Functional Cognitive Disorder

Functional Cognitive Disorder (FCD) is a condition where people experience persistent problems with memory, concentration or thinking, but tests do not show evidence of dementia or structural brain disease.

FCD is understood as part of the spectrum of Functional Neurological Disorder (FND). The brain is structurally healthy, but its normal processing of attention, memory and thinking has become disrupted, leading to very real and often distressing symptoms.

At The Royal Buckinghamshire Hospital, we see FCD in adults with complex neurological, fatigue, pain or FND presentations and provide specialist inpatient neurorehabilitation to help people manage symptoms and improve day-to-day function.

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What Is Functional Cognitive Disorder?

Functional Cognitive Disorder describes cognitive symptoms (such as memory or concentration problems) that cause difficulties in daily life, but where:

• Brain scans and standard tests do not show dementia or another progressive brain disease
• Cognitive testing shows inconsistencies – performance may vary within or between tests
• The person is typically highly aware and worried about their thinking difficulties

People with FCD often fear they are “getting dementia”. In fact, research shows that when FCD is accurately diagnosed:

• It is not a degenerative condition
• It does not progress in the way dementia does
• Many people remain stable or improve over time, especially with clear explanation and support

FCD is sometimes described as a “software” problem, where the brain’s processing of attention and memory has become overloaded, anxious or inefficient, rather than a “hardware” problem with brain cells.

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Causes and Contributing Factors

There is no single cause of Functional Cognitive Disorder. Instead, several factors often interact:

• Stress, anxiety or low mood – especially when there is strong worry about memory
• Sleep problems or chronic fatigue
• Persistent pain or other long-term physical symptoms
• Past or recent trauma or major life events
• Previous neurological illness (e.g. concussion, stroke, migraine)
• High self-monitoring – closely watching memory for mistakes and dwelling on them
• Unhelpful beliefs such as “every lapse means I’m developing dementia”

Over time, the combination of heightened attention to memory, worry, and changes in behaviour (e.g. avoiding tasks, over-checking, relying heavily on lists) can reinforce symptoms and make them feel more entrenched.

Symptoms are not fabricated or imagined. They are genuine experiences that reflect how the brain is functioning under stress and high cognitive load.

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Symptoms of Functional Cognitive Disorder

Symptoms vary between people but typically involve subjective cognitive problems that interfere with everyday life. Common features include:

• Memory lapses – forgetting recent conversations, appointments or why you walked into a room
• Needing to re-read information several times to take it in
• Losing track in conversations or struggling to follow complex information
• Difficulty finding words or feeling that speech is slower or less fluent
• Problems with concentration and multitasking – feeling mentally overloaded by routine tasks
• Feeling mentally “foggy”, slowed or easily overwhelmed
• Increased reliance on notes, lists and reminders
• High levels of worry about cognitive decline, often more than family or colleagues notice

A key feature is often a mismatch between the severity of difficulties the person reports and what is seen in objective testing or in everyday function. For example, someone may give a highly detailed account of their memory problems yet perform relatively well on structured memory tests.

Many people with FCD also experience:

• Fatigue
• Chronic pain or medically unexplained symptoms
• Anxiety, depression or post-traumatic stress
• Other FND symptoms, such as functional limb weakness, functional gait disorder or dissociative (non-epileptic) seizures

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How Functional Cognitive Disorder Is Diagnosed

A diagnosis of FCD is usually made by a neurologist, psychiatrist, geriatrician or specialist memory service, often with input from neuropsychology. The assessment may include:

• A detailed history of symptoms, including onset, progression and impact
• Discussion of mood, sleep, stress, trauma and physical health
• Cognitive screening tests and, where needed, more detailed neuropsychological assessment
• Brain imaging (such as MRI) and blood tests to rule out dementia and other causes
• Review of daily functioning – work, finances, self-care, hobbies and social roles

FCD is diagnosed positively, based on characteristic features such as:

• Inconsistent test performance – results that vary more than expected across tasks or over time
• Cognitive scores that are better than expected given the level of reported difficulty
• High levels of self-monitoring and negative beliefs about memory
• A non-progressive pattern over time, without the decline typical of dementia

An accurate diagnosis – and clear explanation that this is not dementia – is crucial. It allows people to focus on practical management and rehabilitation rather than fearing ongoing deterioration.

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Treatment and Management

There is no single “tablet” for Functional Cognitive Disorder. Effective management focuses on:

• Understanding the diagnosis
• Changing unhelpful patterns of attention, behaviour and beliefs about memory
• Addressing contributing factors such as sleep, pain, mood and fatigue
• Building confidence in everyday thinking skills

Approaches may include:

Education and Reassurance

• Clear, compassionate explanation that FCD is real but non-degenerative
• Discussion about how attention, worry and fatigue affect memory and concentration
• Support for family or carers to understand the condition and respond helpfully

Psychological Therapies

• Cognitive-behavioural and neurobehavioural approaches to address worry about memory, perfectionism and avoidance MedRxiv+2BPS Explore+2
• Strategies for managing attention, reducing internal monitoring and shifting focus back to tasks
• Therapy for anxiety, depression or trauma, where relevant

Practical Cognitive Strategies

• Developing simple, consistent routines for everyday tasks
• Using memory aids (lists, calendars, phone reminders) in a structured, not excessive way
• Breaking complex activities into manageable steps
• Pacing and planning to avoid cognitive “boom–bust” cycles

Addressing Physical and Lifestyle Factors

• Support with sleep hygiene and fatigue management
• Review of medication that may affect cognition
• Advice on activity, exercise and relaxation
• Management of coexisting conditions such as pain or dizziness

With the right explanation and strategies, many people experience improved confidence and function, even if occasional lapses still occur.

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Functional Cognitive Disorder, Dementia and FND

It is important to understand how FCD relates to other conditions:

• FCD vs dementia
  • FCD causes cognitive symptoms without the progressive brain cell loss seen in dementia.
  • In FCD, symptoms often fluctuate and may improve with the right support. dementiaresearcher.nihr.ac.uk+3Alzheimer’s Society+3University of Bristol+3
• FCD as part of FND
  • FCD is recognised as a cognitive subtype of Functional Neurological Disorder, where cognitive symptoms are the main problem but may coexist with other functional neurological or physical symptoms. BPS Explore+2PMC+2

Because of this overlap, multidisciplinary FND-focused rehabilitation – combining psychology, physiotherapy, occupational therapy and education – can be helpful when cognitive symptoms sit within a wider FND or complex neurological picture.

You can read more on our FND pages:

• Functional Neurological Disorder (FND) – Conditions & Symptoms
• Functional Neurological Disorder – Inpatient Rehabilitation – Rehab Centre

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How We Can Help at The Royal Buckinghamshire Hospital

At The Royal Buckinghamshire Hospital, we support adults with Functional Cognitive Disorder in the context of:

• Functional Neurological Disorder (FND)
• Complex neurological conditions (e.g. stroke, neuroinflammatory disease, concussion)
• Persistent symptoms such as fatigue, pain, dizziness or non-epileptic seizures

Our consultant-led inpatient neurorehabilitation programmes may include:

• Neuropsychology and psychology
  • Detailed assessment of cognitive strengths and weaknesses
  • Support with understanding the diagnosis and managing worry about memory
  • Neurobehavioural strategies to change attention, beliefs and habits around thinking
• Occupational therapy
  • Practical strategies for everyday memory, concentration and planning
  • Pacing, energy management and establishment of helpful routines
  • Support for work, study, driving and other meaningful roles
• Physiotherapy and other therapies
  • Where physical FND symptoms, balance problems, pain or fatigue are also present
• Education and family support
  • Information sessions for patients and families
  • Planning for ongoing self-management and community follow-up

Our team will work with you to identify realistic goals, build on your existing strengths and develop a personalised plan to support day-to-day independence.

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When to Seek Medical Advice

This page provides general information and does not replace individual medical assessment.

You should seek advice from your GP or specialist if you:

• Notice persistent memory, concentration or thinking problems
• Are worried you may have dementia or another neurological condition
• Experience cognitive symptoms alongside other neurological changes, such as new weakness, visual loss or speech disturbance

Your clinician can assess whether further tests are needed, explain the likely diagnosis and discuss whether a rehabilitation-focused programme, such as those offered at The Royal Buckinghamshire Hospital, may be appropriate.