Introduction
third-wave, anxiety, dementias, dementia, FCD, hypervigilance, cognitive failures, cognitive disorder, depression, neuropathology
WEST, SYNDROMES, NEUROLOGICAL DISORDERS, NEUROPATHOLOGY
Functional cognitive disorder (FCD) is defined as a complaint about memory function or other cognitive process in the absence of relevant neuropathology and with evidence of inconsistency between symptoms reported, objective signs and known phenomenology of dementia syndromes.Diagnostic memory clinics (DMCs) are funded by clinical commissioning groups and run either by local mental health services or in partnership with acute trusts. Cognitive neurology clinics (CNCs) are increasingly provided by acute trusts and target younger populations with potential young-onset dementias, and are more likely to see patients with FCD. As access to these services has improved, an increasing proportion of attendees are being diagnosed with FCD.Those with FCD seeking referral to memory clinics have elevated levels of distress, depression and anxiety.It is unclear how to help this group of patients. A recent survey of DMCs found 73% immediately discharged them to primary care and treatments offered ranged from simple reassurance to referral to a community mental health team.There is now preliminary evidence that strategies focused on expectations, cognitive restructuring and psychoeducation can be helpful.A rare, high-quality randomised controlled trial (RCT) included in the meta-analysis involved 18 patients receiving 13 sessions of group cognitive–behavioural therapy (CBT) intended to change participants’ beliefs and expectations.St George’s Hospital in South London, in collaboration with South West London and St George’s National Health Service Mental Health Trust, is a centre of excellence for functional neurological disorders. We have developed a five-session group treatment based on the third-wave CBT known as acceptance and commitment therapy (ACT). This intervention focuses on changing a person’s relationship with their thoughts and feelings. It makes use of mindfulness and acceptance processes and increases values-driven behaviour.Perceived threat is thought to be a maintenance factor for FND. Symptoms, such as cognitive failures in the case of FCD, are experienced as threatening, which causes hypervigilance and autonomic arousal. Symptoms are, therefore, experienced in a ‘top-down’ manner—influenced by cognitive and neurobiological processes of expectations and predictions of illness.ACT’s efficacy across a range of conditions has been demonstrated by several RCTs and meta-analyses. A recent review of 20 meta-analyses found it to be superior to inactive controls, treatment as usual (TAU) and active interventions (excluding CBT), with effect sizes ranging from small to medium.Unpublished initial pilot data suggested improvement in measures of quality of life and decreased psychological distress in four cohorts of patients who have received our brief ACT intervention. Following this, we were able to secure funding for a feasibility study from the National Institute for Health and Care Research (NIHR; grant number NIHR202743). We now aim to study the feasibility of delivering an RCT of ACT for FCD as an online group intervention and compare this against current TAU. We also aim to further refine the ACT intervention over the course of the study so it can be adapted and manualised for a future definitive RCT.