Perspectives on the diagnosis and management of functional cognitive disorder: An international Delphi study
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Perspectives on the diagnosis and management of functional cognitive disorder : An international Delphi study. / Cabreira, Verónica; Alty, Jane; Antic, Sonja; Araújo, Rui; Aybek, Selma; Ball, Harriet A.; Baslet, Gaston; Bhome, Rohan; Coebergh, Jan; Dubois, Bruno; Edwards, Mark; Filipović, Saša R.; Frederiksen, Kristian Steen; Harbo, Thomas; Hayhow, Bradleigh; Howard, Robert; Huntley, Jonathan; Isaacs, Jeremy; LaFrance, William Curt; Larner, Andrew J.; Di Lorenzo, Francesco; Main, James; Mallam, Elizabeth; Marra, Camillo; Massano, João; McGrath, Emer R.; McWhirter, Laura; Moreira, Isabel Portela; Nobili, Flavio; Pennington, Catherine; Tábuas-Pereira, Miguel; Perez, David L.; Popkirov, Stoyan; Rayment, Dane; Rossor, Martin; Russo, Mirella; Santana, Isabel; Schott, Jonathan; Scott, Emmi P.; Taipa, Ricardo; Tinazzi, Michele; Tomic, Svetlana; Toniolo, Sofia; Tørring, Caroline Winther; Wilkinson, Tim; Frostholm, Lisbeth; Stone, Jon; Carson, Alan.
In: European Journal of Neurology, 2024.Research output: Contribution to journal › Journal article › Research › peer-review
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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 -
ID: 392446169