Functional Cognitive Disorders (FCD): How Is Metacognition Involved?
Open accessAbstract
Functional cognitive disorders (FCD) have become a subject of increasing clinical interest in recent years, in part because of their high prevalence amongst patients attending dedicated memory clinics. Empirical understanding of FCD based on observational studies is growing, suggesting a relationship to other functional neurological disorders (FND) based on shared phenomenology. However, understanding of FCD at the theoretical level has been lacking. One suggestion has been that FCD are disorders of metacognition, most usually of metamemory. In this article, a brief overview of these constructs is presented along with existing evidence for their impairment in FCD. Previous adaptations of theoretical models of FND to accommodate FCD are reviewed. A novel application to FCD of Nelson and Narens’ monitoring and control model of metamemory is then attempted, positing an improper setting of the monitoring function, with examples of ecological relevance. Formulation of FCD in light of a metacognitive model of anosognosia is also considered. Although lacking mechanistic and neuroanatomical sophistication, this metacognitive formulation of FCD may give pointers for future hypothesis-driven research and a pragmatic basis for management strategies.
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Cites
Metacognitive Aspects of Problem Solving
Flavell, J. H. (2024) · Routledge eBooks · doi:10.4324/9781032646527-16 · Cited by 2,816 · see citing works
Metamemory: A Theoretical Framework and New Findings
Nelson, T. O. (1990) · Psychology of Learning and Motivation · doi:10.1016/s0079-7421(08)60053-5 · Cited by 2,583 · cited 6× · see citing works
“Although more complex than Nelson and Narens’ metamemory model [58], as required to explain the heterogeneity of anosognosia [9], the essential feature of CAM is that task performance is monitored by comparator mechanisms.”
BackgroundMethodInfluentialThe p Factor: One General Psychopathology Factor in the Structure of Psychiatric Disorders?
Caspi, A., Houts, R. M., Belsky, D. W., Goldman-Mellor, S. J., Harrington, H., Israel, S., Meier, M. H., Ramrakha, S., Shalev, I., Poulton, R., et al. (2014) · Clinical Psychological Science · doi:10.1177/2167702613497473 · Cited by 2,449 · see citing works
On the computational architecture of the neocortex: II The role of cortico-cortical loops
Mumford, D. (1992) · Biological Cybernetics · doi:10.1007/bf00198477 · Cited by 1,074 · see citing works
On the computational architecture of the neocortex: I. The role of the thalamo-cortical loop
Mumford, D. (1991) · Biological Cybernetics · doi:10.1007/bf00202389 · Cited by 929 · see citing works
A Bayesian account of ‘hysteria’
Edwards, M. J., Adams, R. A., Brown, H., Parees, I., & Friston, K. J. (2012) · Brain · doi:10.1093/brain/aws129 · Cited by 825 · cited 16× · see citing works
“Brain Sci. 2021, 11, 1082. https://doi.org/10.3390/brainsci11081082 https://www.mdpi.com/journal/brainsci Brain Sci. 2021, 11, 1082 2 of 13 Empirically, the key clinical feature of FCD, as in other FND, is a discrepancy or internal inconsistency between subjective reports and objective measures, specifically in this i…”
BackgroundMethodInfluentialMemory and the feeling-of-knowing experience.
Hart, J. (1965) · Journal of Educational Psychology · doi:10.1037/h0022263 · Cited by 802 · cited 2× · see citing works
“In the sphere of cognitive psychology, Hart (1965) developed the idea of “feeling of knowing” (FOK) [36], which has been used as a method of assessing metamemory judgments for already acquired material.”
BackgroundMethodFirst Discussant’s Comments: What is Memory Development the Development of?
Flavell, J. H. (2009) · Human Development · doi:10.1159/000271221 · Cited by 604 · cited 1× · see citing works
“The term “metamemory” was first used by the developmental psychologist John Flavell (1971) to describe knowledge about one’s memory processes and contents [34].”
MethodThe mismeasure of memory: When retrieval fluency is misleading as a metamnemonic index.
Benjamin, A. S., Bjork, R. A., & Schwartz, B. L. (1998) · Journal of Experimental Psychology General · doi:10.1037/0096-3445.127.1.55 · Cited by 529 · cited 1× · see citing works
“Furthermore, overconfidence about preceding memory performance is a common finding [61], which may lead to unrealistic setting or calibration of the monitor or comparator function.”
BackgroundPsychological Mechanisms of Medically Unexplained Symptoms: An Integrative Conceptual Model.
Brown, R. J. (2004) · Psychological Bulletin · doi:10.1037/0033-2909.130.5.793 · Cited by 498 · cited 1× · see citing works
“The integrative cognitive model (ICM) of psychogenic non-epileptic seizures (PNES), another FND, was developed by Brown and Reuber [55], building upon a prior model of medically unexplained symptoms [56].”
MethodThe Memory Functioning Questionnaire for assessment of memory complaints in adulthood and old age.
Gilewski, M. J., Zelinski, E. M., & Schaie, K. W. (1990) · Psychology and Aging · doi:10.1037//0882-7974.5.4.482 · Cited by 464 · see citing works
The Memory Functioning Questionnaire for assessment of memory complaints in adulthood and old age.
Gilewski, M. J., Zelinski, E. M., & Schaie, K. W. (1990) · Psychology and Aging · doi:10.1037/0882-7974.5.4.482 · Cited by 464 · see citing works
Allostatic Self-efficacy: A Metacognitive Theory of Dyshomeostasis-Induced Fatigue and Depression
Stephan, K. E., Manjaly, Z. M., Mathys, C. D., Weber, L. A. E., Paliwal, S., Gard, T., Tittgemeyer, M., Fleming, S. M., Haker, H., Seth, A. K., et al. (2016) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2016.00550 · Cited by 437 · cited 1× · see citing works
“However, metacognitive mechanisms have also been postulated in the occurrence of depression [74].”
BackgroundThe history of the future of the Bayesian brain
Friston, K. J. (2011) · NeuroImage · doi:10.1016/j.neuroimage.2011.10.004 · Cited by 346 · cited 1× · see citing works
“An inferential “Bayes optimal” hierarchical system, as envisaged for perception, decision making, and sensorimotor integration [73], posits a single mechanism [4], the features of which may generalize from one system (sensory, motor) to another (cognitive).”
BackgroundWhat should we say to patients with symptoms unexplained by disease? The “number needed to offend”
Stone, J., Wojcik, W., Durrance, D., Carson, A., Lewis, S. C., MacKenzie, L., Warlow, C. P., & Sharpe, M. (2002) · BMJ · doi:10.1136/bmj.325.7378.1449 · Cited by 336 · cited 1× · see citing works
“The “functional” nomenclature is apparently the least offensive to patients with these conditions [2].”
BackgroundThe Metamemory in Adulthood (MIA) questionnaire.
Dixon, R. A., Hultsch, D. F., & Hertzog, C. K. (1988) · PubMed · Cited by 300 · see citing works
Towards an integrative theory of psychogenic non-epileptic seizures (PNES)
Brown, R. J., & Reuber, M. (2016) · Clinical Psychology Review · doi:10.1016/j.cpr.2016.06.003 · Cited by 279 · cited 3× · see citing works
“Identical to the limitations of the ICM model, as acknowledged by its authors [55], the proposed metamemory model of FCD adapted from Nelson and Narens lacks mechanistic precision and does not map to anatomical structures.”
BackgroundMethodAGNEW, S. K., & Morris, R. G. (1998) · Aging & Mental Health · doi:10.1080/13607869856876 · Cited by 272 · cited 4× · see citing works
“Deficits of awareness may be associated with impairment at various levels of CAM.”
BackgroundInfluentialSchwartz, B. L., Perfect, T. J., Son, L. K., Maki, R. H., McGuire, M. J., Dunlosky, J., Rawson, K. A., McDonald, S. L., Mazzoni, G. A. L., Kirsh, I., et al. (2002) · Cambridge University Press eBooks · doi:10.1017/cbo9780511489976 · Cited by 258 · see citing works
Anosognosia, autobiographical memory and self knowledge in Alzheimer's disease
Morris, R. G., & Mograbi, D. C. (2012) · Cortex · doi:10.1016/j.cortex.2012.09.006 · Cited by 250 · cited 5× · see citing works
“(It should be noted that Morris and Mograbi ([71], p. 1561) use “meta-level” in a different sense to that of Nelson and Narens [58].)”
BackgroundInfluentialTeodoro, T., Edwards, M. J., & Isaacs, J. D. (2018) · Journal of Neurology, Neurosurgery & Psychiatry · doi:10.1136/jnnp-2017-317823 · Cited by 241 · cited 1× · see citing works
“Some preliminary evidence in support of this theory has been presented, finding a shared profile of cognitive deficits in fibromyalgia and FCD [29].”
ResultMetamemory Experiments in Neurological Populations: A Review
Pannu, J. K., & Kaszniak, A. W. (2005) · Neuropsychology Review · doi:10.1007/s11065-005-7091-6 · Cited by 240 · cited 1× · see citing works
“Metacognition, particularly metamemory, has been examined in the context of a number of neurological disorders [43], including Alzheimer’s disease (AD) [44–46], frontotemporal dementia [47], and multiple sclerosis [48].”
BackgroundFunctional 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 · see citing works
Functional 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 · cited 3× · see citing works
“Proposed operational definition of FCD (based on [27]).”
BackgroundMethodSelf-citationEvidence for the convergent validity of two self-report metamemory questionnaires.
Hertzog, C. K., Hultsch, D. F., & Dixon, R. A. (1989) · Developmental Psychology · doi:10.1037/0012-1649.25.5.687 · Cited by 148 · cited 1× · see citing works
“MIA and MFQ show convergent validity around a factor labelled memory self-efficacy (MSE) [42], defined as beliefs about capability to use memory effectively.”
BackgroundJones, 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 · see citing works
The 8 Pillars of Metacognition
Drigas, A. S., & Mitsea, E. (2020) · International Journal of Emerging Technologies in Learning (iJET) · doi:10.3991/ijet.v15i21.14907 · Cited by 144 · cited 1× · see citing works
“The previous considerations regarding the proposed adaptation of Nelson and Narens’ metamemory model to FCD are compatible with other suggested formulations of metacognition, for example, the “8 pillars of metacognition” model in which the capacities of monitoring, regulation, and adaptation of cognitive mechanisms ar…”
MethodAnosognosia: Possible neuropsychological mechanisms.
Heilman, K. M. (1991) · Cited by 135 · see citing works
Mazancieux, A., Fleming, S. M., Souchay, C., & Moulin, C. J. A. (2020) · Journal of Experimental Psychology: General · doi:10.1037/xge0000746 · Cited by 131 · cited 2× · see citing works
“, whether there is a g factor for metacognition) continues to be a subject of investigation [38].”
BackgroundMetamemory in Alzheimer's Disease
Souchay, C. (2007) · Cortex · doi:10.1016/s0010-9452(08)70696-8 · Cited by 128 · see citing works
Paradise, M., Glozier, N., Naismith, S. L., Davenport, T. A., & Hickie, I. B. (2011) · BMC Psychiatry · doi:10.1186/1471-244x-11-108 · Cited by 128 · cited 6× · see citing works
“The Subj ctive Memory Complai t (SMC) Likert Scale [52], in which patients self-rate their memory on a fiv -p int Likert scale ranging from poor to excellent, has also been used as a global easure of metac gnitive performance.”
BackgroundMethodInfluentialThe Cognitive Neuroscience of Metacognition
Fleming, S., & Frith, C. (2014) · Springer Berlin Heidelberg · doi:10.1007/978-3-642-45190-4 · Cited by 120 · see citing works
Elsey, C., Drew, P., Jones, D., Blackburn, D. J., Wakefield, S., Harkness, K., Venneri, A., & Reuber, M. (2015) · Patient Education and Counseling · doi:10.1016/j.pec.2015.05.021 · Cited by 114 · see citing works
Functional (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 5× · see citing works
“Various FCD typologies have been suggested, including mood disorder, other functional disorders, medication effects, dementia health anxiety, normal cognitive experience, dissociative amnesia, and malingering [6].”
BackgroundMethodInfluentialThe relation between metacognitive monitoring and control
Son, L. K., & Schwartz, B. L. (2002) · Cambridge University Press eBooks · doi:10.1017/cbo9780511489976.003 · Cited by 105 · cited 1× · see citing works
“important process theory of Nelson and Narens” ([72], p.”
BackgroundMemory Complaints Are Frequent but Qualitatively Different in Young and Elderly Healthy People
Ginó, S., Mendes, T., Marôco, J. P., Ribeiro, F., Schmand, B. A., de Mendonça, A., & Guerreiro, M. (2009) · Gerontology · doi:10.1159/000240048 · Cited by 94 · cited 1× · see citing works
“Likert Scale [52]) found that items addressing these symptoms (“Do you ever forget names of family members or friends?” and “Do you ever have difficulties in finding particular words?”) were endorsed no differently in young and old healthy participants [65].”
BackgroundPerformance validity test failure in clinical populations—a systematic review
McWhirter, L., Ritchie, C. W., Stone, J., & Carson, A. J. (2020) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp-2020-323776 · Cited by 94 · cited 1× · see citing works
“Change in focus of attention may also underpin impaired performance in so-called “performance validity” tests [67].”
BackgroundMetternich, B., Schmidtke, K., & Hüll, M. (2009) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2008.07.005 · Cited by 87 · cited 2× · see citing works
“found lower memory self-efficacy in patients diagnosed with functional m mory disorder than in healthy controls despite o significant differences in objective cognitive performance [51].”
BackgroundMemory Disorders in Psychiatric Practice
Berríos, G. E. (2000) · Cambridge University Press eBooks · doi:10.1017/cbo9780511530197 · Cited by 65 · see citing works
Hallam, B., Chan, J., Costafreda, S. G., Bhome, R., & Huntley, J. D. (2020) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2020.06.011 · Cited by 65 · cited 1× · see citing works
“It would be interesting to know if these neural substrates overlapped in any way with those previously defined in the anosognosia of Alzheimer’s disease [75].”
ResultMetacognition in the behavioral variant of frontotemporal dementia and Alzheimer’s disease.
Rosen, H. J., Alcantar, O., Zakrzewski, J. J., Shimamura, A. P., Neuhaus, J. M., & Miller, B. L. (2014) · Neuropsychology · doi:10.1037/neu0000012 · Cited by 62 · see citing works
Loss of ‘Awareness’ in Alzheimer’s Disease
Morris, R. G., & Hannesdóttir, K. (2004) · doi:10.1093/oso/9780198508304.003.0017 · Cited by 62 · see citing works
Structure and pragmatics of a self-theory of memory
Sehulster, J. R. (1981) · Memory & Cognition · doi:10.3758/bf03196960 · Cited by 51 · cited 1× · see citing works
“From a clinical standpoint, a number of clinician-administered performance scales have been developed and used on occasion to assess metamemory, including but not limited to the Metamemory in Adulthood (MIA) Questionnaire [39], the Memory Functioning Questionnaire (MFQ) [40], and the Sehulster Memory Scale [41].”
MethodFunctional Cognitive Disorder: A Common Cause of Subjective Cognitive Symptoms
Pennington, C. M., Hayre, A., Newson, M., & Coulthard, E. J. (2015) · Journal of Alzheimer s Disease · doi:10.3233/jad-150182 · Cited by 50 · 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 1× · see citing works
“The development of a consensus definition of FCD [27], superseding listings of core clinical features used to guide diagnosis hitherto [18], may facilitate further understanding of FCD if widely accepted and adopted (Box 1).”
Memory symptoms and memory performance of neurological patients
Kapur, N., & Pearson, D. (1983) · British Journal of Psychology · doi:10.1111/j.2044-8295.1983.tb01872.x · Cited by 48 · cited 1× · see citing works
“However, lack of meaningful, semantic associations renders the learning of people’s names harder than that of other nouns, which may explain why this symptom is common even in healthy individuals [66].”
BackgroundFunctional Cognitive Disorders: Demographic and Clinical Features Contribute to a Positive Diagnosis
Bharambe, V., & Larner, A. J. (2018) · Neurodegenerative Disease Management · doi:10.2217/nmt-2018-0025 · Cited by 48 · cited 1× · see citing works
“A positive family history of dementia, usually of the late-onset type, may be more common in FCD patients than in non-functional cognitive disorders [14].”
BackgroundSelf-citationMetacognition in functional cognitive disorder- a potential mechanism and treatment target
Bhome, R., McWilliams, A., Huntley, J. D., Fleming, S. M., & Howard, R. J. (2019) · Cognitive Neuropsychiatry · doi:10.1080/13546805.2019.1651708 · Cited by 48 · cited 8× · see citing works
“The possibility that the direction of causality runs from misdirected attention to metacognitive deficits, rather than metacognitive deficits being primary in FCD, has not been entirely discounted by the empirical data [33].”
BackgroundMethodInfluentialFunctional Cognitive Disorder: Diagnostic Challenges and Future Directions
Pennington, C. M., Ball, H. A., & Swirski, M. (2019) · Diagnostics · doi:10.3390/diagnostics9040131 · Cited by 46 · see citing works
Metacognition and self-awareness in Multiple Sclerosis
Mazancieux, A., Souchay, C., Casez, O., & Moulin, C. J. A. (2018) · Cortex · doi:10.1016/j.cortex.2018.11.012 · Cited by 45 · cited 1× · see citing works
“Metacognition, particularly metamemory, has been examined in the context of a number of neurological disorders [43], including Alzheimer’s disease (AD) [44–46], frontotemporal dementia [47], and multiple sclerosis [48].”
BackgroundBhome, R., Huntley, J. D., Price, G., & Howard, R. J. (2019) · Cognitive Neuropsychiatry · doi:10.1080/13546805.2019.1590190 · Cited by 45 · cited 13× · see citing works
“Brain Sci. 2021, 11, 1082. https://doi.org/10.3390/brainsci11081082 https://www.mdpi.com/journal/brainsci Brain Sci. 2021, 11, 1082 2 of 13 Empirically, the key clinical feature of FCD, as in other FND, is a discrepancy or internal inconsistency between subjective reports and objective measures, specifically in this i…”
BackgroundInfluentialMetacognition in older adults: implications for application
Hertzog, C. K. (2002) · Cambridge University Press eBooks · doi:10.1017/cbo9780511489976.009 · Cited by 39 · cited 1× · see citing works
“Moreover, this expectation of impending cognitive decline may be greater in younger than in older adults [60].”
BackgroundPsychologic theories in functional neurologic disorders
Carson, A. J., Ludwig, L., & Welch, K. A. (2016) · Handbook of clinical neurology · doi:10.1016/b978-0-12-801772-2.00010-2 · Cited by 38 · cited 1× · see citing works
“Whilst many psychological theories for FND have been mooted (see [54] for a concise summary), few appear to have been specifically adapted as possible explanations for FCD.”
BackgroundWakefield, S., Blackburn, D. J., Harkness, K., Khan, A., Reuber, M., & Venneri, A. (2017) · Acta Neuropsychiatrica · doi:10.1017/neu.2017.21 · Cited by 37 · see citing works
Sense and sensitivity: metacognition in Alzheimer's disease
Moulin, C. J. A. (2002) · Cambridge University Press eBooks · doi:10.1017/cbo9780511489976.010 · Cited by 33 · see citing works
A Diary Study of Action Slips in Healthy Individuals
Jónsdóttir, M. K., Adólfsdóttir, S., Cortez, R. D., Gunnarsdóttir, M. J., & Gústafsdóttir, Á. H. (2007) · The Clinical Neuropsychologist · doi:10.1080/13854040701220044 · Cited by 33 · cited 1× · see citing works
“Memory lapses and slips are a frequent occurrence in everyday life [62,63].”
BackgroundAnosognosia in patients with Alzheimer's disease: current perspectives
Tagai, K., Nagata, T., Shinagawa, S., & Shigeta, M. (2020) · Psychogeriatrics · doi:10.1111/psyg.12507 · Cited by 33 · cited 2× · see citing works
“Although more complex than Nelson and Narens’ metamemory model [58], as required to explain the heterogeneity of anosognosia [9], the essential feature of CAM is that task performance is monitored by comparator mechanisms.”
BackgroundFunctional cognitive disorders: memory clinic study
Bharambe, V., & Larner, A. J. (2018) · Progress in Neurology and Psychiatry · doi:10.1002/pnp.509 · Cited by 23 · see citing works
Self-citationLarner, A. J. (2020) · Postgraduate Medicine · doi:10.1080/00325481.2020.1739416 · Cited by 21 · cited 1× · see citing works
“Clinical signs suggestive of the diagnosis of FCD include the “attended alone” sign (failure to bring a knowledgeable informant to the clinical consultation to provide collateral history despite the request to do so in the clinic appointment details), which has a high positive predictive value for the absence of any c…”
BackgroundSelf-citationThe frequency and framing of cognitive lapses in healthy adults
McWhirter, L., King, L., McClure, E., Ritchie, C. W., Stone, J., & Carson, A. J. (2021) · CNS Spectrums · doi:10.1017/s1092852920002096 · Cited by 21 · see citing works
How the UK describes functional memory symptoms
Bailey, C., Bell, S. M., & Blackburn, D. M. (2017) · Psychogeriatrics · doi:10.1111/psyg.12232 · Cited by 20 · cited 1× · see citing works
“Previously denoted by a variable and extensive nomenclature [5], the coinage of the term “functional cognitive disorders” (FCD) by Stone et al.”
BackgroundLa maladie du petit papier: A sign of functional cognitive disorder?
Randall, A., & Larner, A. J. (2018) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.4854 · Cited by 20 · cited 1× · see citing works
“Clinical signs suggestive of the diagnosis of FCD include the “attended alone” sign (failure to bring a knowledgeable informant to the clinical consultation to provide collateral history despite the request to do so in the clinic appointment details), which has a high positive predictive value for the absence of any c…”
BackgroundSelf-citationDementia Screening: A Different Proposal
Larner, A. J. (2018) · Future Neurology · doi:10.2217/fnl-2018-0018 · Cited by 19 · cited 2× · see citing works
“One attempt to conceptualize FCD has posited that these may be disorders, indeed primary disorders, of metacognition, in particular of metamemory [32,33].”
BackgroundResultSelf-citationFunctional cognitive disorder in subjective cognitive decline—A 10‐year follow‐up
Schwilk, N., Klöppel, S., Schmidtke, K., & Metternich, B. (2020) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.5466 · Cited by 19 · cited 1× · see citing works
“Prognosis is uncertain, with some evidence that symptoms persist in the short [24] and long [25] term without progression, although possible misdiagnosis of early-stage neurodegeneration as FCD is a recognized pitfall [16,26] (for example, in a patient with an unusually high baseline, or because the objective testing…”
BackgroundMetacognition in Alzheimer’s Disease
Cosentino, S. (2014) · Springer eBooks · doi:10.1007/978-3-642-45190-4_17 · Cited by 17 · see citing works
Metamemory: A construct with diagnostic utility in a cognitive disorders clinic?
Larner, A. J. (2018) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.4766 · Cited by 15 · see citing works
Self-citationAlexander, M., Blackburn, D. J., & Reuber, M. (2018) · Sociology of Health & Illness · doi:10.1111/1467-9566.12819 · Cited by 15 · see citing works
Functional Cognitive Disorders: Can Sleep Disturbance Contribute to a Positive Diagnosis?
Elhadd, K. T., Bharambe, V., & Larner, A. J. (2018) · Journal of Sleep Disorders & Therapy · doi:10.4172/2167-0277.1000291 · Cited by 14 · see citing works
Self-citationAnosognosia and Metacognition in Alzheimer’s Disease
Ernst, A., Moulin, C. J. A., Souchay, C., Mograbi, D. C., & Morris, R. G. (2015) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780199336746.013.12 · Cited by 13 · cited 1× · see citing works
“Metamemory tasks have also been used to explore the anosognosia of AD [49,50].”
MethodSubjective memory complaints: Is family history of dementia a risk factor?
Larner, A. J. (2013) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2013.07.1112 · Cited by 13 · cited 1× · see citing works
“A positive family history of dementia, previously characterized as a factor sensitizing to memory symptoms [64], may be seen as influencing the meta-level monitor, as may memory perfectionism [28].”
BackgroundSelf-citationThe concept of metamemory: cognitive, developmental, and clinical issues
Dixon, R. A. (2000) · Cambridge University Press eBooks · doi:10.1017/cbo9780511530197.004 · Cited by 8 · see citing works
Functional cognitive disorders: update on diagnostic status.
Larner, A. (2020) · Neurodegenerative Disease Management · doi:10.2217/nmt-2019-0038 · Cited by 7 · see citing works
Self-citationThe Selected Writings of Maurice O’Connor Drury
Drury, M. O. (2018) · Bloomsbury Publishing Plc eBooks · doi:10.5040/9781474256391 · Cited by 7 · see citing works
For how long should patients with FCD be followed up?
Hamid, S. H. M., & Larner, A. J. (2019) · Progress in Neurology and Psychiatry · doi:10.1002/pnp.525 · Cited by 5 · cited 1× · see citing works
“Prognosis is uncertain, with some evidence that symptoms persist in the short [24] and long [25] term without progression, although possible misdiagnosis of early-stage neurodegeneration as FCD is a recognized pitfall [16,26] (for example, in a patient with an unusually high baseline, or because the objective testing…”
BackgroundSelf-citationAnosognosia and Metacognition in Alzheimer's disease: Insights from Experimental Psychology
Ernst, A., Moulin, C. J. A., Souchay, C., Mograbi, D. C., & Morris, R. G. (2015) · HAL · Cited by 5 · see citing works
Fleming, S. M. (2021) · The New Scientist · doi:10.1016/s0262-4079(21)00794-6 · Cited by 4 · see citing works
039 Functional cognitive disorders: prognosis
Elhadd, K. T., Bharambe, V., & Larner, A. J. (2019) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp-2019-abn-2.64 · Cited by 3 · see citing works
Self-citationMichael Faraday’s “loss of memory” revisited
Larner, A. J. (2020) · Journal of the History of the Neurosciences · doi:10.1080/0964704x.2020.1814978 · Cited by 3 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 3
- [1]Hallett M. Stone J. Carson A. Functional Neurologic Disorders (Handbook of Clinical Neurology Volume 139, 3rd Series) Elsevier Amsterdam, The Netherlands 2016 10.1016/B978-0-12-801722-2 · DOI
- [29]Bharambe V. Williamson J.C. Larner A.J. Re: A Unifying Theory for Cognitive Abnormalities in Functional Neurological Disorders, Fibromyalgia and Chronic Fatigue Syndrome 2018 Available online: https://jnnp.bmj.com/content/89/12/1308.responses (accessed on 7 May 2021) PMC6288708 29735513
- [49]Kaszniak A.W. Edmonds E.C. Anosognosia and Alzheimer’s disease: Behavioral studies The Study of Anosognosia Prigatano G.P. Oxford University Press Oxford, UK 2010 189 227
Cited by
Sorted by citations
Patten, R. V., Mulhauser, K. R. W., Austin, T. A., Bellone, J. A., Cotton, E., Chan, L. C. N., Twamley, E. W., Sawyer, K., & LaFrance, W. C., Jr. (2025) · Clinical Psychology Review · doi:10.1016/j.cpr.2025.102648 · Cited by 38 · see citing works
Millman, L. S. M., Short, E., Stanton, B. R., Winston, J. S., Nicholson, T. R., Mehta, M. A., Reinders, A. A. T. S., Edwards, M. J., Goldstein, L. H., David, A. S., et al. (2023) · Behaviour Research and Therapy · doi:10.1016/j.brat.2023.104379 · Cited by 35 · see citing works
“…contrary to other studies reporting reduced intero-ceptive accuracy in more specific FND subgroups, including those with FMS (Demartini et al., 2019; Ricciardi et al., 2016, 2021) and FS (Koreki et al., 2020), and does not support the proposal that altered inter-oception is a core feature in FND.”
BackgroundResultNeuropsychological evaluation of functional cognitive disorder: A narrative review
Silverberg, N., & Rush, B. (2023) · Clinical Neuropsychologist · doi:10.1080/13854046.2023.2228527 · Cited by 29 · see citing works
“…tasks differently (e.g. to retrieve a target word while speaking), with increased effortful control that interferes with the automaticity of the task (e.g. word-finding), similar to how professional athletes sometimes “choke” under pressure (Ball et al., 2021; larner, 2021; Potter & Brown, 2012).”
BackgroundResultInfluentialCabreira, V., Alty, J., Antic, S., Araújo, R., Aybek, S., Ball, H. A., Baslet, G., Bhome, R., Coebergh, J., Dubois, B., et al. (2025) · European Journal of Neurology · doi:10.1111/ene.16318 · Cited by 24 · 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-citationMemory 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 · see citing works
Cabreira, V., McWhirter, L., & Carson, A. J. (2023) · Neurologic Clinics · doi:10.1016/j.ncl.2023.02.004 · Cited by 21 · see citing works
Factors perpetuating functional cognitive symptoms after mild traumatic brain injury
Picon, E. L., Wardell, V., Palombo, D., Todd, R., Aziz, B., Bedi, S., & Silverberg, N. (2023) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/13803395.2023.2247601 · Cited by 10 · see citing works
“Metacognitive impairment is thought to be the core underlying feature of FCD (Ball et al., 2020; Bharambe & Larner, 2018; Bhome, Huntley et al., 2019; Bhome, McWilliams et al., 2019; Larner, 2018, 2021; Metternich, Schmidtke et al., 2009; Pennington, Newson et al., 2015).”
BackgroundMemory 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 · see citing works
“People with memory concerns may more readily notice memory lapses (Larner, 2021; Teodoro et al., 2018).”
BackgroundInfluentialThe neuropsychology of functional neurological disorders
Patten, R. V., & Bellone, J. A. (2023) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/13803395.2024.2322798 · Cited by 12 · see citing works
“(2) There is debate and uncertainty about the underlying mechanisms leading to FCD (with global metacognition as a notable contender; Bhome et al., 2019, 2022; Larner, 2021).”
BackgroundPatten, R. V., Lü, M., Austin, T. A., Cotton, E., Chan, L., Bellone, J. A., Mordecai, K. L., Twamley, E. W., Sawyer, K., & LaFrance, W. C., Jr. (2024) · The Clinical Neuropsychologist · doi:10.1080/13854046.2024.2440949 · Cited by 11 · see citing works
“However, in spite of conjecture that FND is characterized by a subjective/objective discrepancy in cognition (Larner, 2021), no study to our knowledge has specifically examined this question in FS, reflecting a gap in the literature.”
Mavroudis, 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
“…distinguish metacognitive deficits from insight: while patients with FCD may exhibit metacognitive interference affecting their task performance, they can still retain good insight, often providing detailed, coherent accounts of their perceived cognitive difficulties (Wolstencroft, 2024; Larner, 2021).”
InfluentialFunctional 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
Metacognition in functional cognitive disorder: contradictory or convergent experimental results?
Larner, A. (2022) · Brain Communications · doi:10.1093/braincomms/fcac138 · Cited by 5 · see citing works
Self-citationWittgenstein, neurology, and neuroscience
Larner, A. J. (2021) · Brain · doi:10.1093/brain/awab418 · Cited by 3 · see citing works
Self-citationCognitive profile in functional disorders
Roivainen, E., Peura, M., & Pätsi, J. (2023) · Cognitive Neuropsychiatry · doi:10.1080/13546805.2023.2275336 · Cited by 3 · see citing works
“However, when cognitive symptoms are severe enough to require diagnosis, patients with FCD often show a discrepancy between their subjective experience and objective de fi cits on neuropsychological assessment (Larner, 2021).”
BackgroundLarner, A. (2022) · Cognitive Neuropsychiatry · doi:10.1080/13546805.2022.2054694 · Cited by 2 · see citing works
“FCD patients could accordingly be viewed as Bayes “non-optimal”, with failure to update priors adequately on the basis of sensory feedback (Larner, 2021).”
BackgroundMethodResultInfluentialSelf-citationTowards a Neural Network Hypothesis for Functional (Dissociative) Amnesia: Catastrophic Forgetting
Larner, A. J., & Larner, A. J. (2022) · Neurology and Neurobiology · doi:10.31487/j.nnb.2022.03.02 · Cited by 3 · see citing works
Self-citationA 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
[Functional cognitive disorders].
Chutko, L., & Surushkina, S. (2022) · Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova · doi:10.17116/jnevro202212202143 · Cited by 4 · see citing works
Recommendations 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
Ageing 2023: Proceedings of 6th Gerontological Interdisciplinary Conference
(2023) · Univerzita Karlova eBooks · doi:10.14712/9788090734746 · Cited by 1 · see citing works
Akbarifeizabadi, F., Nouri, R., & Mosmer, R. (2022) · International Journal of Health Sciences · doi:10.53730/ijhs.v6ns7.13460
“Additionally, by designing this software, we wanted to lay a foundation for future research on one of the hottest areas in cognitive neuroscience: the relationship between metacognition and functional cognitive impairments (Larner, 2021).”
MethodClassification of Metrics of Binary Classification
Larner, A. J. (2024) · Springer eBooks · doi:10.1007/978-3-031-47194-0_9
Self-citationFunctional Neurological Disorder: A Primer for Neuropsychologists
Kavish, N., & Maietta, J. E. (2026) · Springer eBooks · doi:10.1007/978-3-032-07777-6_20
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
“Internal inconsistency in the FCD often manifests as moderate to severe cognitive disorders in the patient, but with milder deficits in cognitive tests (24).”
Landínez-Martínez, D., Londoño, D. M. M., & Gutierrez, A. P. (2026) · Aging Neuropsychology and Cognition · doi:10.1080/13825585.2026.2727870
- Authors
- Larner, A. J.
- Affiliations
- Walton Centre (GB)
- Corresponding author
- Larner, Andrew J.
- ORCID
- Larner, Andrew J.
- Venue
- Brain Sciences
- Publisher
- MDPI AG
- Published
- 2021-08-18
- Volume
- 11
- Issue
- 8
- Pages
- 1082
- ISSN
- 2076-3425 (ISSN-L)
- PMC
- PMC8393342
- OpenAlex
- W3195177301
- Cited by
- 27
- References
- 77
- Citations by year
- 2026: 5 · 2025: 3 · 2024: 4 · 2023: 7 · 2022: 7 · 2021: 1
- FWCI
- 3.41
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Brain Sciences (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Cognitive Functions and Memory
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Keywords
- functional cognitive disorder, metacognition, metamemory, conversion disorder, anosognosia, memory clinics, phenomenology, metacognitive model
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