This episode is a conversation about functional cognitive disorder (FCD) with Dr. Laura McWhirter. The discussion covers preliminary diagnostic criteria, internal inconsistency, epidemiology, clinical features, differential diagnosis with neurodegenerative diseases, common diagnostic pitfalls, etiology/mechanism, metacognition, subjective cognitive concerns, objective cognitive testing, performance validity, genetics and neurobiology, and pushback against FCD as a diagnosis.
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About Laura
Dr. Laura McWhirter graduated MBChB from the University of Edinburgh in 2008, having taken an unusual route to medicine after a degree in music from the University of York in 2001. Dr McWhirter completed specialist training in General Adult and Liaison Psychiatry in South East Scotland in June 2018. She has been active in neuropsychiatry research since 2013 as part of the Edinburgh Functional Disorders Research Group. Her research program is in cognition and functional neurological disorders.
References
Ball, H. A., McWhirter, L., Ballard, C., Bhome, R., Blackburn, D. J., Edwards, M. J., Fleming, S. M., Fox, N. C., Howard, R., Huntley, J., Isaacs, J. D., Larner, A. J., Nicholson, T. R., Pennington, C. M., Poole, N., Price, G., Price, J. P., Reuber, M., Ritchie, C., … Carson, A. J. (2020). Functional cognitive disorder: Dementia’s blind spot. Brain, 143(10), 2895–2903. https://doi.org/10.1093/brain/awaa224
Ball, H. A., McWhirter, L., Ballard, C., Bhome, R., Blackburn, D. J., Edwards, M. J., Fox, N. C., Howard, R., Huntley, J., Isaacs, J. D., Larner, A. J., Nicholson, T. R., Pennington, C. M., Poole, N., Price, G., Price, J. P., Reuber, M., Ritchie, C., Rossor, M. N., … Carson, A. J. (2021). Reply: Functional cognitive disorder: Dementia’s blind spot. Brain, 144(9). https://doi.org/10.1093/brain/awab305
Beck, K., Arumuham, A., Santangelo, B., Veronese, M., McCutcheon, R., Kaar, S., McGinnity, C., Pillinger, T., Borgan, F., Hammers, A., & Howes, O. (2021). N-methyl-D-aspartate receptor binding in first-episode psychosis: A pet brain imaging study. BJPsych Open, 7(S1). https://doi.org/10.1192/bjo.2021.79
Bennett, K., Diamond, C., Hoeritzauer, I., Gardiner, P., McWhirter, L., Carson, A., & Stone, J. (2021). A practical review of functional neurological disorder (FND) for the general physician. Clinical Medicine, 21(1), 28–36. https://doi.org/10.7861/clinmed.2020-0987
Bhome, R., McWilliams, A., Huntley, J. D., Fleming, S. M., & Howard, R. J. (2019). Metacognition in functional cognitive disorder- a potential mechanism and treatment target. Cognitive Neuropsychiatry, 24(5), 311–321. https://doi.org/10.1080/13546805.2019.1651708
Bhome, R., Huntley, J. D., Price, G., & Howard, R. J. (2019). Clinical presentation and neuropsychological profiles of functional cognitive disorder patients with and without co-morbid depression. Cognitive Neuropsychiatry, 24(2), 152–164. https://doi.org/10.1080/13546805.2019.1590190
Bhome, R., McWilliams, A., Price, G., Poole, N. A., Howard, R. J., Fleming, S. M., & Huntley, J. D. (2022). Metacognition in functional cognitive disorder. Brain Communications, 4(2). https://doi.org/10.1093/braincomms/fcac041
Bhome, R., McWilliams, A., Price, G., Poole, N. A., Howard, R. J., Fleming, S. M., & Huntley, J. D. (2022b). Response to: Metacognition in functional cognitive disorder: Contradictory or convergent experimental results? Brain Communications, 4(3). https://doi.org/10.1093/braincomms/fcac139
Borelli, W. V., de Senna, P. N., Brum, W. S., Schumacher-Schuh, A. F., Zimmer, E. R., Fagundes Chaves, M. L., & Castilhos, R. M. (2022). Functional cognitive disorder presents high frequency and distinct clinical profile in patients with low education. Frontiers in Aging Neuroscience, 14. https://doi.org/10.3389/fnagi.2022.789190
Cabreira, V., McWhirter, L., & Carson, A. (2023). Functional cognitive disorder. Neurologic Clinics. https://doi.org/10.1016/j.ncl.2023.02.004
Jessen, F., Amariglio, R. E., Boxtel, M., Breteler, M., Ceccaldi, M., Chételat, G., Dubois, B., Dufouil, C., Ellis, K. A., Flier, W. M., Glodzik, L., Harten, A. C., Leon, M. J., McHugh, P., Mielke, M. M., Molinuevo, J. L., Mosconi, L., Osorio, R. S., Perrotin, A., … Wagner, M. (2014). A conceptual framework for research on subjective cognitive decline in preclinical alzheimer’s disease. Alzheimer’s & Dementia, 10(6), 844–852. https://doi.org/10.1016/j.jalz.2014.01.001
Jessen, F., Amariglio, R. E., Buckley, R. F., van der Flier, W. M., Han, Y., Molinuevo, J. L., Rabin, L., Rentz, D. M., Rodriguez-Gomez, O., Saykin, A. J., Sikkes, S. A., Smart, C. M., Wolfsgruber, S., & Wagner, M. (2020). The characterisation of subjective cognitive decline. The Lancet Neurology, 19(3), 271–278. https://doi.org/10.1016/s1474-4422(19)30368-0
Johnson, J. C., McWhirter, L., Hardy, C. J., Crutch, S. J., Marshall, C. R., Mummery, C. J., Rohrer, J. D., Rossor, M. N., Schott, J. M., Weil, R. S., Fox, N. C., & Warren, J. D. (2021). Suspecting dementia: Canaries, chameleons and Zebras. Practical Neurology, 21(4), 300–312. https://doi.org/10.1136/practneurol-2021-003019
Kemp, S., Kapur, N., Graham, C. D., & Reuber, M. (2022). Functional cognitive disorder: Differential diagnosis of common clinical presentations. Archives of Clinical Neuropsychology, 37(6), 1158–1176. https://doi.org/10.1093/arclin/acac020
Larner, A. (2022). Metacognition in functional cognitive disorder: Contradictory or convergent experimental results? Brain Communications, 4(3). https://doi.org/10.1093/braincomms/fcac138
McWhirter, L., King, L., McClure, E., Ritchie, C., Stone, J., & Carson, A. (2021). The frequency and framing of cognitive lapses in healthy adults. CNS Spectrums, 27(3), 331–338. https://doi.org/10.1017/s1092852920002096
McWhirter, L., Ritchie, C. W., Stone, J., & Carson, A. (2020b). Performance validity test failure in clinical populations—a systematic review. Journal of Neurology, Neurosurgery & Psychiatry, 91(9), 945–952. https://doi.org/10.1136/jnnp-2020-323776
McWhirter, L., Ritchie, C., Stone, J., & Carson, A. (2020). Functional cognitive disorders: A systematic review. The Lancet Psychiatry, 7(2), 191–207. https://doi.org/10.1016/s2215-0366(19)30405-5
McWhirter, L., Ritchie, C., Stone, J., & Carson, A. (2021). Identifying functional cognitive disorder: A proposed diagnostic risk model. CNS Spectrums, 27(6), 754–763. https://doi.org/10.1017/s1092852921000845
McWhirter, L., Sargent, B., Ritchie, C., Stone, J., & Carson, A. (2019). I think, therefore I forget – using experimental simulation of dementia to understand functional cognitive disorders. CNS Spectrums, 25(4), 511–518. https://doi.org/10.1017/s1092852919001329
McWhirter, L., Smyth, H., Hoeritzauer, I., Couturier, A., Stone, J., & Carson, A. J. (2022). What is brain fog? Journal of Neurology, Neurosurgery & Psychiatry, 94(4), 321–325. https://doi.org/10.1136/jnnp-2022-329683
Pennington, C., Ball, H., & Swirski, M. (2019). Functional cognitive disorder: Diagnostic challenges and Future Directions. Diagnostics, 9(4), 131. https://doi.org/10.3390/diagnostics9040131
Pennington, C., Hayre, A., Newson, M., & Coulthard, E. (2015). Functional cognitive disorder: A common cause of subjective cognitive symptoms. Journal of Alzheimer’s Disease, 48(s1). https://doi.org/10.3233/jad-150182
Picon, E. L., Todorova, E., Palombo, D. J., Perez, D. L., Howard, A., & Silverberg, N. D. (2021). Memory Perfectionism Is Associated with Persistent Memory Complaints after Concussion. https://doi.org/10.1101/2021.11.15.21266362
Poole, N., Cope, S., Vanzan, S., Duffus, A., Mantovani, N., Smith, J., Barrett, B. M., Tokley, M., Scicluna, M., Beardmore, S., Turner, K., Edwards, M., & Howard, R. (2023). Feasibility randomised controlled trial of online group acceptance and commitment therapy for functional cognitive disorder (ACT4FCD). BMJ Open, 13(5). https://doi.org/10.1136/bmjopen-2023-072366
Schwilk, N., Klöppel, S., Schmidtke, K., & Metternich, B. (2020). Functional cognitive disorder in subjective cognitive decline—a 10‐year follow‐up. International Journal of Geriatric Psychiatry, 36(5), 677–683. https://doi.org/10.1002/gps.5466
Teodoro, T., Koreki, A., Chen, J., Coebergh, J., Poole, N., Ferreira, J. J., Edwards, M. J., & Isaacs, J. D. (2022). Functional cognitive disorder affects reaction time, subjective mental effort and global metacognition. Brain, 146(4), 1615–1623. https://doi.org/10.1093/brain/awac363
