaccompanied clinic attendance as the most distinguishable features of FCD [9].”
The long-term memory sign: A clinical marker of functional cognitive disorders
Tyson, B. T., Randolph, L., Bayrhammer-Savel, M., Al-Khafaji, A., & Erdődi, L. A. (2026) · Applied Neuropsychology Adult · doi:10.1080/23279095.2026.2658676 · Cited by 1 · see citing works
Investigation, innovation, and integration
Fiedorowicz, J. G. (2024) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2024.111794 · Cited by 1 · see citing works
Rosmalen, J. G. M. (2024) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2024.111825 · Cited by 1 · see citing works
Hamm, B., & Rosenthal, L. J. (2024) · Seminars in Neurology · doi:10.1055/s-0044-1791226 · Cited by 1 · see citing works
“79 Many patients vividly articulate their perceived cognitive de fi cits with more prolonged communication than patients with neurodegenerative disorders.”
Shaw, J., Muralidhar, M., Demnitz‐King, H., Rait, G., Schott, J. M., Mukadam, N., Marshall, C. R., Oommen, A., Smith, D. K., Hadley, C., et al. (2025) · Research Square · doi:10.21203/rs.3.rs-8165369/v1 · Cited by 1 · see citing works
Funktionelle kognitive und amnestische Störungen
Popkirov, S. (2024) · Springer eBooks · doi:10.1007/978-3-662-69215-8_12
Foreign accent syndrome in neurodegenerative disorders
Miller, N., & Stewart, F. A. (2025) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780198888482.013.0010
Funktionelle Störungen (Psychosomatik)
Furmaniak, A., & Henningsen, P. (2025) · Elsevier eBooks · doi:10.1016/b978-3-437-21344-1.00030-0
Mohan, A., Hayes, C. J., & Krishnan, A. V. (2026) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000001062
Functional Neurological Disorder: A Primer for Neuropsychologists
Kavish, N., & Maietta, J. E. (2026) · Springer eBooks · doi:10.1007/978-3-032-07777-6_20
Perception Is Everything: Functional Cognitive Disorders
Hayden, S. (2026) · Springer eBooks · doi:10.1007/978-3-032-21818-6_6
Context Matters: Psychosocial Factors and Cognition
Hayden, S. (2026) · Springer eBooks · doi:10.1007/978-3-032-21818-6_7
Kapfhammer, H. (2026) · Springer Reference Medizin · doi:10.1007/978-3-642-45028-0_73-2
Medically Unexplained Symptoms
Myles, A. B., Ejova, A., de Zoete, R. M. J., Mahdavi, E. G., & Roberts, R. M. (2026) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000001396
Funktionelle kognitive Störungen erkennen und verstehen
Beckers, J., Popkirov, S., Michaelis, R., Seliger, C., & Jungilligens, J. (2026) · Zeitschrift für Neuropsychologie · doi:10.1024/1016-264x/a000443
Okazaki, M., Adachi, N., Sunaga, A., Watanabe, S., Ikegaya, N., Iwasaki, M., Hara, K., Ito, M., Kato, M., & Onuma, T. (2026) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2026.111163
Methylphenidate-associated improvement in complex functional/ dissociative disorder: A case report
Laatsch, J., Philipsen, A., & Pensel, M. C. (2026) · Psychiatry Research Case Reports · doi:10.1016/j.psycr.2026.100338
Kouassi, K. L., Yao, A. V., Broh, N. Y. C., Yeo, S., Abbé, A. S., Beuseize, A., Souza, A. N. T. E.-D., Diakite, I., & Doumbia-Ouattara, M. (2026) · Frontiers in Neurology · doi:10.3389/fneur.2026.1836371
Chare, I. A., Mhanna, E., Palisson, J., & Garcin, B. (2026) · La Revue de Médecine Interne · doi:10.1016/j.revmed.2026.08.009
Pick, S., & Hotopf, M. H. (2026) · Philosophical Transactions of the Royal Society B Biological Sciences · doi:10.1098/rstb.2024.0471
Mavroudis, I. A., Das, O., Petridis, F. E., & Kazis, D. (2026) · Brain Science · doi:10.3390/brainsci16101026
Khalil, A., Chetty, T., Mukateova‐Ladinska, E., & Critchfield, M. (2026) · BJPsych Bulletin · doi:10.1192/bjb.2026.10280
- Authors
- Cabreira, V., Frostholm, L., McWhirter, L., Stone, J., & Carson, A.
- Affiliations
- University of Edinburgh (GB)
- Aarhus University Hospital (DK)
- Corresponding author
- Cabreira, Verónica
- Venue
- Journal of Psychosomatic Research
- Publisher
- Elsevier BV
- Published
- 2023-10
- Volume
- 173
- Pages
- 111447
- ISSN
- 0022-3999 (ISSN-L)
- OpenAlex
- W4385566435
- Cited by
- 43
- References
- 73
- Citations by year
- 2026: 15 · 2025: 17 · 2024: 10 · 2023: 1
- FWCI
- 1.96
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Psychosomatic Research (publishedVersion, other-oa)
- PubMed (publishedVersion)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by)
- Funders
- European Union
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Social Sciences › Psychology › Applied Psychology › Psychological Testing and Assessment
- Keywords
- functional cognitive disorder, differential diagnosis, neurodegeneration, memory impairment, clinical signs, diagnostic accuracy, language assessment, working memory, anxiety, depression, sleep disorders, memory clinics
- MeSH terms
- Cognition Disorders, Humans, Language, Comorbidity, Cognitive Dysfunction
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