I retired as a doctor 2 years ago. My career was in psychiatry for older adults and I succesfully campaigned for a Timely approach to the diagnosis of dementia. I was concerned that an incentivised, target-based approach for early diagnosis, would result in unnecessary harm. The primary difficulty being that the neuro-pathological pathways to dementia were still not sufficiently understood to make accurate early diagnosis. Furthermore the various terms that had been used to describe mild-impairments of memory and other cognitive processes lacked in predictive value.
Since I have retired a whole new area of research has opened up under the rubric “Functional Disorders”. It seems to me, despite the lack in a clear understanding of this generalised [and reductive term], that it is being zealously introduced into the clinical domain. This, at best, seems premature to me. There is huge momentum behind this ‘FUNCTIONAL’ rubric, and it is being widely funded by government and industry.
“Functional Cognitive Disorder” seems to be replacing the term ‘Mild Cognitive Impairment’. This is a very difficult and complicated area which is full of uncertainties. My concern is that there are just as many uncertainties with “Functional Cognitive Disorder” as with the old ‘label’, and that these uncertainties are not being fully shared with patients. Furthermore, it is likely that a subtle, but important shift, will result from this new terminology. What I mean is that the word “functional” places the onus on the patient and that this may allow professionals to re-attribute responsibility, and thus skew any balance of understanding.
This whole ‘FUNCTIONAL business’, has, in my opinion, become something of a ‘cult’. I am very much reminded of Improvement Science which I did my best to raise concerns about.
I am also troubled that those who are promoting this new diagnostic rubric have chosen NOT to include iatrogenic causes of ‘Functional Disorder’ – such as medicines taken as prescribed. I find this decision unscientific, unethical and mystifying [In delirium research, for example, iatrogenic aetiologies are essential considerations].
The following paper was recently widely shared Professor Rob Howard, a leading and influential expert in dementia. It was shared without any acknowledgement of a wide range of uncertainties [some of which I have highlighted in yellow]:
