Identifying functional cognitive disorder: a proposed diagnostic risk model
Open accessAbstract
Background: 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. Methods: 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. Results: 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%. Conclusions: 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.
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Health anxiety about dementia is a common concern among people with FCD.
“those participants who experienced health anxiety about dementia, which is a common concern among people with FCD (1)”
From A qualitative analysis of patients' day-to-day living with functional cognitive disorder (FCD). (2025) · cites this paper as [1]
The Introduction (p. 5) lists health anxiety about dementia as a presentation of FCD, supporting its association with the disorder. It does not establish how common that specific concern is among people with FCD; the higher anxiety scores reported under Psychiatric symptoms and diagnoses (p. 10) are not specific to dementia. (LLM, conf=0.82)
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- Authors
- McWhirter, L., Ritchie, C., Stone, J., & Carson, A.
- Affiliations
- University of Edinburgh (GB)
- Corresponding author
- McWhirter, Laura
- Venue
- CNS Spectrums
- Publisher
- Cambridge University Press (CUP)
- Published
- 2021-09-17
- Volume
- 27
- Issue
- 6
- Pages
- 754-763
- ISSN
- 1092-8529 (ISSN-L)
- 2165-6509
- OpenAlex
- W3199516084
- Cited by
- 40
- References
- 21
- Citations by year
- 2026: 12 · 2025: 11 · 2024: 9 · 2023: 6 · 2022: 2
- FWCI
- 3.05
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- cc-by-nc-nd
- www.cambridge.org/core/terms (unspecified)
- Locations
- CNS Spectrums (publishedVersion)
- PubMed (publishedVersion)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by-nc-nd)
- 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 › Clinical Psychology › Historical and Modern Theater Studies
- Keywords
- functional cognitive disorder, differential diagnosis of neurodegenerative diseases, anxiety and depression, psychiatric comorbidity, performance validity, cognitive failure, diagnostic biomarkers
- MeSH terms
- Adult, Cognition, Cognition Disorders, Humans, Psychiatric Status Rating Scales, Surveys and Questionnaires, Neurodegenerative Diseases, Cognitive Dysfunction
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