Functional cognitive disorder: Beyond pseudodementia

Many patients with cognitive symptoms, such as subjective memory complaints, may in fact have functional cognitive disorder. 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. 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. Muchos pacientes con síntomas cognitivos, como aquellos con quejas subjetivas de memoria, pueden ser mejor clasificados en un trastorno cognitivo funcional. A lo largo de esta revisión se exploran diversos aspectos del trastorno cognitivo funcional. Se describen las características clínicas que apoyan el diagnóstico, la necesidad de no considerarlo como un diagnóstico de exclusión, sino como una posibilidad que se sustenta en hallazgos positivos como la inconsistencia interna de los síntomas cognitivos. Se exponen los mecanismos que podrían explicar esta condición, los cuales incluyen las fallas en la metacognición, automonitoreo excesivo, procesamiento emocional, entre otras. Se explica la frecuente comorbilidad con otras condiciones, en particular con patologías psiquiátricas. Se describen circunstancias en donde se requieren apoyos diagnósticos y la valoración neuropsicológica. Se enfatiza en el pronóstico de esta condición, en donde, a pesar de llegar a ser incapacitante y acompañarse de angustia, muy poc