Functional Cognitive Disorder: An Underdiagnosed Condition

Some people suffer from mild cognitive impairment that isn't related to dementia. It's a condition that, up until fairly recently, wasn't properly diagnosed. Now, we're learning a great deal more about it.
Functional Cognitive Disorder: An Underdiagnosed Condition
Valeria Sabater

Written and verified by the psychologist Valeria Sabater.

Last update: 29 August, 2023

Going blank in the middle of a conversation. Not remembering a PIN code. Having to read a page of a book several times because it’s so difficult to understand. Cognitive alterations, especially those related to age, give rise to high stress. They appear gradually but often interfere with life to the extent of making the individual wonder if they’re developing dementia.

As a rule, when forgetfulness first appears in the elderly, it causes great concern, both in the individual and their environment. However, experiencing small memory, attention, and even information processing errors is common. In fact, sometimes, it can be due to something as simple as anxiety.

On the other hand, cognitive decline doesn’t always occur with a neurodegenerative process. Indeed, not every symptom suggests the onset of dementia or Alzheimer’s disease. In fact, a few years ago, experts identified a clinical condition that, to date, remains underdiagnosed. It’s known as functional cognitive disorder (FCD).

It’s estimated that one in four people who exhibit memory and attention problems don’t actually have dementia.

Girl hugging older woman
One of the characteristics of functional cognitive disorder is difficulty in focusing attention.

Cognitive functional disorder

In 2020, Dr. Harriet Ball and her team at the University of Bristol (UK) published an interesting study. They presented the preliminary definition of a functional neurological disorder that was well-recognized by experts in neurology and aging. But, in reality, it was little diagnosed. As such, its symptoms were frequently appreciated, although criteria for evaluating the disorder weren’t yet available.

Functional cognitive disorder identifies patients with problems of a cognitive nature that don’t conform to the clinical pictures of neurodegenerative diseases. They’re individuals who experience difficulties in memory, attention, and thinking, but won’t develop dementia.

In fact, it’s estimated that one in four patients with cognitive alterations have this condition. They’re individuals over 60 years of age whose cognitive difficulties aren’t serious enough to affect their functionality. This doesn’t mean that, understandably, they feel just as concerned about how their condition may progress.

Functional cognitive disorder requires an adequate neuropsychological and neurological evaluation to rule out other diseases.

The characteristics of functional cognitive disorder

One of the most common characteristics reported by the sufferer of functional cognitive disorder is difficulty in focusing attention. Indeed, they have a hard time concentrating. They also tend to forget, in the middle of doing something, what they were meant to be doing. Here are some more symptoms:

  • Sleep disturbances.
  • Frequent memory failures.
  • Limitations in learning new information.
  • “I have it on the tip of my tongue” phenomenon.
  • Apathy and depressive symptoms.
  • Not understanding information that’s offered to them at any given time.
  • Interruptions in their flow of thoughts and conversations. In effect, ‘going blank’.
  • Sensations of pain, a lack of strength, and fatigue.
  • Forgetting significant events from their recent past. For example, their conversations, actions, and where they’ve been.
  • Getting ‘stuck’ in a certain set of thoughts. They’re loops from which they can’t escape.

However, people with this condition are usually functional. This means they’re autonomous in many of their daily responsibilities.

People with functional cognitive disorder worry a great deal about ending up with dementia. This can make their situation worse, raising the risk of it turning into anxiety or depression.

The origins of cognitive functional disorder

We still don’t know the triggers for cognitive functional disorder. The University of London (UK) conducted research to address its possible origins. They claimed that it seems likely that it’s related to conditions such as fibromyalgia and chronic fatigue syndrome.

In some cases, sufferers experience routine cognitive processes with increasing effort and difficulty. This could be a trigger, but it’s not conclusive. Likewise, many elderly people who suffer from a depressive disorder show, in turn, a functional cognitive disorder.

In these scenarios, the clinical picture improves when they start suitable treatment. What’s most important, in all cases, is to have a proper adequate medical and psychological diagnosis, with which to rule out other conditions. Generally, it’s a type of cognitive decline that appears after the age of 60 and peaks at 71.

Seniors on the beach
Leading an active life and being aware that any cognitive decline isn’t associated with dementia can help in the case of functional cognitive disorder.

Appropriate treatment

Every person who’s received a diagnosis needs to be clear about a series of ideas. Firstly, the professional must alleviate their fears and explain that their condition isn’t linked to dementia. This will bring them peace of mind and they’ll be able to exert greater control over their lives.

As with all neurological disorders, a mainstay of clinical management involves explaining the assessment and the clinical condition to both patients and family members. Once again, we must emphasize the fact that this type of pathology can increase the risk of the individual suffering some alteration in their state of mind. Therefore, they should know to possibly expect, for example, depression and understand how to deal with it.

The therapeutic strategies consist of the following treatments:

Cognitive stimulation

A decisive key for the sufferer of the disorder is to start cognitive stimulation therapy. This will allow them, in many cases, to recover some of their faculties, such as memory and attention.

Cognitive behavioral therapy

Cognitive behavioral therapy seeks to improve an individual’s approach to thinking. As we mentioned earlier, it’s common for them to fall into negative reasoning loops. They might also get stuck in certain ideas. The goal in these cases is multiple: to improve their thought patterns, shape a favorable state of mind, and work on motivation and self-efficacy.

Medical and pharmacological treatments

The patient suffering from functional cognitive disorder usually suffers sleep disturbances, in addition to numerous physical complaints and fatigue. The health professional must treat these conditions, whether they’re due to the disorder itself, age, or their own causes.

Conclusion

Finally, we must emphasize that this is a disorder that requires further investigation and attention. As more people are treated, we’ll start to understand both the risk factors and the best therapeutic strategies.

Although not all cognitive decline is associated with dementia, the suffering they cause is significant. Offering these patients and their families appropriate care is essential.

It might interest you...
Cognitive Impairment in Older Adults: Normal or Pathological Aging?
Exploring your mind
Read it in Exploring your mind
Cognitive Impairment in Older Adults: Normal or Pathological Aging?

Cognitive impairment in older adults can range from small expected deficits to dementias. Find out how to recognize the symptoms.


All cited sources were thoroughly reviewed by our team to ensure their quality, reliability, currency, and validity. The bibliography of this article was considered reliable and of academic or scientific accuracy.


  • Ball, H., McWhirter, L., Ballard, C., Bhome, R., Blackburn, D., Edwards, M., Fleming, S., Fox, N., Howard, R., Huntley, J., Isaacs, J., Larner, A., Nicholson, T., Pennington, C., Poole, P., Price, G., Price, J., Reuber, M., Ritchie, C., Rossor, M., Schott, J., Teodoro, T., Venneri, A., Stone, J., Carson, A. (2020). Functional cognitive disorder: dementia’s blind spot. Brain, 143(10), 2895–2903, https://doi.org/10.1093/brain/awaa224
  • Borelli WV, de Senna PN, Brum WS, Schumacher-Schuh AF, Zimmer ER, Fagundes Chaves ML, Castilhos RM. El trastorno cognitivo funcional presenta un perfil clínico diferenciado y de alta frecuencia en pacientes con bajo nivel educativo. Neurociencia del envejecimiento frontal. 31 de marzo de 2022; 14: 789190. doi: 10.3389/fnagi.2022.789190. PMID: 35431909; PMCID: PMC9011344.
  • Pennington, C., Ball, H., & Swirski, M. (2019). Functional Cognitive Disorder: Diagnostic Challenges and Future Directions. Diagnostics (Basel, Switzerland)9(4), 131. https://doi.org/10.3390/diagnostics9040131
  • Teodoro, T., Edwards, M. J., & Isaacs, J. D. (2018). A unifying theory for cognitive abnormalities in functional neurological disorders, fibromyalgia and chronic fatigue syndrome: systematic review. Journal of neurology, neurosurgery, and psychiatry89(12), 1308–1319. https://doi.org/10.1136/jnnp-2017-317823

The contents of Exploring Your Mind are for informational and educational purposes only. They don't replace the diagnosis, advice, or treatment of a professional. In the case of any doubt, it's best to consult a trusted specialist.