Functional Neurological Disorder (FND) : a patient's guide
including Functional/Dissociative (non-epileptic) Seizures, Functional Movement Disorder and other functional symptoms
Functional Memory and Concentration Symptoms
“I went upstairs /to the next room and couldn’t remember why I was there’
‘I keep losing my wallet / keys’
‘I lost track of the conversation’
‘I couldn’t recall the entire car journey home’
‘I pick up a book and I can’t remember the bit I read before’
‘I forget the name of the place I went on holiday and what we did every day’
‘I completely forgot to go to a meeting / send someone a birthday card'
Functional Memory and Concentration symptoms (also called functional cognitive symptoms) frequently co-exist alongside functional and dissociative symptoms.
This is especially the case when there is sleep disturbance, fatigue, anxiety or depression. However, it is important to state that you can have these memory and concentration symptoms without anxiety or depression.
Functional Cognitive Symptoms are becoming more common - possibly because we now have many more memory clinics than there used to be and dementia is quite widely publicised as a problem.
Studies in the UK show that over half of patients attending a memory clinic dont have dementia and many have a functional cognitive disorder.
Common memory complaints are as follows. Many may be everyday experiences that are experienced more often than usual.
Like all functional symptoms, deciding whether these symptoms are part of a neurological disease or not must be done carefully.
But often, these kinds of symptoms do not indicate a memory problem at all. They can mostly be explained as a consequence of poor concentration or absentmindedness. If you are not concentrating to begin with, perhaps because you are tired, or distracted, then you are not going to remember things.
So whilst you used to be able to walk upstairs and ‘keep in mind’ the reason for it, you now don’t because your pain or fatigue or leg weakness is getting in the way of your concentration.
People who notice these kinds of symptoms have often had above average ability to remember things in the first place. People who have always been a bit absentminded tend to notice them less.
Sometimes these symptoms become a focus for worry about health, especially if there is a family history of dementia or the person is familiar with dementia. Thinking or worrying about memory symptoms tends to make them worse. Most brain functions, like movement sleep and thinking work best when you dont try too hard to make them work
It may be helpful to find out how common memory symptoms are in the population. Here are some figures from healthy people in their 20s and 30s.
When doctors assess memory problems in the clinic they may look for certain clues to help them work out if memory symptoms are functional or not. They may carry out neuropsychological tests using a pen and paper or computer. Clinicians need to be careful as some patients with functional cognitive disorder perform worse on testing than they do in real life and the results can create a false impression.
None of the features below are completely diagnostic and the diagnosis should be made by an expert. In some patients it may not be possible to be sure, but have a look at this to decide which side you are more likely to be on:
Is this the same as Mild Cognitive Impairment (MCI)
No. MCI is a label commonly given to older patients who have cognitive symptoms but who do not have dementia. Some of those patients may indeed have functional cognitive symptoms but some will go on to get dementia.
Functional cognitive disorder is a much more specific and identifiable problem with typical clinical features.
Treatment of Functional Cognitive Symptoms
These are some of the things that may help people suffering from functional cognitive symptoms
1. Make a positive diagnosis. Like all functional neurological disorders it should not be a diagnosis of exclusion.
2. Identify whether there is an obvious cause like sleep deprivation, excessive medication or anxiety which can be a target for treatment
3. People who used to have a brilliant memory may need time to recognise that the memory symptoms they have, although different for them, are still normal for the population. Education and discussion may help here.
4. Training to accept memory mistakes when they occur and not to focus on them for too long (ie reduced self-criticism)
There is a useful PAGE OF TIPS ON MANAGING MEMORY AND CONCENTRATION SYMPTOMS ON THIS WEBSITE. It has been written for people with mild head injury but the advice is similar in terms of learning to gain more control back over your memory.
Longer Periods of Amnesia / Dissociative Amnesia
Sometimes patients with functional neurological symptoms report quite dramatic periods of amnesia, for example, for a whole afternoon or a whole car journey. This is especially the case in people with dissociative seizures who often have amnesia for symptoms just preceding the attack.
When a whole block of time like this is lost, then the explanation is more likely to be dissociative amnesia. Click on dissociative symptoms to find out more about the general meaning of dissociation.
In dissociative amnesia, the person is not able to remember anything because either
•during the period in question they were either in a trance like state, or
•They are having difficulty accessing normal memories because of a change in function of the brain, which is part of a functional or dissociative illness