BMJ Neurology Open (Feb 2025)
Development of a diagnostic checklist to identify functional cognitive disorder versus other neurocognitive disorders
- Jon Stone,
- Suvankar Pal,
- Francesco Di Lorenzo,
- Tiago Teodoro,
- Tim Wilkinson,
- Jan Coebergh,
- Laura McWhirter,
- Alan Carson,
- Bruno Dubois,
- Mark Edwards,
- Jane Alty,
- Isabel Santana,
- Martin Rossor,
- Miguel Tábuas-Pereira,
- Stoyan Popkirov,
- Rui Araújo,
- Robert Howard,
- Selma Aybek,
- Jonathan Huntley,
- Rohan Bhome,
- Thomas Harbo,
- Catherine M Pennington,
- Flavio Nobili,
- Ricardo Taipa,
- Gaston Baslet,
- Michele Tinazzi,
- Martin Zeidler,
- Harriet A Ball,
- Lisbeth Frostholm,
- Emer R McGrath,
- Andrew Larner,
- Jonathan Schott,
- Elizabeth Mallam,
- Verónica Cabreira,
- João Massano,
- Mirella Russo,
- James Main,
- Dane Rayment,
- David Perez,
- Sonja Antic,
- Sasa R Filipovic,
- Kristian Steen Frederiksen,
- Bradleigh Hayhow,
- Jeremy Darryl Isaacs,
- Curt LaFrance,
- Camillo Marra,
- Isabel Portela Moreira,
- Emmi P Scott,
- Svetlana Tomic,
- Sofia Toniolo,
- Caroline Winther Tørring
Affiliations
- Jon Stone
- Department of Clinical Neurosciences, University of Edinburgh, Edinburgh, UK
- Suvankar Pal
- University of Edinburgh, National CJD Research and Surveillance Unit, Edinburgh, UK
- Francesco Di Lorenzo
- 1 Non Invasive Brain Stimulation Unit, Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
- Tiago Teodoro
- 3 Neurosciences Research Centre, St George`s University of London, London, UK
- Tim Wilkinson
- University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
- Jan Coebergh
- Ashford and St Peter`s Hospitals NHS Trust, Chertsey, UK
- Laura McWhirter
- 1Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Bruno Dubois
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau - ICM, Inserm U1127, CNRS UMR 7225, AP-HP - Hôpital Pitié-Salpêtrière, Paris, France
- Mark Edwards
- consultant in anaesthesia and perioperative medicine
- Jane Alty
- 1University of Tasmania, Sandy Bay, TAS, Australia
- Isabel Santana
- Neurology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Martin Rossor
- Dementia Research Centre, ION, University College London Faculty of Brain Sciences, London, UK
- Miguel Tábuas-Pereira
- Neurology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Stoyan Popkirov
- Neurology, University Hospital Essen, Essen, Germany
- Rui Araújo
- Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal
- Robert Howard
- UCL Division of Psychiatry, London, UK
- Selma Aybek
- Psychosomatic Medicine, Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland
- Jonathan Huntley
- 1 Division of Psychiatry, University College London, London, UK
- Rohan Bhome
- 1 Division of Psychiatry, University College London, London, UK
- Thomas Harbo
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
- Catherine M Pennington
- neurologist
- Flavio Nobili
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Ricardo Taipa
- Neuropathology Unit, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Gaston Baslet
- Psychiatry, Brigham and Women`s Hospital, Boston, Massachusetts, USA
- Michele Tinazzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Martin Zeidler
- Department of Neurology, NHS Fife, Kirkcaldy, UK
- Harriet A Ball
- 4 Bristol Medical School, University of Bristol Faculty of Health Sciences, Bristol, UK
- Lisbeth Frostholm
- 3 Department of Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
- Emer R McGrath
- University of Galway School of Medicine, Galway, Ireland
- Andrew Larner
- Walton Centre
- Jonathan Schott
- 1 National Hospital for Neurology and Neurosurgery
- Elizabeth Mallam
- 29 The Rosa Burden Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
- Verónica Cabreira
- 1Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- João Massano
- Neurology, Centro Hospitalar Universitario de Sao Joao, Porto, Portugal
- Mirella Russo
- Department of Neurosciences, Imaging and Clinical Sciences, G. d`Annunzio University of Chieti-Pescara, Chieti, Italy
- James Main
- core trainee 1, psychiatry
- Dane Rayment
- North Bristol NHS Trust, Westbury on Trym, UK
- David Perez
- 14Functional Neurological Disorder Research Group at Mass General Hospital
- Sonja Antic
- Neurology, Aarhus Universitetshospital, Aarhus, Denmark
- Sasa R Filipovic
- Institute for Medical Research, University of Belgrade, Belgrade, Serbia
- Kristian Steen Frederiksen
- Clinical Trial Unit, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Bradleigh Hayhow
- Neurology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- Jeremy Darryl Isaacs
- Department of Neurology, St George’s Hospital, London, UK
- Curt LaFrance
- Alpert Medical School Area Health Education Centre, Providence, Rhode Island, USA
- Camillo Marra
- Universita Cattolica del Sacro Cuore Sede di Roma, Roma, Italy
- Isabel Portela Moreira
- Neurology Department, Private Hospital of Gaia of the Trofa Saúde Group, Vila Nova de Gaia, Portugal
- Emmi P Scott
- Medical University of South Carolina, Charleston, South Carolina, USA
- Svetlana Tomic
- Neurology, University Hospital Center, Osijek, Croatia
- Sofia Toniolo
- Cognitive Disorder Clinic, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
- Caroline Winther Tørring
- Neurology, Aarhus Universitetshospital, Aarhus, Denmark
- DOI
- https://doi.org/10.1136/bmjno-2024-000918
- Journal volume & issue
-
Vol. 7,
no. 1
Abstract
Background Functional cognitive disorder (FCD) poses a diagnostic challenge due to its resemblance to other neurocognitive disorders and limited biomarker accuracy. We aimed to develop a new diagnostic checklist to identify FCD versus other neurocognitive disorders.Methods The clinical checklist was developed through mixed methods: (1) a literature review, (2) a three-round Delphi study with 45 clinicians from 12 countries and (3) a pilot discriminative accuracy study in consecutive patients attending seven memory services across the UK. Items gathering consensus were incorporated into a pilot checklist. Item redundancy was evaluated with phi coefficients. A briefer checklist was produced by removing items with >10% missing data. Internal validity was tested using Cronbach’s alpha. Optimal cut-off scores were determined using receiver operating characteristic curve analysis.Results A full 11-item checklist and a 7-item briefer checklist were produced. Overall, 239 patients (143 FCD, 96 non-FCD diagnoses) were included. The checklist scores were significantly different across subgroups (FCD and other neurocognitive disorders) (F(2, 236)=313.3, p<0.001). The area under the curve was excellent for both the full checklist (0.97, 95% CI 0.95 to 0.99) and its brief version (0.96, 95% CI 0.93 to 0.98). Optimal cut-off scores corresponded to a specificity of 97% and positive predictive value of 91% for identifying FCD. Both versions showed good internal validity (>0.80).Conclusions This pilot study shows that a brief clinical checklist may serve as a quick complementary tool to differentiate patients with neurodegeneration from those with FCD. Prospective blind large-scale validation in diverse populations is warranted.Cite Now
