Perspectives on the diagnosis and management of functional cognitive disorder: An international Delphi study.

Autor: Cabreira V; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK., Alty J; Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia., Antic S; Department of Neurology, Aarhus University Hospital, Aarhus, Denmark., Araújo R; Department of Neurology, Centro Hospitalar Universitário São João, Porto, Portugal.; Department of Clinical Neurosciences and Mental Health, Faculty of Medicine University of Porto, Porto, Portugal., Aybek S; Neurology, Faculty of Sciences and Medicine, Fribourg University, Fribourg, Switzerland., Ball HA; Population Health Sciences, Bristol Medical School, Bristol, UK., Baslet G; Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Bhome R; Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK.; Centre for Medical Image Computing, University College London, London, UK., Coebergh J; Department of Neurology, St George's University of London, London, UK., Dubois B; Department of Neurology, Institut de la mémoire et de la maladie d'Alzheimer (IM2A), AP-HP, Brain Institute, Sorbonne University, Paris, France., Edwards M; Department of Basic and Clinical Neurosciences, Institute of Psychiatry Psychology and Neurosciences, Kings College London, London, UK., Filipović SR; University of Belgrade Institute for Medical Research, Belgrade, Serbia., Frederiksen KS; Clinical Trial Unit, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark., Harbo T; Department of Neurology, Aarhus University Hospital, Aarhus, Denmark., Hayhow B; Department of Neurology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.; School of Medicine, University of Notre Dame Australia, Fremantle, Western Australia, Australia., Howard R; Division of Psychiatry, University College London, London, UK., Huntley J; Division of Psychiatry, University College London, London, UK.; Camden and Islington NHS Foundation Trust, London, UK., Isaacs J; Department of Neurology, St George's University of London, London, UK., LaFrance WC Jr; Alpert Medical School, Brown University, Providence, Rhode Island, USA.; Neuropsychiatry and Behavioral Neurology, Rhode Island Hospital, Providence, Rhode Island, USA., Larner AJ; Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Liverpool, UK., Di Lorenzo F; Department of Clinical and Behavioural Neurology, Santa Lucia Foundation IRCCS, Rome, Italy., Main J; Bristol Dementia Wellbeing Service, Devon Partnership NHS Trust, Bristol, UK., Mallam E; Neurology Department, North Bristol NHS Trust, Bristol, UK., Marra C; Department of Neuroscience, Catholic University of the Sacred Heart, Memory Clinic - Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy., Massano J; Department of Neurology, Centro Hospitalar Universitário São João, Porto, Portugal.; Department of Clinical Neurosciences and Mental Health, Faculty of Medicine University of Porto, Porto, Portugal., McGrath ER; School of Medicine, University of Galway, Galway, Ireland., McWhirter L; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK., Moreira IP; Neurology Department, Private Hospital of Gaia of the Trofa Saúde Group, Vila Nova de Gaia, Portugal., Nobili F; IRCCS Ospedale Policlinico San Martino, Genoa, Italy., Pennington C; Clinical Lecturer, University of Edinburgh, Edinburgh, UK.; Neurology Department, NHS Forth Valley, Larbert, UK.; Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK., Tábuas-Pereira M; Neurology Department, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, Coimbra, Portugal.; Faculty of Medicine, University of Coimbra, Coimbra, Portugal.; Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal., Perez DL; Department of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA., Popkirov S; Department of Neurology, University Hospital Essen, Essen, Germany., Rayment D; Rosa Burden Centre for Neuropsychiatry, Southmead Hospital, Bristol, UK., Rossor M; Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK., Russo M; Department of Neuroscience, Imaging and Clinical Sciences G. d'Annunzio University of Chieti-Pescara, Chieti, Italy., Santana I; Faculty of Medicine, University of Coimbra, Coimbra, Portugal.; Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal., Schott J; Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK., Scott EP; Medical University of South Carolina, Charleston, South Carolina, USA., Taipa R; Neuropathology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal., Tinazzi M; Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy., Tomic S; Department of Neurology, University Hospital Center Osijek, Medical School on University of Osijek, Osijek, Croatia., Toniolo S; Cognitive Disorder Clinic, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK., Tørring CW; Department of Neurology, Aarhus University Hospital, Aarhus, Denmark., Wilkinson T; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK., Frostholm L; Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.; Department of Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark., Stone J; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK., Carson A; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
Jazyk: angličtina
Zdroj: European journal of neurology [Eur J Neurol] 2024 May 03, pp. e16318. Date of Electronic Publication: 2024 May 03.
DOI: 10.1111/ene.16318
Abstrakt: 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.
(© 2024 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.)
Databáze: MEDLINE
Externí odkaz: