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Attention impairment in motor functional neurological disorders: a neuropsychological study

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Abstract

Objective

Our objective was to assess cognitive functioning across multiple cognitive domains using a standardised neuropsychological battery in patients with motor functional neurological disorders (mFND).

Methods

Thirty patients with clinically established mFND and 30 age-, sex- and education-matched control subjects underwent a thorough neuropsychological assessment evaluating (1) attention including processing speed, (2) executive functions including working memory, (3) short-term memory, (4) speech and language and (5) visuospatial functions. Performance validity tests (PVT) and self-report measures of depression, anxiety and cognitive complaints were included in the assessment. Only patients with valid test performance were included in the analysis.

Results

Three patients scored below the cut-off scores in PVT. Patients performed significantly worse than controls in the following areas: (1) the attention domain which included a slow processing speed (p = 0.005, Cohen’s d = 0.89), (2) executive functions (p = 0.01, Cohen’s d = 0.88) and (3) speech and language domains (p = 0.025, Cohen’s d = 0.77). Patients with mFND showed greater intra-individual variability in cognitive performance (p = 0.005, Cohen’s d = 0.94). Cognitive impairments were independent of depressive symptoms, which were higher in mFND patients.

Conclusion

This study revealed both subjective and objective cognitive impairment in patients with mFND. The neuropsychological profile in mFND was characterised primarily by attentional impairment including a slow processing speed and a high intra-individual variability in cognitive performance. Cognitive impairment was associated with a valid test performance, highlighting that the deficits observed were not likely to be explained by a lack of effort in the patient group. Attention is considered to play a key role in mFND pathophysiology, and the results suggest that such impairments are objectively measurable.

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Data availability

Datasets analysed during the current study are available upon reasonable request. All data will be anonymised.

Abbreviations

AVLT:

The Auditory Verbal Learning Test

AVLT FCR:

The Auditory Verbal Learning Test forced choice recognition

BDI-II:

Beck Depression Inventory

DMS-48:

Delayed Matching-to-Sample Task 48

FND:

Functional neurological disorder

JLO:

Judgement of Line Orientation

mFND:

Motor functional neurological disorder

MMSE:

Mini-Mental State Examination

OLS:

Ordinary least squares

PVT:

Performance validity tests

QPC:

Cognitive Complaints Questionnaire (Questionnaire de plainte cognitive)

RDS:

Reliable Digit Span

ROCF:

Rey–Osterrieth Complex Figure

SD:

Standard deviation

STAI X:

State-Trait Anxiety Inventory

S-FMDRS:

Simplified Functional Movement Disorders Rating Scale

TMT:

Trail Making Test

VOSP:

Visual Object and Space Perception Battery

References

  1. Alluri PR, Solit J, Leveroni CL, Goldberg K, Vehar JV, Pollak LE, Colvin MK, Perez DL (2020) Cognitive complaints in motor functional neurological (conversion) disorders: a focused review and clinical perspective. Cogn Behav Neurol 33:77–89

    Article  PubMed  Google Scholar 

  2. APA (2013) Diagnostic and statistical manual of mental disorders, 5th ed. In: American Psychiatric Publishing, Arlington

  3. Barbeau E, Didic M, Tramoni E, Felician O, Joubert S, Sontheimer A, Ceccaldi M, Poncet M (2004) Evaluation of visual recognition memory in MCI patients. Neurology 62:1317–1322

    Article  CAS  PubMed  Google Scholar 

  4. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J (1961) An inventory for measuring depression. Arch Gen Psychiatry 4:561–571

    Article  CAS  PubMed  Google Scholar 

  5. Benito-Leon J, Louis ED, Bermejo-Pareja F, Neurological Disorders in Central Spain Study G (2006) Population-based case-control study of cognitive function in essential tremor. Neurology 66:69–74

    Article  PubMed  Google Scholar 

  6. Bezdicek O, Motak L, Axelrod BN, Preiss M, Nikolai T, Vyhnalek M, Poreh A, Ruzicka E (2012) Czech version of the Trail Making Test: normative data and clinical utility. Arch Clin Neuropsychol 27:906–914

    Article  PubMed  Google Scholar 

  7. Bezdicek O, Stepankova H, Motak L, Axelrod BN, Woodard JL, Preiss M, Nikolai T, Ruzicka E, Poreh A (2014) Czech version of Rey Auditory Verbal Learning test: normative data. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 21:693–721

    Article  PubMed  Google Scholar 

  8. Daum C, Hubschmid M, Aybek S (2014) The value of “positive” clinical signs for weakness, sensory and gait disorders in conversion disorder: a systematic and narrative review. J Neurol Neurosurg Psychiatry 85:180–190

    Article  PubMed  Google Scholar 

  9. de Vroege L, Koppenol I, Kop WJ, Riem MME, van der Feltz-Cornelis CM (2021) Neurocognitive functioning in patients with conversion disorder/functional neurological disorder. J Neuropsychol 15:69–87

    Article  PubMed  Google Scholar 

  10. Drozdová K, Štěpánková H, Lukavský J, Bezdíček O, Kopeček M (2015) Normative data for the rey-osterrieth complex figure test in older Czech adults. Cesk Slov Neurol N 78:542–549

    Google Scholar 

  11. Edwards MJ, Adams RA, Brown H, Parees I, Friston KJ (2012) A Bayesian account of “hysteria.” Brain 135:3495–3512

    Article  PubMed  PubMed Central  Google Scholar 

  12. Edwards MJ, Fotopoulou A, Parees I (2013) Neurobiology of functional (psychogenic) movement disorders. Curr Opin Neurol 26:442–447

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Espay AJ, Lang AE (2015) Phenotype-specific diagnosis of functional (psychogenic) movement disorders. Curr Neurol Neurosci Rep 15:32

    Article  PubMed  Google Scholar 

  14. Forejtova Z, Serranova T, Sieger T, Slovak M, Novakova L, Vechetova G, Ruzicka E, Edwards MJ (2022) The complex syndrome of functional neurological disorder. Psychol Med. https://doi.org/10.1017/S0033291721005225

    Article  PubMed  Google Scholar 

  15. Fulda S, Schulz H (2001) Cognitive dysfunction in sleep disorders. Sleep Med Rev 5:423–445

    Article  CAS  PubMed  Google Scholar 

  16. Gazzaniga MS, Ivry RB, Mangun GR (2009) Cognitive neuroscience: the biology of the mind. Norton, New York

    Google Scholar 

  17. Gelauff JM, Rosmalen JGM, Gardien J, Stone J, Tijssen MAJ (2020) Shared demographics and comorbidities in different functional motor disorders. Parkinsonism Relat Disord 70:1–6

    Article  CAS  PubMed  Google Scholar 

  18. Greiffenstein MF, Baker WJ, Gola T (1994) Validation of malingered amnesia measures with a large clinical sample. Psychol Assess 6:218–224

    Article  Google Scholar 

  19. Griem J, Stone J, Carson A, Kopelman MD (2016) Psychologic/functional forms of memory disorder. Handb Clin Neurol 139:407–417

    Article  CAS  PubMed  Google Scholar 

  20. Gupta A, Lang AE (2009) Psychogenic movement disorders. Curr Opin Neurol 22:430–436

    Article  PubMed  Google Scholar 

  21. Heintz CE, van Tricht MJ, van der Salm SM, van Rootselaar AF, Cath D, Schmand B, Tijssen MA (2013) Neuropsychological profile of psychogenic jerky movement disorders: importance of evaluating non-credible cognitive performance and psychopathology. J Neurol Neurosurg Psychiatry 84:862–867

    Article  PubMed  Google Scholar 

  22. Hindle JV, Petrelli A, Clare L, Kalbe E (2013) Nonpharmacological enhancement of cognitive function in Parkinson’s disease: a systematic review. Mov Disord 28:1034–1049

    Article  PubMed  Google Scholar 

  23. Huys AML, Bhatia KP, Edwards MJ, Haggard P (2020) The flip side of distractibility-executive dysfunction in functional movement disorders. Front Neurol 11:969

    Article  PubMed  PubMed Central  Google Scholar 

  24. Chun MM, Golomb JD, Turk-Browne NB (2011) A taxonomy of external and internal attention. Annu Rev Psychol 62:73–101

    Article  PubMed  Google Scholar 

  25. Jahanshahi M, Torkamani M (2017) The cognitive features of idiopathic and DYT1 dystonia. Mov Disord 32:1348–1355

    Article  CAS  PubMed  Google Scholar 

  26. John OP, Srivastava S (1999) The Big-Five trait taxonomy: history, measurement, and theoretical perspectives. Guilford Press, New York

    Google Scholar 

  27. Kranick S, Ekanayake V, Martinez V, Ameli R, Hallett M, Voon V (2011) Psychopathology and psychogenic movement disorders. Mov Disord 26:1844–1850

    Article  PubMed  PubMed Central  Google Scholar 

  28. Krivá L (2013) Stroopův test. Hogrefe-Testcentrum, Praha

    Google Scholar 

  29. Laingová H (2002) The Visual Object and Space Perception Battery (Baterie testů vizuálního vnímání předmětů a prostoru). Hogrefe-Testcentrum, Praha

    Google Scholar 

  30. Lezak MD, Howieson DB, Bigler ED, Tranel D (2012) Neuropsychological assessment, 5th edn. Oxford University Press, New York

    Google Scholar 

  31. Mack WJ, Freed DM, Williams BW, Henderson VW (1992) Boston Naming Test: shortened versions for use in Alzheimer’s disease. J Gerontol 47:P154-158

    Article  CAS  PubMed  Google Scholar 

  32. Markova H, Andel R, Stepankova H, Kopecek M, Nikolai T, Hort J, Thomas-Anterion C, Vyhnalek M (2017) Subjective cognitive complaints in cognitively healthy older adults and their relationship to cognitive performance and depressive symptoms. J Alzheimers Dis 59:871–881

    Article  PubMed  Google Scholar 

  33. Merema MR, Speelman CP, Foster JK, Kaczmarek EA (2013) Neuroticism (not depressive symptoms) predicts memory complaints in some community-dwelling older adults. Am J Geriatr Psychiatry 21:729–736

    Article  PubMed  Google Scholar 

  34. Mitrushina M, Boone KB, Razani J, D’Elia LF (2005) Handbook of normative data for neuropsychological assessment, 2nd edn. Oxford University Press, New York

    Google Scholar 

  35. Nielsen G, Ricciardi L, Meppelink AM, Holt K, Teodoro T, Edwards M (2017) A simplified version of the psychogenic movement disorders rating scale: the simplified functional movement disorders rating scale (S-FMDRS). Mov Disord Clin Prac 4:710–716

    Article  Google Scholar 

  36. Nicholson TR, Carson A, Edwards MJ, Goldstein LH, Hallett M, Mildon B, Nielsen G, Nicholson C, Perez DL, Pick S, Stone J, the FNDCOMG, follows F-Cgcaa (2020) Outcome measures for functional neurological disorder: a review of the theoretical complexities. J Neuropsychiatry Clin Neurosci 32:33–42

    Article  PubMed  Google Scholar 

  37. Nikolai T, Cechova K, Bukacova K, Fendrych Mazancova A, Markova H, Bezdicek O, Hort J, Vyhnalek M (2020) Delayed matching to sample task 48: assessment of malingering with simulating design. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn. https://doi.org/10.1080/13825585.2020.1826898

    Article  PubMed  Google Scholar 

  38. Nikolai T, Štěpánková H, Michalec J, Bezdíček O, Horáková K, Marková H, Růžička E, Kopeček M (2015) Tests of verbal fluency, Czech normative study in older patients. Cesk Slov Neurol N 78:292–299

    Article  Google Scholar 

  39. Parees I, Kassavetis P, Saifee TA, Sadnicka A, Davare M, Bhatia KP, Rothwell JC, Bestmann S, Edwards MJ (2013) Failure of explicit movement control in patients with functional motor symptoms. Mov Disord 28:517–523

    Article  PubMed  Google Scholar 

  40. Pick S, Anderson DG, Asadi-Pooya AA, Aybek S, Baslet G, Bloem BR, Bradley-Westguard A, Brown RJ, Carson AJ, Chalder T, Damianova M, David AS, Edwards MJ, Epstein SA, Espay AJ, Garcin B, Goldstein LH, Hallett M, Jankovic J, Joyce EM, Kanaan RA, Keynejad RC, Kozlowska K, LaFaver K, LaFrance WC Jr, Lang AE, Lehn A, Lidstone S, Maurer CW, Mildon B, Morgante F, Myers L, Nicholson C, Nielsen G, Perez DL, Popkirov S, Reuber M, Rommelfanger KS, Schwingenshuh P, Serranova T, Shotbolt P, Stebbins GT, Stone J, Tijssen MA, Tinazzi M, Nicholson TR (2020) Outcome measurement in functional neurological disorder: a systematic review and recommendations. J Neurol Neurosurg Psychiatry 91:638–649

    Article  PubMed  Google Scholar 

  41. Poreh A, Bezdicek O, Korobkova I, Levin JB, Dines P (2016) The Rey Auditory Verbal Learning Test forced-choice recognition task: base-rate data and norms. Appl Neuropsychol Adult 23:155–161

    Article  PubMed  Google Scholar 

  42. Preiss M, Bartoš A, Čermáková R, Nondek M, Benešová M, Rodriguez M, Nikolai T (2012) Neuropsychologická baterie Psychiatrického centra Praha. Psychiatrické centrum Praha, Praha

    Google Scholar 

  43. Rock PL, Roiser JP, Riedel WJ, Blackwell AD (2014) Cognitive impairment in depression: a systematic review and meta-analysis. Psychol Med 44:2029–2040

    Article  CAS  PubMed  Google Scholar 

  44. Roelofs K, van Galen GP, Eling P, Keijsers GP, Hoogduin CA (2003) Endogenous and exogenous attention in patients with conversion paresis. Cogn Neuropsychol 20:733–745

    Article  PubMed  Google Scholar 

  45. Schroeder RW, Twumasi-Ankrah P, Baade LE, Marshall PS (2012) Reliable Digit Span: a systematic review and cross-validation study. Assessment 19:21–30

    Article  PubMed  Google Scholar 

  46. Slovak M, Sieger T, Bonnet C, Ulmanova O, Hanuska J, Ruzicka E, Serranova T (2016) Antisaccades and vergence abnormalities in functional movement disorders: a video-oculographic study. Mov Disord 31:1072–1073

    Article  PubMed  Google Scholar 

  47. Snitz BE, Weissfeld LA, Cohen AD, Lopez OL, Nebes RD, Aizenstein HJ, McDade E, Price JC, Mathis CA, Klunk WE (2015) Subjective cognitive complaints, personality and brain amyloid-beta in cognitively normal older adults. Am J Geriatr Psychiatry 23:985–993

    Article  PubMed  PubMed Central  Google Scholar 

  48. Spielberger CD (1983) STAI: manual for the stait-trait anxiety inventory. Consulting Psychologists Press, Palo Alto

    Google Scholar 

  49. Stein DJ, Costa DLC, Lochner C, Miguel EC, Reddy YCJ, Shavitt RG, van den Heuvel OA, Simpson HB (2019) Obsessive-compulsive disorder. Nat Rev Dis Primers 5:52

    Article  PubMed  PubMed Central  Google Scholar 

  50. Stepankova H, Lukavsky J, Buschkuehl M, Kopecek M, Ripova D, Jaeggi SM (2014) The malleability of working memory and visuospatial skills: a randomized controlled study in older adults. Dev Psychol 50:1049–1059

    Article  PubMed  Google Scholar 

  51. Stone J, Carson A, Duncan R, Roberts R, Warlow C, Hibberd C, Coleman R, Cull R, Murray G, Pelosi A, Cavanagh J, Matthews K, Goldbeck R, Smyth R, Walker J, Sharpe M (2010) Who is referred to neurology clinics?–the diagnoses made in 3781 new patients. Clin Neurol Neurosurg 112:747–751

    Article  CAS  PubMed  Google Scholar 

  52. Štěpánková H, Nikolai T, Lukavský J, Bezdíček O, Vrajová M, Kopeček M (2015) Mini-Mental State Examination – česká normativní studie. Česká a slovenská neurologie a neurochirurgie 78:57–63

    Google Scholar 

  53. Teodoro T, Edwards MJ, Isaacs JD (2018) A unifying theory for cognitive abnormalities in functional neurological disorders, fibromyalgia and chronic fatigue syndrome: systematic review. J Neurol Neurosurg Psychiatry 89:1308–1319

    Article  PubMed  Google Scholar 

  54. Van den Bergh O, Witthoft M, Petersen S, Brown RJ (2017) Symptoms and the body: taking the inferential leap. Neurosci Biobehav Rev 74:185–203

    Article  PubMed  Google Scholar 

  55. van Poppelen D, Saifee TA, Schwingenschuh P, Katschnig P, Bhatia KP, Tijssen MA, Edwards MJ (2011) Attention to self in psychogenic tremor. Mov Disord 26:2575–2576

    Article  PubMed  Google Scholar 

  56. Vechetova G, Slovak M, Kemlink D, Hanzlikova Z, Dusek P, Nikolai T, Ruzicka E, Edwards MJ, Serranova T (2018) The impact of non-motor symptoms on the health-related quality of life in patients with functional movement disorders. J Psychosom Res 115:32–37

    Article  PubMed  Google Scholar 

  57. Voon V, Ekanayake V, Wiggs E, Kranick S, Ameli R, Harrison NA, Hallett M (2013) Response inhibition in motor conversion disorder. Mov Disord 28:612–618

    Article  PubMed  PubMed Central  Google Scholar 

  58. Wardle-Pinkston S, Slavish DC, Taylor DJ (2019) Insomnia and cognitive performance: a systematic review and meta-analysis. Sleep Med Rev 48:101205

    Article  PubMed  Google Scholar 

  59. Wechsler D (2010) WAIS-III: Wechslerova inteligenční škála pro dospělé WAIS-III. Hogrefe-Testcentrum, Praha

    Google Scholar 

  60. Willment K, Hill M, Baslet G, Loring DW (2015) Cognitive impairment and evaluation in psychogenic nonepileptic seizures: an integrated cognitive-emotional approach. Clin EEG Neurosci 46:42–53

    Article  PubMed  Google Scholar 

  61. Yates JA, Clare L, Woods RT, Matthews FE, Cognitive F, Ageing Study W (2015) Subjective memory complaints are involved in the relationship between mood and mild cognitive impairment. J Alzheimers Dis 48(Suppl 1):S115-123

    Article  PubMed  Google Scholar 

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Funding

The study was supported by the Ministry of Health of the Czech Republic, AZV No. 16-29651A.

Author information

Authors and Affiliations

  1. Department of Neurology and Centre of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Kateřinská 30, 120 00, Prague 2, Czech Republic

    Gabriela Věchetová, Tomáš Nikolai, Matěj Slovák, Zuzana Forejtová, Eva Straková, Evžen Růžička & Tereza Serranová

  2. National Institute of Mental Health, Klecany, Czech Republic

    Gabriela Věchetová & Eva Straková

  3. Department of Psychology, Charles University, Prague, Czech Republic

    Tomáš Nikolai & Marek Vranka

  4. Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George’s University of London, London, UK

    Tiago Teodoro & Mark J. Edwards

  5. Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal

    Tiago Teodoro

Authors
  1. Gabriela Věchetová
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  2. Tomáš Nikolai
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  3. Matěj Slovák
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  4. Zuzana Forejtová
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  5. Marek Vranka
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  6. Eva Straková
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  7. Tiago Teodoro
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  8. Evžen Růžička
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  9. Mark J. Edwards
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  10. Tereza Serranová
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Corresponding author

Correspondence to Tomáš Nikolai.

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The authors declare that they have no conflict of interest. The authors have no relevant financial or non-financial interests to disclose.

Ethical standards

The study has been approved by the appropriate ethics committee. This research is animal cruelty-free, this study and all the cited studies were conducted strictly in humans.

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Věchetová, G., Nikolai, T., Slovák, M. et al. Attention impairment in motor functional neurological disorders: a neuropsychological study. J Neurol 269, 5981–5990 (2022). https://doi.org/10.1007/s00415-022-11211-x

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  • DOI: https://doi.org/10.1007/s00415-022-11211-x

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