Perspectives on the diagnosis and management of functional cognitive disorder: An international Delphi study
Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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.
| Originalsprog | Engelsk |
|---|---|
| Tidsskrift | European Journal of Neurology |
| ISSN | 1351-5101 |
| DOI | |
| Status | Accepteret/In press - 2024 |
Bibliografisk note
Funding Information:
The authors have stated explicitly that there are no conflicts of interest in connection with this article. J.S. reports personal fees from UptoDate, outside the submitted work, runs a self\u2010help website for patients with functional neurological symptoms (www. neurosymptoms.org ) which is free and has no advertising, provides independent medical testimony in personal injury and negligence cases regarding patients with functional disorders, and is secretary of the International Functional Neurological Disorder Society. He is a Chief Scientists Office NHS Research Scotland Career Researcher. A.J.C. is a director of a limited personal services company that provides independent medical testimony in court cases on a range of neuropsychiatric topics on a 50% pursuer 50% defender basis, a paid associate editor of the , and unpaid president elect of the International Functional Neurological Disorder Society. D.L.P. has received honoraria for continuing medical education lectures in functional neurological disorder, royalties from Springer Nature for a functional movement disorder textbook, is on the editorial boards of (paid), , and , and has received funding from the National Institutes for Health (NIH) and the Sidney R. Baer, Jr. Foundation unrelated to this work. M.J.E. does medical expert reporting in personal injury and clinical negligence cases, including in cases of functional neurological disorder (FND). M.J.E. has shares in Brain & Mind, which provides neuropsychiatric and neurological rehabilitation in the independent medical sector, including in people with FND. M.J.E. has received financial support for lectures from the International Parkinson and Movement Disorder Society and the FND Society (FNDS). M.J.E. receives royalties from Oxford University Press for his book . M.J.E has received honoraria for medical advice to Teva Pharmaceuticals. M.J.E. receives grant funding, including for studies related to FND, from the National Institute for Health and Care Research (NIHR) and the Medical Research Council (MRC). M.J.E. is an associate editor of the . M.J.E. is a member of the international executive committee of the International Parkinson and Movement Disorder Society and a board member of the FNDS. M.J.E. is on the medical advisory boards of the charities FND Hope UK and Dystonia UK. Journal of Neurology Neurosurgery and Psychiatry Brain and Behavior Epilepsy & Behavior Journal of Neuropsychiatry and Clinical Neurosciences The Oxford Specialist Handbook of Parkinson's Disease and Other Movement Disorders European Journal of Neurology
Funding Information:
V.C. has received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Sk\u0142odowska\u2010Curie Grant Agreement No. 956673. This article reflects only the author's view, the agency is not responsible for any use that may be made of the information it contains.
Publisher Copyright:
© 2024 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.
ID: 392446169