title: Functional (Psychogenic) Cognitive Disorders: A Perspective from the Neurology Clinic.
abstract: Cognitive symptoms such as poor memory and concentration represent a common cause of morbidity among patients presenting to general practitioners and may result in referral for a neurological opinion. In many cases, these symptoms do not relate to an underlying neurological disease or dementia. In this article we present a personal perspective on the differential diagnosis of cognitive symptoms in the neurology clinic, especially as this applies to patients who seek advice about memory problems but have no neurological disease process. These overlapping categories include the following 'functional' categories: 1) cognitive symptoms as part of anxiety or depression; 2) "normal" cognitive symptoms that become the focus of attention; 3) isolated functional cognitive disorder in which symptoms are outwith 'normal' but not explained by anxiety; 4) health anxiety about dementia; 5) cognitive symptoms as part of another functional disorder; and 6) retrograde dissociative (psychogenic) amnesia. Other 'non-dementia' diagnoses to consider in addition are 1) cognitive symptoms secondary to prescribed medication or substance misuse; 2) diseases other than dementia causing cognitive disorders; 3) patients who appear to have functional cognitive symptoms but then go on to develop dementia/another neurological disease; and finally 4) exaggeration/malingering. We discuss previous attempts to classify the problem of functional cognitive symptoms, the importance of making a positive diagnosis for the patient, and the need for large cohort studies to better define and manage this large group of patients.
authors.affiliation: Centre for Clinical Brain Sciences, University of Edinburgh, Western General Hospital, Crewe Rd, Edinburgh, UK.
authors.forename: Jon
authors.initials: J
authors.lastname: Stone
authors.affiliation: Centre for Clinical Brain Sciences, University of Edinburgh, Western General Hospital, Crewe Rd, Edinburgh, UK.|Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, UK.
authors.forename: Suvankar
authors.initials: S
authors.lastname: Pal
authors.affiliation: Department of Neuroscience, University of Sheffield, Sheffield, UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Blackburn
authors.affiliation: Department of Neuroscience, University of Sheffield, Sheffield, UK.
authors.forename: Markus
authors.initials: M
authors.lastname: Reuber
authors.affiliation: Centre for Clinical Brain Sciences, University of Edinburgh, Western General Hospital, Crewe Rd, Edinburgh, UK.
authors.forename: Parvez
authors.initials: P
authors.lastname: Thekkumpurath
authors.affiliation: Centre for Clinical Brain Sciences, University of Edinburgh, Western General Hospital, Crewe Rd, Edinburgh, UK.|Department of Rehabilitation Medicine and Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK.
authors.forename: Alan
authors.initials: A
authors.lastname: Carson
mesh_terms: D003072:Cognition Disorders / Q000150:complications / Q000175:diagnosis* / Q000523:psychology* / Q000628:therapy*; D006801:Humans; D019964:Mood Disorders / Q000209:etiology; D009462:Neurology
keywords: Conversion disorder; dissociative amnesia; functional memory disorder; malingering; memory; psychogenic