Perspectives on the diagnosis and management of functional cognitive disorder: An international Delphi study
Open accessAbstract
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.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
It is recommended that treatment begin with being informed of the diagnosis and signposted to psychoeducational materials.
“Currently, it is recommended that treatment begin with being informed of the diagnosis, which we found was done inconsistently, and signposted to psychoeducational materials (8, 38).”
From A qualitative analysis of patients' day-to-day living with functional cognitive disorder (FCD). (2025) · cites this paper as [38]
In Results > Treatment and follow-up (page unavailable), participants emphasise communicating the diagnosis and explaining symptoms and memory functioning. The Discussion > Position statement also calls for education elements in treatment plans. Neither passage specifies that treatment should begin with diagnosis disclosure or that patients should be signposted to psychoeducational materials. (LLM, conf=0.85)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
The Measurement of Observer Agreement for Categorical Data
Landis, J. R., & Koch, G. G. (1977) · Biometrics · doi:10.2307/2529310 · Cited by 81,148 · cited 1× · see citing works
“Fleiss' kappa was run to determine inter-rater agreement for diagnostic investigations and treatment approaches ( < 0: no agreement; 0–0.20: slight; 0.21–0.40: fair; 0.41–0.60: moderate; 0.61–0.80: substantial; 0.81–1: almost perfect agreement) [22].”
InfluentialEssentials of nursing research: Methods, appraisal, and utilization
Polit, D. F., & Hungler, B. P. (1989) · Cited by 3,211 · see citing works
The Delphi technique: a worthwhile research approach for nursing?
McKenna, H. (1994) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.1994.tb01207.x · Cited by 1,151 · cited 1× · see citing works
“We used an online modified Delphi methodology which is a group facilitation iterative technique that seeks to obtain consensus based on the opinions of ‘experts’ through a series of consecutive rounds [19].”
The Delphi technique: a critique
Goodman, C. (1987) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.1987.tb01376.x · Cited by 928 · cited 2× · see citing works
“Experts with an interest and experience in cognitive disorders were selected to ensure that the information obtained reflected current scientific evidence and/or clinical expertise [20].”
Alzheimer’s disease drug development pipeline: 2022
Cummings, J., Lee, G., Nahed, P., Kambar, M. E. Z. N., Zhong, K., Fonseca, J., & Taghva, K. (2022) · Alzheimer's & Dementia: Translational Research & Clinical Interventions · doi:10.1002/trc2.12295 · Cited by 665 · see citing works
Functional neurological disorder: new subtypes and shared mechanisms
Hallett, M., Aybek, S., Dworetzky, B. A., McWhirter, L., Staab, J. P., & Stone, J. (2022) · The Lancet Neurology · doi:10.1016/s1474-4422(21)00422-1 · Cited by 538 · cited 2× · see citing works
“Functional cognitive disorder (FCD) is a common cause of non-neurodegenerative memory complaints seen in primary care, memory clinics and other specialised services [1–3].”
Self-citationRegional brain volume in depression and anxiety disorders
van Tol, M.-J., van der Wee, N. J. A., van den Heuvel, O. A., Nielen, M. M. A., Demenescu, L. R., Aleman, A., Renken, R., van Buchem, M. A., Zitman, F. G., & Veltman, D. J. (2010) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2010.121 · Cited by 370 · see citing works
Teodoro, T., Edwards, M. J., & Isaacs, J. D. (2018) · Journal of Neurology, Neurosurgery & Psychiatry · doi:10.1136/jnnp-2017-317823 · Cited by 241 · cited 4× · see citing works
“…self-efficacy and intolerance to minor memory lapses, increased anxiety about the symptoms, increased vigilance over cognitive complaints, and impaired global metacognition (i.e., the way one's own thoughts are appraised) [5, 6, 14, 15], all feeding into a loop of symptom perpetuation [6, 12, 16].”
InfluentialSelf-citationFunctional cognitive disorders: a systematic review
McWhirter, L., Ritchie, C., Stone, J., & Carson, A. (2020) · The Lancet Psychiatry · doi:10.1016/s2215-0366(19)30405-5 · Cited by 240 · cited 2× · see citing works
“The current FCD model is partially centred on attentional dysregulation that results in memory lapses including difficulty concentrating or completing tasks, retrieval blocks for overlearned information, word-finding difficulties, effortful thinking, or inability to follow conversations [2, 13].”
Self-citationFunctional cognitive disorder: dementia’s blind spot
Ball, H. A., McWhirter, L., Ballard, C., Bhome, R., Blackburn, D. J., Edwards, M. J., Fleming, S. M., Fox, N. C., Howard, R., Huntley, J., et al. (2020) · Brain · doi:10.1093/brain/awaa224 · Cited by 203 · see citing works
Self-citationFrisoni, G. B., Altomare, D., Ribaldi, F., Villain, N., Brayne, C., Mukadam, N., Abramowicz, M. J., Barkhof, F., Berthier, M. L., Bieler-Aeschlimann, M., et al. (2023) · The Lancet Regional Health - Europe · doi:10.1016/j.lanepe.2022.100576 · Cited by 187 · cited 2× · see citing works
“This comes at a time when models of brain health clinics are being discussed to replace traditional cognitive clinics focused on a neurodegenerative paradigm and to incorporate the new complementary tools and biomarkers in the diagnosis of neurocognitive disorders [23, 24].”
Self-citationEuropean intersocietal recommendations for the biomarker-based diagnosis of neurocognitive disorders
Frisoni, G. B., Festari, C., Massa, F., Ramusino, M. C., Orini, S., Aarsland, D., Agosta, F., Babiloni, C., Borroni, B., Cappa, S. F., et al. (2024) · The Lancet Neurology · doi:10.1016/s1474-4422(23)00447-7 · Cited by 170 · cited 2× · see citing works
“This comes at a time when models of brain health clinics are being discussed to replace traditional cognitive clinics focused on a neurodegenerative paradigm and to incorporate the new complementary tools and biomarkers in the diagnosis of neurocognitive disorders [23, 24].”
Self-citationJones, D., Drew, P., Elsey, C., Blackburn, D. J., Wakefield, S., Harkness, K., & Reuber, M. (2015) · Aging & Mental Health · doi:10.1080/13607863.2015.1021753 · Cited by 146 · cited 2× · see citing works
“Alzheimer's disease, cognitive disorders, consensus, Delphi, functional cognitive disorder BOX 1 Functional cognitive disorder (FCD) diagnostic criteria [1] and characteristic history and clinical signs informed by the literature [7–12] that inspired the FCD clinical vignettes (B, C and F).”
Biomarker-based prognosis for people with mild cognitive impairment (ABIDE): a modelling study
van Maurik, I. S., Vos, S. J. B., Bos, I., Bouwman, F. H., Teunissen, C. E., Scheltens, P., Barkhof, F., Frölich, L., Kornhuber, J., Wiltfang, J., et al. (2019) · The Lancet Neurology · doi:10.1016/s1474-4422(19)30283-2 · Cited by 126 · see citing works
Self-citationInterventions for subjective cognitive decline: systematic review and meta-analysis
Bhome, R., Berry, A. J., Huntley, J. D., & Howard, R. J. (2018) · BMJ Open · doi:10.1136/bmjopen-2018-021610 · Cited by 123 · cited 1× · see citing works
“…this, while on one hand, CSF and neuroimaging biomarkers hold promise for a distinction between preclinical AD and non-neurodegenerative symptoms [42], as auxiliary tests, many participants pointed out their limited specificity and sensitivity, high costs, invasiveness and the limited…”
Self-citationFunctional (Psychogenic) Cognitive Disorders: A Perspective from the Neurology Clinic
Stone, J., Pal, S., Blackburn, D., Reuber, M., Thekkumpurath, P., & Carson, A. (2015) · Journal of Alzheimer's Disease · doi:10.3233/jad-150430 · Cited by 107 · cited 4× · see citing works
“…that mood and behavioural changes can potentially represent a prodrome to neurodegeneration, and the same might apply to a subset of individuals with FCD [13, 28, 29, 32], as observed for Parkinson's disease and multiple sclerosis [33, 34] with FND overlap, often preceding these conditions.”
InfluentialSelf-citationPotter, S., & Brown, R. G. (2011) · Neuropsychological Rehabilitation · doi:10.1080/09602011.2011.630883 · Cited by 74 · cited 1× · see citing works
“We also included post-TBI cognitive symptoms which are prevalent [35], and are thought to be reinforced via similar mechanisms to those recognised in FCD including memory perfectionism, phobic anxiety, behaviour avoidance, hypervigilance, and concern about an underlying brain damage [36–38].”
Functional (psychogenic) symptoms in Parkinson's disease
Pareés, I., Saifee, T. A., Kojović, M., Kassavetis, P., Rubio‐Agusti, I., Sadnicka, A., Bhatia, K. P., & Edwards, M. J. (2013) · Movement Disorders · doi:10.1002/mds.25544 · Cited by 69 · cited 1× · see citing works
“…that mood and behavioural changes can potentially represent a prodrome to neurodegeneration, and the same might apply to a subset of individuals with FCD [13, 28, 29, 32], as observed for Parkinson's disease and multiple sclerosis [33, 34] with FND overlap, often preceding these conditions.”
Self-citationBlackburn, D. J., Wakefield, S., Shanks, M. F., Harkness, K. A., Reuber, M., & Venneri, A. (2014) · British Medical Bulletin · doi:10.1093/bmb/ldu029 · Cited by 67 · see citing works
Toward the Automation of Diagnostic Conversation Analysis in Patients with Memory Complaints
Mirheidari, B., Blackburn, D., Harkness, K., Walker, T., Venneri, A., Reuber, M., & Christensen, H. (2017) · Journal of Alzheimer’s Disease · doi:10.3233/jad-160507 · Cited by 54 · see citing works
Functional cognitive disorder: what is it and what to do about it?
Pennington, C., Newson, M., Hayre, A., & Coulthard, E. (2015) · Practical Neurology · doi:10.1136/practneurol-2015-001127 · Cited by 49 · cited 2× · see citing works
“…that mood and behavioural changes can potentially represent a prodrome to neurodegeneration, and the same might apply to a subset of individuals with FCD [13, 28, 29, 32], as observed for Parkinson's disease and multiple sclerosis [33, 34] with FND overlap, often preceding these conditions.”
Self-citationMetacognition in functional cognitive disorder
Bhome, R., McWilliams, A., Price, G., Poole, N., Howard, R., Fleming, S., & Huntley, J. (2021) · medRxiv · doi:10.1093/braincomms/fcac041 · Cited by 49 · cited 1× · see citing works
“…self-efficacy and intolerance to minor memory lapses, increased anxiety about the symptoms, increased vigilance over cognitive complaints, and impaired global metacognition (i.e., the way one's own thoughts are appraised) [5, 6, 14, 15], all feeding into a loop of symptom perpetuation [6, 12, 16].”
Self-citationUse of mild cognitive impairment and prodromal AD/MCI due to AD in clinical care: a European survey
Bertens, D., Vos, S. J. B., Kehoe, P. G., Wolf, H., Nobili, F. M., de Mendonça, A., van Rossum, I., Hort, J., Molinuevo, J. L., Heneka, M. T., et al. (2019) · Alzheimer s Research & Therapy · doi:10.1186/s13195-019-0525-9 · Cited by 47 · cited 1× · see citing works
“The FCD case vignettes were labelled with diverse terms including mood/anxiety, SCI or MCI, or stress, in line with findings from previous surveys conducted across European countries and the USA [25–27] (Table S2).”
Self-citationFunctional Cognitive Disorder: Diagnostic Challenges and Future Directions
Pennington, C. M., Ball, H. A., & Swirski, M. (2019) · Diagnostics · doi:10.3390/diagnostics9040131 · Cited by 46 · cited 1× · see citing works
“…that mood and behavioural changes can potentially represent a prodrome to neurodegeneration, and the same might apply to a subset of individuals with FCD [13, 28, 29, 32], as observed for Parkinson's disease and multiple sclerosis [33, 34] with FND overlap, often preceding these conditions.”
Self-citationBhome, R., Huntley, J. D., Price, G., & Howard, R. J. (2019) · Cognitive Neuropsychiatry · doi:10.1080/13546805.2019.1590190 · Cited by 45 · cited 2× · see citing works
“Contemporary views acknowledge that FCD can coexist with these conditions if cognitive symptoms are in excess of what would be expected in these cases, and with an inconsistent pattern and hyper-vigilance for cognitive symptoms [5, 17].”
Self-citationFunctional motor phenotypes: to lump or to split?
Tinazzi, M., Geroin, C., Marcuzzo, E., Cuoco, S., Ceravolo, R., Mazzucchi, S., Pilotto, A., Padovani, A., Romito, L. M., Eleopra, R., et al. (2021) · Journal of Neurology · doi:10.1007/s00415-021-10583-w · Cited by 45 · cited 1× · see citing works
“Similar discussions have been held regarding conceptualisation of functional motor phenotypes [30, 31], and a FCD classification had been previously proposed by Stone et al. [5, 28].”
Self-citationReframing postconcussional syndrome as an interface disorder of neurology, psychiatry and psychology
Clark, C. N., Edwards, M. J., Ong, B. E., Goodliffe, L., Ahmad, H., Dilley, M. D., Betteridge, S., Griffin, C., & Jenkins, P. O. (2022) · Brain · doi:10.1093/brain/awac149 · Cited by 45 · see citing works
Self-citationClinical signs in functional cognitive disorders: A systematic review and diagnostic meta-analysis
Cabreira, V., Frostholm, L., McWhirter, L., Stone, J., & Carson, A. (2023) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2023.111447 · Cited by 43 · cited 1× · see citing works
“…characteristics that enabled diagnostic formulation of a reasonably consistent diagnosis among these experts merit further consideration and clearer classification, and should be further validated and operationalised, including in settings with less expertise in cognitive neurology [10, 12].”
Self-citationReuber, M., Blackburn, D. J., Elsey, C., Wakefield, S., Ardern, K., Harkness, K., Venneri, A., Jones, D., Shaw, C. B., & Drew, P. (2018) · Alzheimer Disease & Associated Disorders · doi:10.1097/wad.0000000000000231 · Cited by 41 · see citing works
Fully automated cognitive screening tool based on assessment of speech and language
O’Malley, R., Mirheidari, B., Harkness, K., Reuber, M., Venneri, A., Walker, T., Christensen, H., & Blackburn, D. J. (2020) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp-2019-322517 · Cited by 41 · cited 1× · see citing works
“Namely, further positive diagnostic signs and diagnostic decision tools to support clinicians in differentiating FCD from other causes of cognitive impairment are needed to enable earlier diagnosis and increase specificity [48, 51].”
Screening Utility of the “Attended Alone” Sign for Subjective Memory Impairment
Larner, A. J. (2012) · Alzheimer Disease & Associated Disorders · doi:10.1097/wad.0b013e3182769b4f · Cited by 38 · see citing works
Self-citationParedes-Echeverri, S., Guthrie, A. J., & Perez, D. L. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.1040911 · Cited by 38 · cited 1× · see citing works
“Similar discussions have been held regarding conceptualisation of functional motor phenotypes [30, 31], and a FCD classification had been previously proposed by Stone et al. [5, 28].”
Self-citationWakefield, S., Blackburn, D. J., Harkness, K., Khan, A., Reuber, M., & Venneri, A. (2017) · Acta Neuropsychiatrica · doi:10.1017/neu.2017.21 · Cited by 37 · cited 1× · see citing works
“Neuropsychology can be very informative both in diagnosis and treatment of FCD [12, 52], particularly in cases where history and bedside testing are incongruent; however, there is a lack of consensus and regional variability regarding”
Al-Hameed, S., Benaissa, M., Christensen, H., Mirheidari, B., Blackburn, D., & Reuber, M. (2019) · PLOS ONE · doi:10.1371/journal.pone.0217388 · Cited by 37 · see citing works
Teodoro, T., Koreki, A., Chen, J., Coebergh, J. A., Poole, N. A., Ferreira, J. J., Edwards, M. J., & Isaacs, J. D. (2022) · Brain · doi:10.1093/brain/awac363 · Cited by 34 · cited 5× · see citing works
“Similar discussions have been held regarding conceptualisation of functional motor phenotypes [30, 31], and a FCD classification had been previously proposed by Stone et al. [5, 28].”
InfluentialSelf-citationWhat Do Cognitive Complaints in a Sample of Memory Clinic Outpatients Reflect?
Mascherek, A., Zimprich, D., Rupprecht, R., & Lang, F. R. (2011) · GeroPsych · doi:10.1024/1662-9647/a000046 · Cited by 33 · see citing works
Neuropsychological evaluation of functional cognitive disorder: A narrative review
Silverberg, N., & Rush, B. (2023) · Clinical Neuropsychologist · doi:10.1080/13854046.2023.2228527 · Cited by 29 · cited 6× · see citing works
“To date, the diagnostic criteria have not yet been externally validated, and inter-rater reliability for positive features of FCD (Box 1) has not been established [7–12].”
InfluentialDifferentiating Functional Cognitive Disorder from Early Neurodegeneration: A Clinic-Based Study
Ball, H. A., Swirski, M., Newson, M., Coulthard, E. J., & Pennington, C. M. (2021) · Brain Sciences · doi:10.3390/brainsci11060800 · Cited by 28 · cited 3× · see citing works
“…that mood and behavioural changes can potentially represent a prodrome to neurodegeneration, and the same might apply to a subset of individuals with FCD [13, 28, 29, 32], as observed for Parkinson's disease and multiple sclerosis [33, 34] with FND overlap, often preceding these conditions.”
Self-citationFunctional Cognitive Disorders (FCD): How Is Metacognition Involved?
Larner, A. J. (2021) · Brain Sciences · doi:10.3390/brainsci11081082 · Cited by 27 · cited 2× · see citing works
“…self-efficacy and intolerance to minor memory lapses, increased anxiety about the symptoms, increased vigilance over cognitive complaints, and impaired global metacognition (i.e., the way one's own thoughts are appraised) [5, 6, 14, 15], all feeding into a loop of symptom perpetuation [6, 12, 16].”
Self-citationA Pilot Group Therapy for Functional Memory Disorder
Metternich, B., Schmidtke, K., Dykierek, P., & ll, M. H. U. (2008) · Psychotherapy and Psychosomatics · doi:10.1159/000128166 · Cited by 26 · see citing works
Memory Perfectionism is Associated with Persistent Memory Complaints after Concussion
Picon, E. L., Todorova, E., Palombo, D. J., Perez, D. L., Howard, A. K., & Silverberg, N. D. (2022) · Archives of Clinical Neuropsychology · doi:10.1093/arclin/acac021 · Cited by 22 · cited 1× · see citing works
“The emphasis on occupational therapy and physiotherapy in this scenario perhaps supports the adoption of interventions commonly used post-TBI and targeting maladaptive beliefs, dysfunctional coping strategies and disease comorbidities [35–37] to FCD cases.”
Self-citationHow the UK describes functional memory symptoms
Bailey, C., Bell, S. M., & Blackburn, D. M. (2017) · Psychogeriatrics · doi:10.1111/psyg.12232 · Cited by 20 · see citing works
Bailey, C., Poole, N. A., & Blackburn, D. J. (2018) · British Journal of General Practice · doi:10.3399/bjgp18x694601 · Cited by 20 · see citing works
Functional cognitive disorders: clinical presentations and treatment approaches
McWhirter, L., & Carson, A. (2023) · Practical Neurology · doi:10.1136/pn-2022-003608 · Cited by 20 · cited 2× · see citing works
“Given that FCD is a likely common cause for cognitive symptoms, continuous work is required to improve screening and diagnostic workflow [18].”
Self-citationWalker, T., Christensen, H., Mirheidari, B., Swainston, T., Rutten, C., Mayer, I., Blackburn, D., & Reuber, M. (2020) · Dementia · doi:10.1177/1471301218795238 · Cited by 18 · cited 1× · see citing works
“Namely, further positive diagnostic signs and diagnostic decision tools to support clinicians in differentiating FCD from other causes of cognitive impairment are needed to enable earlier diagnosis and increase specificity [48, 51].”
LaFrance, W. C., Jr., Tedesco, R., Baird, G. L., Wincze, J. P., Tocco, K., & Anderson, J. (2023) · Seizure · doi:10.1016/j.seizure.2023.03.005 · Cited by 18 · cited 1× · see citing works
“…of this formulation, individuals with functional seizures and cognitive symptoms post-TBI displayed objective cognitive improvement after receiving neurobehavioral therapy [39], a multimodality, integrative psychotherapy used in patients with other functional neurological disorder subtypes [3, 40].”
Poole, N., Cope, S., Vanzan, S., Duffus, A., Mantovani, N., Smith, J., Barrett, B. M., Tokley, M., Scicluna, M., Beardmore, S., et al. (2023) · BMJ Open · doi:10.1136/bmjopen-2023-072366 · Cited by 14 · see citing works
Self-citationSaunders, S., Ritchie, C. W., Russ, T. C., Terrera, G. M., & Milne, R. (2022) · BMC Geriatrics · doi:10.1186/s12877-021-02693-x · Cited by 14 · cited 1× · see citing works
“The FCD case vignettes were labelled with diverse terms including mood/anxiety, SCI or MCI, or stress, in line with findings from previous surveys conducted across European countries and the USA [25–27] (Table S2).”
McWhirter, L., Sargent, B., Ritchie, C. W., Stone, J., & Carson, A. J. (2019) · CNS Spectrums · doi:10.1017/s1092852919001329 · Cited by 12 · cited 1× · see citing works
“…FCD is characterised by positive features and ‘internal inconsis-tency’ (reflecting differences in automatic versus explicit processing within the same cognitive domain) [4–6], is persistent and distressing, and not explained by another condition (e.g., a neurodegenerative or psychiatric disorder).”
Self-citationMemory for forgetting in adults with persistent symptoms following concussion
Rioux, M., Wardell, V., Palombo, D. J., Picon, E. L., Le, M. L., & Silverberg, N. D. (2022) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/13803395.2022.2067326 · Cited by 12 · cited 1× · see citing works
“We also included post-TBI cognitive symptoms which are prevalent [35], and are thought to be reinforced via similar mechanisms to those recognised in FCD including memory perfectionism, phobic anxiety, behaviour avoidance, hypervigilance, and concern about an underlying brain damage [36–38].”
Piliavska, K., Dantlgraber, M., Dettmers, C., Jöbges, M., Liepert, J., & Schmidt, R. (2023) · Frontiers in Neurology · doi:10.3389/fneur.2023.1077838 · Cited by 12 · cited 1× · see citing works
“…that mood and behavioural changes can potentially represent a prodrome to neurodegeneration, and the same might apply to a subset of individuals with FCD [13, 28, 29, 32], as observed for Parkinson's disease and multiple sclerosis [33, 34] with FND overlap, often preceding these conditions.”
Patten, R. V., Chan, L., Tocco, K., Mordecai, K. L., Altalib, H. H., Twamley, E. W., Gaston, T. E., Grayson, L. E., Martin, A. M., Fry, S., et al. (2023) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2023.07.038 · Cited by 9 · cited 1× · see citing works
“…of this formulation, individuals with functional seizures and cognitive symptoms post-TBI displayed objective cognitive improvement after receiving neurobehavioral therapy [39], a multimodality, integrative psychotherapy used in patients with other functional neurological disorder subtypes [3, 40].”
Alzheimer's disease risk biomarkers: progress and challenges
Adkins‐Jackson, P. B., & Belsky, D. W. (2022) · The Lancet Healthy Longevity · doi:10.1016/s2666-7568(22)00191-x · Cited by 8 · see citing works
A Case of Functional Cognitive Disorder: Psychotherapy and Speech and Language Therapy Insights
Godena, E. J., Freeburn, J. L., Silverberg, N. D., & Perez, D. L. (2023) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000379 · Cited by 6 · see citing works
Self-citationMetacognition in functional cognitive disorder: contradictory or convergent experimental results?
Larner, A. (2022) · Brain Communications · doi:10.1093/braincomms/fcac138 · Cited by 5 · cited 1× · see citing works
“…self-efficacy and intolerance to minor memory lapses, increased anxiety about the symptoms, increased vigilance over cognitive complaints, and impaired global metacognition (i.e., the way one's own thoughts are appraised) [5, 6, 14, 15], all feeding into a loop of symptom perpetuation [6, 12, 16].”
Self-citationMillstein, D. J., Perez, D. L., & Langfitt, J. T. (2023) · Journal of the Academy of Consultation-Liaison Psychiatry · doi:10.1016/j.jaclp.2023.01.003 · Cited by 5 · see citing works
Self-citation
Flagged first, then by citations
1 of the 57 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Cabreira, V., Alty, J., Antić, S., Araújo, R., Aybek, S., Ball, H. A., Baslet, G. C., Bhome, R., Coebergh, J. A., Dubois, B., et al. (2025) · BMJ Neurology Open · doi:10.1136/bmjno-2024-000918 · Cited by 15 · see citing works
Self-citationMavroudis, I. A., Petridis, F. E., Franekova, K., Visternicu, M., Rarinca, V., Burlui, V., Ciobîcă, A., Novac, B., Dobrin, I., Hogas, M., et al. (2025) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2025.1665510 · Cited by 7 · see citing works
Precipitating Factors for Functional Cognitive Disorder
Cabreira, V., McWhirter, L., Stone, J., & Carson, A. J. (2025) · European Journal of Neurology · doi:10.1111/ene.70082 · Cited by 10 · see citing works
Self-citationFunctional cognitive disorder in Alzheimer's disease
Cabreira, V., Zeidler, M., McWhirter, L., Pal, S., Stone, J., & Carson, A. J. (2025) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2025.123618 · Cited by 8 · see citing works
“However, the accuracy of “ internal inconsistency ” and “ positive ” signs for FCD [12] in the setting of a dual diagnosis [27] is not yet known.”
Self-citationPoole, N. A., Cope, S. R., Vanzan, S., Duffus, A., Williams, T., Mantovani, N., Smith, J. G., Barrett, B. M., Scicluna, M., Beardmore, S., et al. (2025) · BJPsych Open · doi:10.1192/bjo.2025.33 · Cited by 6 · 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
“14 Digital interventions are less costly and potentially scalable, but they also allow individuals to engage in self-care and receive support in a way that suits their own unique circumstances.”
Self-citationAlshimemeri, S. A., Alabandi, F. A., Binabbad, R. S., Elmutawi, H., Alabdi, G., & Gilmour, G. S. (2024) · BMC Neurology · doi:10.1186/s12883-024-03810-0 · Cited by 4 · see citing works
“Furthermore, heterogeneity in labelling and framing, reflecting varied conceptualizations of FND, was observed in a study where international experts had less than 50% agreement on the terminology used for diagnosing patients with Functional Cognitive Disorders [26].”
BackgroundA 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
“The value of positive signs is that they assist the clinician in differentiating the functional condition from superficially similar ones caused by neurological disease and, especially in the case of FCD, from primary psychiatric disorders which present with cognitive symptoms [39].”
Self-citationGomes, T., Benedetti, A., Postuma, R. B., Lafontaine, A., Kimoff, R. J., & Kamińska, M. (2025) · Sleep And Breathing · doi:10.1007/s11325-025-03525-7 · Cited by 2 · see citing works
“There is converging evidence suggesting that OSA can significantly exacerbate cognitive dysfunction in various clinical populations [30, 31].”
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
Self-citationRecommendations for Refining the Diagnosis of Functional Cognitive Disorder
Patten, R. V. (2026) · Journal of Neuropsychiatry · doi:10.1176/appi.neuropsych.20250279 · Cited by 1 · see citing works
Patten, R. V. (2026) · Archives of Clinical Neuropsychology · doi:10.1093/arclin/acag023 · Cited by 1 · see citing works
Promoting Brain Health in the Context of Normal Aging and Mild Cognitive Impairment: A Tutorial
Cohen, M. L., Lanzi, A. M., Rothbart, A., Keatley, E. S., Seagly, K., Strong, K. A., Paul, D. R., & Sohlberg, M. M. (2026) · American Journal of Speech-Language Pathology · doi:10.1044/2026_ajslp-25-00494 · Cited by 2 · see citing works
Further exploration of functional cognitive impairment in Alzheimer's disease – authors' reply
Cabreira, V. (2025) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2025.123703
Self-citationSpatial Cognition and Functional Dizziness
Breinbauer, H. A. (2026) · Contemporary clinical neuroscience · doi:10.1007/978-3-032-07539-0_17
Webster-Cordero, F., & Giménez‐Llort, L. (2026) · Research Square · doi:10.21203/rs.3.rs-9059640/v1
Measuring Cognition in the Diagnosis of Dementias
Hayden, S. (2026) · Springer eBooks · doi:10.1007/978-3-032-21818-6_2
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
Self-citation(2026) · Український медичний часопис · doi:10.32471/umj.1680-3051.279254
Roadmap for functional neurological disorders: Shared circuitry and future directions
Ertenu, D. D., Papolu, A., Quezada, J., Jadhav, S., Dean, S. L., & Salpekar, J. A. (2026) · International review of neurobiology · doi:10.1016/bs.irn.2026.08.014
Treatment of Functional Neurological Disorders
Park, J. E. (2026) · Journal of Clinical Neurology · doi:10.3988/jcn.2026.0223
“22 Patients with FCD have been found not to consistently fail tests of performance validity or effort, but may display impaired selective attention.”
InfluentialКогнітивні порушення та нейродегенерація: побачити невидиме
(2026) · Український медичний часопис · doi:10.32471/umj.1680-3051.281065
Neuropsychological assessment in functional cognitive disorder: a scoping review
Mammì, A., Reuber, M., Pascarella, A., Abelardo, D., Cutellè, R., Bulgari, A., Ferlazzo, E., & Gasparini, S. (2026) · Psychiatry Research · doi:10.1016/j.psychres.2026.117508
- Authors
- Cabreira, V., Alty, J., Antic, S., Araújo, R., Aybek, S., Ball, H. A., Baslet, G., Bhome, R., Coebergh, J., Dubois, B., Edwards, M., Filipović, S. R., Frederiksen, K. S., Harbo, T., Hayhow, B., Howard, R., Huntley, J., Isaacs, J., LaFrance, W. C., Larner, A. J., Di Lorenzo, F., Main, J., Mallam, E., Marra, C., Massano, J., McGrath, E. R., McWhirter, L., Moreira, I. P., Nobili, F., Pennington, C., Tábuas‐Pereira, M., Perez, D. L., Popkirov, S., Rayment, D., Rossor, M., Russo, M., Santana, I., Schott, J., Scott, E. P., Taipa, R., Tinazzi, M., Tomic, S., Toniolo, S., Tørring, C. W., Wilkinson, T., Frostholm, L., Stone, J., & Carson, A.
- Affiliations
- University of Edinburgh (GB)
- University of Tasmania (AU)
- Department of Neurology Aarhus University Hospital Aarhus Denmark
- Universidade do Porto (PT)
- University of Fribourg (CH)
- University of Bristol (GB)
- Brigham and Women's Hospital (US)
- UCL Queen Square Institute of Neurology (GB)
- St George's, University of London (GB)
- Sorbonne Université (FR)
- King's College London (GB)
- University of Belgrade (RS)
- University of Copenhagen (DK)
- Aarhus University Hospital (DK)
- Department of Neurology Fiona Stanley Hospital Murdoch Western Australia Australia
- University College London (GB)
- Alpert Medical School Brown University Providence Rhode Island USA
- Walton Centre (GB)
- Department of Clinical and Behavioural Neurology Santa Lucia Foundation IRCCS Rome Italy
- Devon Partnership NHS Trust (GB)
- North Bristol NHS Trust (GB)
- Università Cattolica del Sacro Cuore (IT)
- Ollscoil na Gaillimhe – University of Galway (IE)
- Centro Hospitalar de Vila Nova de Gaia (PT)
- Ospedale Policlinico San Martino (IT)
- NHS Lothian (GB)
- Unidade Local de Saúde de Coimbra (PT)
- Harvard University (US)
- Essen University Hospital (DE)
- Southmead Hospital (GB)
- University of Chieti-Pescara (IT)
- Centro de Inovação em Biomedicina e Biotecnologia (PT)
- Medical University of South Carolina (US)
- Hospital de Santo António (PT)
- Department of Neurosciences, Biomedicine and Movement University of Verona Verona Italy
- Department of Neurology University Hospital Center Osijek, Medical School on University of Osijek Osijek Croatia
- University of Oxford (GB)
- Corresponding author
- Cabreira, Verónica
- ORCID
- Cabreira, Verónica
- Alty, Jane
- 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
- Howard, Robert
- Huntley, Jonathan
- Isaacs, Jeremy
- LaFrance, William Curt
- Larner, Andrew J.
- Marra, Camillo
- Massano, João
- McGrath, Emer R.
- McWhirter, Laura
- Moreira, Isabel Portela
- Nobili, Flavio
- Pennington, Catherine
- Tábuas‐Pereira, Miguel
- Perez, David L.
- Popkirov, Stoyan
- Rossor, Martin
- Russo, Mirella
- Santana, Isabel
- Schott, Jonathan
- Scott, Emmi P.
- Taipa, Ricardo
- Toniolo, Sofia
- Tørring, Caroline Winther
- Wilkinson, Tim
- Frostholm, Lisbeth
- Stone, Jon
- Carson, Alan
- Venue
- European Journal of Neurology
- Publisher
- Wiley
- Published
- 2024-05-03
- Volume
- 32
- Issue
- 1
- Pages
- e16318-e16318
- ISSN
- 1351-5101 (ISSN-L)
- 1468-1331
- PMC
- PMC11617961
- OpenAlex
- W4396625210
- Cited by
- 24
- References
- 57
- Citations by year
- 2026: 12 · 2025: 10 · 2024: 2
- FWCI
- 7.05
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- European Journal of Neurology (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, cc-by-nc-nd)
- UCL Discovery (University College London) (submittedVersion, cc-by-nc-nd)
- St George's Online Research Archive (St George's University of London) (submittedVersion)
- ResearchOnline@ND (The University of Notre Dame) (submittedVersion)
- Universitätsbibliographie, Universität Duisburg-Essen (submittedVersion)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by-nc-nd)
- RIMI (Institute for Medical Research, University of Belgrade) (submittedVersion, cc-by-nc-nd)
- Funders
- European Commission (956673)
- 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
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Keywords
- functional cognitive disorder, diagnosis, management, neurodegenerative diseases, differential diagnosis, diagnostic criteria, diagnostic terminology, clinical vignettes, interobserver agreement, neuropsychological assessment, blood analysis, psychotherapy, psychiatric referral, comorbidities
- MeSH terms
- Adult, Cognition Disorders, Delphi Technique, Female, Humans, Male, Middle Aged, Neuropsychological Tests, Neurodegenerative Diseases
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
