Differentiating Functional Cognitive Disorder from early neurodegeneration: A clinic based study

Harriet A Ball*, Marta Swirski, Margaret A Newson, E J Coulthard, Catherine M Pennington

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

11 Citations (Scopus)
180 Downloads (Pure)


Functional cognitive disorder (FCD) is a relatively common cause of cognitive symptoms, characterised by inconsistency between symptoms and observed or self-reported cognitive functioning. We aimed to improve the clinical characterisation of FCD, in particular its differentiation from early neurodegeneration. Two patient cohorts were recruited from a UK-based tertiary cognitive clinic, diagnosed following clinical assessment, investigation and expert multidisciplinary team review: FCD, (n = 21), and neurodegenerative Mild Cognitive Impairment (nMCI, n = 17). We separately recruited a healthy control group (n = 25). All participants completed an assessment battery including: Hopkins Verbal Learning Test-Revised (HVLT-R), Trail Making Test Part B (TMT-B); Depression Anxiety and Stress Scale (DASS) and Minnesota Multiphasic Personality Inventory (MMPI-2RF). In comparison to healthy controls, the FCD and nMCI groups were equally impaired on trail making, immediate recall, and recognition tasks; had equally elevated mood symptoms; showed similar aberration on a range of personality measures; and had similar difficulties on inbuilt performance validity tests. However, participants with FCD performed significantly better than nMCI on HVLT-R delayed free recall and retention (regression coefficient −10.34, p = 0.01). Mood, personality and certain cognitive abilities were similarly altered across nMCI and FCD groups. However, those with FCD displayed spared delayed recall and retention, in comparison to impaired immediate recall and recognition. This pattern, which is distinct from that seen in prodromal neurodegeneration, is a marker of internal inconsistency. Differentiating FCD from nMCI is challenging, and the identification of positive neuropsychometric features of FCD is an important contribution to this emerging area of cognitive neurology.
Original languageEnglish
Article number800
Number of pages12
JournalBrain Sciences
Issue number6
Publication statusPublished - 17 Jun 2021

Bibliographical note

Funding Information:
The project was given Research Ethics Committee approval by the South West— Cornwall and Plymouth Research Ethics Committee, REC reference 15/SW/0298 and IRAS project ID:188539. All participants provided informed consent. The study was funded by the BRACE charity.

Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.


  • functional cognitive disorder
  • functional neurological disorder
  • dementia
  • neurodegeneration
  • neuropsychometry


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