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.

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.

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%.

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.

功能性认知障碍 (FCD) 是神经退行性疾病的重要鉴别诊断。建议的诊断特征的效用尚未在“真实世界”临床人群中进行前瞻性探索。本研究旨在确定 FCD 的阳性临床标志物。

从记忆、神经病学和神经精神病学诊所招募有认知问题但没有痴呆症的成年人。参与者接受了结构化访谈、迷你国际神经精神病学访谈、蒙特利尔认知评估、Luria 3 步、互锁手指、手指跨度和医学症状有效性测试、患者健康问卷 15、医院焦虑和抑郁量表、多因素记忆问卷和匹兹堡睡眠质量量表. 使用逻辑回归对潜在的诊断变量进行了专家共识诊断的测试。

FCD 在 31/49 参与者中被识别出来。与没有 FCD 的参与者相比，患有 FCD 的参与者更年轻，在提示“告诉我您一直遇到的问题”时说话时间更长，并且有更多的焦虑和抑郁症状以及精神病学诊断。在性别、教育或认知得分方面没有显着差异。更年轻的年龄和更长的言语反应预测模型中的 FCD 诊断，该模型解释了 74% 的诊断变异性并且曲线下面积 (AUC) 为 94%。

对认知失败的详细描述是 FCD 的一个敏感而具体的积极特征，证明了经验和观察到的功能之间的内部不一致。认知和行为有效性测试似乎对 FCD 诊断帮助不大。与其他认知障碍患者相比，患有 FCD 的人并不“担心”，但往往在考试中表现不佳，并且有更多的焦虑、抑郁和身体症状。作为神经退行性疾病的鉴别诊断和临床试验的独立目标，识别诊断特征是 FCD 获得同等重视的重要一步。