Laura McWhirter

• BA(Hons) MBChB PhD MRCP MRCPsych
• Consultant Neuropsychiatrist at NHS Lothian

Cognitive symptoms are common, and yet many who seek help for cognitive symptoms neither have, nor go on to develop, dementia. A proportion of these people are likely to have functional cognitive disorders, a subtype of functional neurological disorders, in which cognitive symptoms are present, associated with distress or disability, but caused by...

Mild traumatic brain injury (TBI) is common and associated with a range of diffuse, non-specific symptoms including headache, nausea, dizziness, fatigue, hypersomnolence, attentional difficulties, photosensitivity and phonosensitivity, irritability and depersonalisation. Although these symptoms usually resolve within 3 months, 5%–15% of patients ar...

Objective Foreign accent syndrome (FAS) is widely understood as an unusual consequence of structural neurological damage, but may sometimes represent a functional neurological disorder. This observational study aimed to assess the prevalence and utility of positive features of functional FAS in a large group of individuals reporting FAS. Methods P...

Objective: There has been a recent resurgence of interest in physical treatments for functional motor disorders (FMD) including Transcranial Magnetic Stimulation (TMS). This pilot study aimed to test the effectiveness of a single session of motor cortex TMS as a treatment for functional upper limb weakness. Methods: Ten subjects with a diagnosis...

The use of electricity in medical treatment has always been technology-driven, rather than aetiology-driven; as new techniques have appeared, clinicians have quickly looked to try them in the treatment of all sorts of conditions where existing treatment options are limited. Functional disorders--as identified anachronistically in our analysis--have...

Background The underlying mechanisms of functional cognitive disorder (FCD) are still poorly understood. This hinders diagnostic identification and establishment of personalised and effective treatments. We aimed to describe the precipitating factors for new‐onset FCD and explore differences between the acute and gradual onset FCD groups. Methods...

Background Functional cognitive disorder (FCD) poses a diagnostic challenge due to its resemblance to other neurocognitive disorders and limited biomarker accuracy. We aimed to develop a new diagnostic checklist to identify FCD versus other neurocognitive disorders. Methods The clinical checklist was developed through mixed methods: (1) a literatu...

Background: Functional cognitive disorder (FCD) is a subtype of functional neurological disorder (FND). FCD can present with various cognitive symptoms, precipitants, and comorbidities (other FNDs, concussion, fatigue, fibromyalgia, etc.). However, there are no widely available existing behavioral health interventions for FCD. The authors aim was t...

‘Brain fog’ is a term that patients use increasingly frequently in the neurology clinic. We may think that we know what patients are talking about but at least some of the time we are likely to be getting it wrong. Patients use the term ‘brain fog’ to describe a wide range of subjective phenomena and symptoms. This paper suggests useful lines of qu...

Even within a single protein, antibody binding can have beneficial, neutral, or harmful effects during the response to infection. Resolving a polyclonal antibody repertoire across a pathogen’s proteome to specific epitopes may therefore explain much of the heterogeneity in susceptibility to infectious disease. However, the three-dimensional nature...

Even within a single protein, antibody binding can have beneficial, neutral, or harmful effects during the response to infection. Resolving a polyclonal antibody repertoire across a pathogen’s proteome to specific epitopes may therefore explain much of the heterogeneity in susceptibility to infectious disease. However, the three-dimensional nature...

Background Current proposed criteria for functional cognitive disorder (FCD) have not been externally validated. We sought to analyse the current perspectives of cognitive specialists in the diagnosis and management of FCD in comparison with neurodegenerative conditions. Methods International experts in cognitive disorders were invited to assess s...

Background Functional neurological disorder (FND) is characterised by neurological symptoms, such as seizures and abnormal movements. Despite its significance to patients, the clinical features of chronic pain in people with FND, and of FND in people with chronic pain, have not been comprehensively studied. Methods We systematically reviewed PubMe...

Introduction Currently there is no standardized way to diagnose functional cognitive disorder (FCD) in clinical practice. We aimed to develop a bedside screening tool to differentiate between FCD and neurodegenerative causes of memory complaints. Methods A Delphi methodology was used to obtain consensus based on expert opinion through a series of...

Objective: Functional cognitive disorder (FCD) accounts for around a third of patients attending specialized memory clinics. It is also overrepresented in patients with other functional and somatic diagnoses. So far, no long-term diagnostic validity studies were conducted, and a positive diagnostic profile is yet to be identified. We aimed to revi...

Background: Chronic pain is a common comorbidity in those with functional neurological disorder (FND), however the prevalence and characteristics of FND in those with chronic pain is unknown. Methods: A retrospective electronic records review of consecutive new patients attending a chronic pain clinic of a regional service. Clinical features, me...

Functional neurological disorder (FND) is a common and disabling disorder, often misunderstood by clinicians. Although viewed sceptically by some, FND is a diagnosis that can be made accurately, based on positive clinical signs, with clinical features that have remained stable for over 100 years. Despite some progress in the last decade, people wit...

Observational population studies indicate that prevention of dementia and cognitive decline is being accomplished, possibly as an unintended result of better vascular prevention and healthier lifestyles. Population aging in the coming decades requires deliberate efforts to further decrease its prevalence and societal burden. Increasing evidence sup...

Background: Performance Validity Tests (PVTs) are used in neuropsychological assessments to detect patterns of performance suggesting that the broader evaluation may be an invalid reflection of an individual's abilities. Data on Functional motor disorder (FMD) are currently poor and conflicting. Objectives: We aimed to examine the rate of failur...

Functional cognitive disorders (FCDs) are a common cause of subjective and mild cognitive impairment. Isolated FCDs commonly present to the cognitive clinic, but examination of the nature of the symptoms suggests that they can also be understood as a transdiagnostic feature of many other conditions. This article examines methods of formulating the...

Background The term ‘brain fog’ is increasingly used colloquially to describe difficulties in the cognitive realm. But what is brain fog? What sort of experiences do people talk about when they talk about brain fog? And, in turn, what might this tell us about potential underlying pathophysiological mechanisms? This study examined first-person descr...

Objectives/Aims Chronic pain is commonly reported as a comorbidity in patients with functional neurological disorder (FND) however the prevalence of FND in those presenting with chronic pain is unknown. We aimed to estimate 1) the prevalence of FND in patients seen at a chronic pain clinic and 2) how patients with chronic pain and comorbid FND diff...

Objectives The term ‘brain fog’ is increasingly used in social and other media. But what is brain fog? What sort of experiences do people talk about when they talk about brain fog? And, in turn, what might this tell us about potential underlying pathophysiological mechanisms? In this study we examined first-person descriptions of brain fog in order...

Antibodies can have beneficial, neutral, or harmful effects so resolving an antibody repertoire to its target epitopes may explain heterogeneity in susceptibility to infectious disease. However, the three-dimensional nature of antibody-epitope interactions limits discovery of important targets. We describe and experimentally validated a computation...

Functional neurological disorder is common in neurological practice. A new approach to the positive diagnosis of this disorder focuses on recognisable patterns of genuinely experienced symptoms and signs that show variability within the same task and between different tasks over time. Psychological stressors are common risk factors for functional n...

Cognitive behavioral therapy (CBT) is a widely used therapeutic modality in general psychiatric practice. In this review, we consider its application to neurological disorders. We examine the basic framework of CBT—that symptoms, emotions, thoughts, and behaviors are all interrelated and that therapeutic interventions that lead to change in thought...

We envisage the development of new Brain Health Services to achieve primary and secondary dementia prevention. These services will complement existing memory clinics by targeting cognitively unimpaired individuals, where the focus is on risk profiling and personalized risk reduction interventions rather than diagnosing and treating late-stage disea...

Although prevention of dementia and late-life cognitive decline is a major public health priority, there are currently no generally established prevention strategies or operational models for implementing such strategies into practice. This article is a narrative review of available evidence from multidomain dementia prevention trials targeting sev...

Dementia has a devastating impact on the quality of life of patients and families and comes with a huge cost to society. Dementia prevention is considered a public health priority by the World Health Organization. Delaying the onset of dementia by treating associated risk factors will bring huge individual and societal benefit. Empirical evidence s...

Background Functional cognitive disorders (FCD) are an important differential diagnosis of neurodegenerative disease. The utility of suggested diagnostic features has not been prospectively explored in “real world” clinical populations. This study aimed to identify positive clinical markers of FCD. Methods Adults with cognitive complaints but not...

The early and accurate diagnosis of dementia is more important than ever before but remains challenging. Dementia is increasingly the business of neurologists and, with ageing populations worldwide, will become even more so in future. Here we outline a practical, symptom-led, bedside approach to suspecting dementia and its likely diagnosis, inspire...

Communication problems (eg, dysphonia, dysfluency and language and articulation disorders), swallowing disorders (dysphagia and globus), cough and upper airway symptoms, resulting from functional neurological disorder (FND), are commonly encountered by speech and language professionals. However, there are few descriptions in the literature of the m...

Aims This study aimed to explore the terms used by old-age psychiatrists and psychologists to describe subjective and mild cognitive impairment and functional cognitive disorders (FCD) in clinical practice. Method Participants were selected from across the United Kingdom based on their clinical involvement in the assessment of cognitive complaints...

Objective Many people present to health services with concern about cognitive symptoms. In a significant proportion those symptoms are not the result of pathologically defined brain disease. In some they are part of a functional cognitive disorder (FCD). We assessed the frequency of cognitive lapses in a non-clinical sample in order to consider the...

We present a practical overview of functional neurological disorder (FND), its epidemiology, assessment and diagnosis, diagnostic pitfalls, treatment, aetiology and mechanism. We present an update on functional limb weakness, tremor, dystonia and other abnormal movements, dissociative seizures, functional cognitive symptoms and urinary retention, a...

In order to address the oft-cited societal, economic, and health and social care impacts of neurodegenerative diseases, such as Alzheimer’s disease, we must move decisively from reactive to proactive clinical practice and to embed evidence-based brain health education throughout society. Most disease processes can be at least partially prevented, s...

Introduction It has been suggested for over 100 years that patterns of neurological symptoms and signs in functional neurological disorders may be shaped at a neural level by underlying ideas or preconceptions how neurological symptoms present. This study used experimental simulation to probe ideas about seizures in healthy volunteers, with a view...

An increasing proportion of cognitive difficulties are recognized to have a functional cause, the chief clinical indicator of which is internal inconsistency. When these symptoms are impairing or distressing, and not better explained by other disorders, this can be conceptualized as a cognitive variant of functional neurological disorder, termed fu...

Stroke is one of the leading causes of death and disability both in the United Kingdom and worldwide. Approximately one-fifth of strokes are preceded by a transient ischaemic attack (TIA), with TIA patients being at greatest risk of stroke in the days immediately following TIA onset. This chapter examines the clinical presentation of stroke, along...

Performance validity tests (PVTs) are widely used in attempts to quantify effort and/or detect negative response bias during neuropsychological testing. However, it can be challenging to interpret the meaning of poor PVT performance in a clinical context. Compensation-seeking populations predominate in the PVT literature. We aimed to establish base...

Background Symptoms of functional neurological disorder have traditionally been thought to depend, in part, on patients’ ideas about symptoms rather than on the rules of pathophysiology. The possibility that functional cognitive symptoms might similarly reflect ideas of dementia has not been explored. We aimed to assess beliefs, through performance...

Improving Diagnosis in Cognitive Disorders (IDCD) study protocol.

Objectives/Aims Symptoms and signs of functional (psychogenic) motor and sensory disorder often depend on the individual’s ideas about symptoms rather than on the rules of anatomy and physiology. The possibility that functional cognitive symptoms might similarly reflect beliefs about cognitive disorders such as dementia has not been widely explored...

Objectives/Aims Foreign accent syndrome (FAS) is a disorder of speech in which listeners perceive the affected individual as speaking with a foreign or different regional accent that is not their habitual accent. FAS is widely understood as an unusual consequence of stroke or other lesions within speech-motor networks. However, case reports of FAS...

Functional cognitive disorders are likely to account for a significant proportion of adults presenting with cognitive (memory and thinking) symptoms which are not caused by neurodegenerative disease or structural brain lesions, incorporating those with isolated functional cognitive symptoms, those with primary psychiatric disorders, and those with...

Functional motor disorder (FMD), also called psychogenic motor disorder or conversion disorder, describes impairments of motor function where there is no evidence of organic disease. The diagnosis is usually confirmed by positive clinical signs, such as Hoover's sign, in which normal power returns when attention is diverted away from the affected l...

Functional coma – here defined as a prolonged motionless dissociative attack with absent or reduced response to external stimuli – is a relatively rare presentation. In this chapter we examine a wide range of terms used to describe states of unresponsiveness in which psychologic factors are relevant to etiology, such as depressive stupor, catatonia...

Functional neurological disorders are common problems in neurologic practice. In the past decade there has been an increasing interest in this group of disorders both from a clinical as well as research point of view. In this review, we highlight some of the most salient and exciting publications from recent years focusing especially on new finding...

Hoover's sign - weakness of voluntary hip extension with normal involuntary hip extension during contralateral hip flexion against resistance - is a commonly used sign in the diagnosis of functional weakness of the lower limb. However, little is known about the performance of this sign in clinical practice. Hoover's sign was tested as part of the d...

Kratom (Mitragyna speciosa) has been used for medicinal and recreational purposes. It has reported analgesic, euphoric and antitussive effects via its action as an agonist at opioid receptors. It is illegal in many countries including Thailand, Malaysia, Myanmar, South Korea and Australia; however, it remains legal or uncontrolled in the UK and USA...