The Common Yet Little Known Condition Often Misdiagnosed As Dementia May Affect Up To Half of All Patients!

A health condition that could easily be mistaken for early-stage dementia, particularly in middle-aged patients, is virtually unknown among the public, and even most health professionals haven’t heard of it.

However, alarming new research shows that up to half of those diagnosed with dementia at specialized memory clinics don’t have dementia at all...

To make sure you don’t mistakenly get labeled as a dementia patient, it’s crucial to get to know this underrecognized condition called functional cognitive disorder.

Memory Concerns are Common and Widespread

Recently, we’ve reported on several health issues that can mimic early dementia. For example, the treatable liver condition hepatic encephalopathy can cause memory problems that resemble dementia. And there are many others…

Numerous hidden medical conditions including anemia, vitamin B deficiencies, and normal pressure hydrocephalus, or NPH, a treatable buildup of cerebrospinal fluid in the brain that can lead to a false diagnosis of dementia. Not to mention dementia symptoms brought on by prescription drugs.

Memory slips and other cognitive problems can be the product of normal brain aging. Most young adults commonly have difficulties finding the right word, entering rooms only to forget what they’d gone in for, and forgetting to buy something when out shopping.

As you can see, the lack of a gold standard test for dementia means diagnosing the condition is no easy task when memory concerns are so common and so widespread. And now there’s another issue frequently mistaken for dementia…

Functional Cognitive Disorder is Growing

Functional cognitive disorder (FCD) is a surprisingly common problem that has caught the attention of researchers in recent years. However, medical authorities have not yet entirely agreed upon its definition. What is known is that symptoms often overlap with dementia, posing a diagnostic challenge for clinicians.

The main symptoms of FCD are memory and thinking problems, especially those related to staying focused and maintaining attention. For example, someone with FCD will feel mentally sluggish, go blank on something they would normally know, like a PIN number, misplace things, be unable to bring a word to mind, and lose track of their thought process during conversations.

These symptoms may be much the same as dementia, but the difference is that there’s no damage to brain areas involved in memory. The brain just isn’t processing information as well as it should.

Unlike dementia, which gets worse over time, this rarely occurs with FCD, which either remains the same, comes and goes, or gets better over time. That’s good news, but because clinicians can’t tell the difference between the two conditions, thousands suffer from a misdiagnosis.

An estimated one-third to more than half of people attending specialized memory clinics have FCD rather than dementia. That bears repeating: Nearly half of all diagnosed dementia patients don’t have dementia, but instead they suffer from FCD.

How Can You Tell if It’s FCD or Dementia?

A recent review of 30 studies involving 8,602 participants concluded that the following six features are most typical of FCD patients.¹

1. Age onset from midlife to early sixties
2. Higher education level
3. Family history of a single individual with late-onset dementia
4. Symptoms with shorter duration and/or abrupt onset following a significant life event
5. Higher rates of anxiety, depression, and sleep disturbances
6. Internal inconsistency

The last feature listed, internal inconsistency, is considered the core diagnostic feature of functional cognitive disorder. It refers to the patient reporting cognitive symptoms, usually relating to memory, but their concerns are not in line with findings from objective memory tests, which may be slightly worse than in people with good memories.

Patients often remember what they claim to have forgotten and can even give a detailed account of these memory lapses. The level of detail provided, with specific examples and expansive answers, also points to FCD.

Another sign of FCD is attending the clinic on their own despite being asked to bring someone who is acquainted with their condition. This “attended alone” sign is thought to have “a high positive predictive value for the absence of any cognitive impairment.”²

Yet another factor that can point to FCD is if the patient brings a written list of their symptoms to their consultation.

Although FCD may only present as cognitive symptoms, it’s common for patients to also have symptoms of functional neurological disorder.²

What is a Functional Neurological Disorder?

People with FCD tend to have higher rates of anxiety, depression, and sleep disorders, but are also overrepresented in a variety of neurological disorders called functional neurological disorder (FND). Examples include pain disorders, fibromyalgia, chronic fatigue syndrome, post-traumatic brain injury, limb weakness, and blackouts.

In two studies of FCD patients, about half had features of depression, anxiety, obsessiveness, fatigue, pain, sleep disturbances, or dissociation (feeling disconnected from yourself and the world around you), which were in excess compared to healthy controls.

Researchers believe that because FCD can be part of a complex pattern of symptoms, any cognitive deficiencies will often improve once the main symptoms get managed.

Often Misdiagnosed

A large group of British researchers published a review paper called “Functional cognitive disorder: dementia's blind spot.”⁴

Commenting on their paper, first author Harriet Ball said: “Dysfunction of day-to-day thinking processes is a feature of FCD, but it is often misdiagnosed as early dementia. While FCD involves impairment of thinking processes, unlike dementia, it is not expected to progress.

“Having clear diagnostic criteria for FCD will enable us to better characterize the condition and better explain it - and its prognosis - to patients and their families.

"Treatment up to now has focused on management of aspects that we know can help in general, for example cutting down medications that might be making things worse, working on better sleep patterns; but in future we'd like to test specific cognitive therapies which could prove much more successful."⁵

Our Takeaway

If you or a loved one has any memory-related diagnosis, it’s vital that you ensure you’re not dealing with functional cognitive disorder instead. It’s a good idea to get familiar with the symptoms listed above and talk to your healthcare team about functional cognitive disorder and any concerns you might have.