Functional cognitive disorder: Beyond pseudodementia

Introduction

Many patients with cognitive symptoms, such as subjective memory complaints, may in fact have functional cognitive disorder.

Development

This review explores various aspects of functional cognitive disorder. We describe the clinical characteristics that support diagnosis. Diagnosis is not made by exclusion; rather, it is supported by positive findings, such as internal inconsistencies in cognitive symptoms. We also explore the mechanisms that could explain this condition, which include metacognitive errors, excessive self-monitoring, and abnormal emotional processing, among others. Functional cognitive disorders frequently copresent with other conditions, particularly with psychiatric disorders. We describe circumstances in which diagnostic support and neuropsychological assessment are required. Special emphasis is placed on the prognosis of this condition, which, despite the associated disability and distress, rarely progresses to dementia. Therefore, correct identification of cases and differentiation from mild cognitive impairment can help avoid unnecessary testing and reduce patient uncertainty. Treatment begins from the moment the patient is informed about their diagnosis, and is based on psychotherapy and metacognitive training.

Conclusions

Patients with functional cognitive disorder account for a significant percentage of consultations due to memory complaints and have particular needs. Use of specific clinical criteria allow early diagnosis and appropriate treatment.