TY - JOUR

T1 - Perspectives on the diagnosis and management of functional cognitive disorder

T2 - An international Delphi study

AU - Cabreira, Verónica

AU - Alty, Jane

AU - Antic, Sonja

AU - Araújo, Rui

AU - Aybek, Selma

AU - Ball, Harriet A.

AU - Baslet, Gaston

AU - Bhome, Rohan

AU - Coebergh, Jan

AU - Dubois, Bruno

AU - Edwards, Mark

AU - Filipović, Saša R.

AU - Frederiksen, Kristian Steen

AU - Harbo, Thomas

AU - Hayhow, Bradleigh

AU - Howard, Robert

AU - Huntley, Jonathan

AU - Isaacs, Jeremy

AU - LaFrance, William Curt

AU - Larner, Andrew J.

AU - Di Lorenzo, Francesco

AU - Main, James

AU - Mallam, Elizabeth

AU - Marra, Camillo

AU - Massano, João

AU - McGrath, Emer R.

AU - McWhirter, Laura

AU - Moreira, Isabel Portela

AU - Nobili, Flavio

AU - Pennington, Catherine

AU - Tábuas-Pereira, Miguel

AU - Perez, David L.

AU - Popkirov, Stoyan

AU - Rayment, Dane

AU - Rossor, Martin

AU - Russo, Mirella

AU - Santana, Isabel

AU - Schott, Jonathan

AU - Scott, Emmi P.

AU - Taipa, Ricardo

AU - Tinazzi, Michele

AU - Tomic, Svetlana

AU - Toniolo, Sofia

AU - Tørring, Caroline Winther

AU - Wilkinson, Tim

AU - Frostholm, Lisbeth

AU - Stone, Jon

AU - Carson, Alan

N1 - Publisher Copyright: © 2024 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.

PY - 2024

Y1 - 2024

N2 - 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.

AB - 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.

KW - Alzheimer's disease

KW - cognitive disorders

KW - consensus

KW - Delphi

KW - functional cognitive disorder

U2 - 10.1111/ene.16318

DO - 10.1111/ene.16318

M3 - Journal article

C2 - 38700361

AN - SCOPUS:85192207508

JO - European Journal of Neurology

JF - European Journal of Neurology

SN - 1351-5101

ER -