Metacognition in functional cognitive disorder- a potential mechanism and treatment target
Open accessAbstract
Introduction: Functional Cognitive Disorder (FCD) is common. Despite this, there is no evidence-based consensus on how to treat FCD. Poor metacognitive ability has been suggested as a key mechanism underlying the disorder. This paper evaluates the proposal that strategies which improve metacognition could provide a mechanistically plausible translational therapy.Methods: We reviewed the existing literature relating to metacognition in FCD, previous strategies to improve metacognitive ability in FCD and whether metacognitive performance can be modulated.Results: Though limited, there is evidence to suggest that metacognition is impaired in FCD. Converging evidence from neuroimaging studies suggests that metacognitive performance can be modulated. The effectiveness of existing strategies to improve metacognition including cognitive training, psychoeducation and lifestyle interventions have been equivocal. Recently, a potential treatment option has emerged in the form of a computer-based metacognitive training paradigm.Conclusions: There is an urgent need for effective treatments in FCD. Impaired metacognition may be a plausible therapeutic target but, in the first instance, further research is required to demonstrate deficits in “local” metacognitive ability in FCD patients when measured objectively. If so, clinical trials of interventions, such as computerised metacognitive training, are required to evaluate their effectiveness in improving FCD symptoms.
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Clinical literature indicates that FCD symptoms often cause anxiety, anger and frustration, arguing this can increase the risk of further cognitive failures, generating a reinforcing cycle that results in significant underperformance in social, work and home settings.
“Clinical literature indicates that FCD symptoms often cause anxiety, anger and frustration, arguing this can increase the risk of further cognitive failures, generating a reinforcing cycle that results in significant underperformance in social, work and home settings (29).”
From A qualitative analysis of patients' day-to-day living with functional cognitive disorder (FCD). (2025) · cites this paper as [29]
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Millman, L. S. M., Hunter, E. C. M., Terhune, D. B., & Orgs, G. (2025) · The Arts in Psychotherapy · doi:10.1016/j.aip.2025.102374 · Cited by 2 · see citing works
The relationship of action, affect, and metacognition in functional seizures
Jungilligens, J., Flohr, M.-C., Lange, M., Wellmer, J., & Popkirov, S. (2023) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/13803395.2023.2287778 · Cited by 2 · see citing works
“…discussed for functional cognitive disorder – subjective cognitive deficits without underlying neurodegeneration, often characterized by excessive self-monitoring and biased performance evaluation – which has been conceptualized as being primarily a disorder of metacognition (Bhome et al., 2019).”
BackgroundMavroudis, I. A., Das, O., Petridis, F. E., & Kazis, D. (2026) · Brain Science · doi:10.3390/brainsci16101026
“They address aberrantly precise priors about cognitive failure, memory perfectionism and catastrophic interpretation of normal mnemonic noise, and they provide the broadened experiential distribution that an overfitted system requires for recalibration [27,51,57,58,72].”
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Correlates and Predictors of Metamemory in an Online Sample.
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Nakamura, Z., Small, B. J., Ahles, T., & Smith, P. J. (2026) · Journal of the International Neuropsychological Society · doi:10.1017/s1355617726102112
Funktionelle kognitive Störungen erkennen und verstehen
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“Currently, ruling out AD may not necessarily help diagnose FCD, since biomarker (e.g. pTau) negativity could also be consistent with pure DLB or vascular cognitive impairments.”
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“7 Furthermore, some reports emphasise that individuals with preclinical Alzheimer ’ s disease have a tendency to overestimate their current cognitive performance compared to those who report subjective cognitive decline due to neuroticism or psychiatric conditions.”
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Popkirov, S. (2020) · Springer eBooks · doi:10.1007/978-3-662-61272-9_12
- Authors
- Bhome, R., McWilliams, A., Huntley, J. D., Fleming, S. M., & Howard, R. J.
- Affiliations
- University College London (GB)
- Wellcome Centre for Human Neuroimaging (GB)
- Corresponding author
- Bhome, Rohan
- Venue
- Cognitive Neuropsychiatry
- Publisher
- Informa UK Limited
- Published
- 2019-08-07
- Volume
- 24
- Issue
- 5
- Pages
- 311-321
- ISSN
- 1354-6805 (ISSN-L)
- 1464-0619
- OpenAlex
- W2966578785
- Cited by
- 48
- References
- 0
- Citations by year
- 2026: 8 · 2025: 5 · 2024: 5 · 2023: 8 · 2022: 11 · 2021: 5 · 2020: 6
- FWCI
- 4.38
- Type
- journal article
- Language
- en
- Open access
- green
- discovery.ucl.ac.uk
- Locations
- Cognitive Neuropsychiatry (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- MPG.PuRe (Max Planck Society) (submittedVersion)
- Funders
- Wellcome Trust (203147/Z/16/Z, 206648/Z/17/Z, 203376/2/16/Z)
- National Institute for Health and Care Research (NF-SI-0616-10042, ACF-2015-17-019, ACF-2017-18-025)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Cognitive Functions and Memory
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- functional cognitive disorder, metacognition, metacognitive training, treatment goals, cognitive training, psychoeducation, lifestyle intervention, computer-based training
- MeSH terms
- Metacognition, Cognition Disorders, Conversion Disorder, Humans, Cognitive Behavioral Therapy
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