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首页> 外文期刊>Journal of Neurology, Neurosurgery and Psychiatry >A unifying theory for cognitive abnormalities in functional neurological disorders, fibromyalgia and chronic fatigue syndrome: systematic review
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A unifying theory for cognitive abnormalities in functional neurological disorders, fibromyalgia and chronic fatigue syndrome: systematic review

机译：功能性神经障碍，纤维肌痛和慢性疲劳综合征的认知异常统一理论：系统评价

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Background Functional cognitive disorder (FCD) describes cognitive dysfunction in the absence of an organic cause. It is increasingly prevalent in healthcare settings yet its key neuropsychological features have not been reported in large patient cohorts. We hypothesised that cognitive profiles in fibromyalgia (FM), chronic fatigue syndrome (CFS) and functional neurological disorders (FNDs) would provide a template for characterising FCD. Methods We conducted a systematic review of studies with cognition-related outcomes in FM, CFS and FND. Results We selected 52 studies on FM, 95 on CFS and 39 on FND. We found a general discordance between high rates of subjective cognitive symptoms, including forgetful ness, distractibility and word-finding difficulties, and inconsistent objective neuropsychological deficits. Objective deficits were reported, including poor selective and divided attention, slow information processing and vulnerability to distraction. In some studies, cognitive performance was inversely correlated with pain, exertion and fatigue. Performance validity testing demonstrated poor effort in only a minority of subjects, and patients with CFS showed a heightened perception of effort. Discussion The cognitive profiles of FM, CFS and non-cognitive FND are similar to the proposed features of FCD, suggesting common mechanistic underpinnings. Similar findings have been reported in patients with mild traumatic brain injury and whiplash. We hypothesise that pain, fatigue and excessive interoceptive monitoring produce a decrease in externally directed attention. This increases susceptibility to distraction and slows information processing, interfering with cognitive function, in particular multitasking. Routine cognitive processes are experienced as unduly effortful. This may reflect a switch from an automatic to a less efficient controlled or explicit cognitive mode, a mechanism that has also been proposed for impaired motor control in FND. These experiences might then be overinterpreted due to memory perfectionism and heightened self-monitoring of cognitive performance.
机译：背景技术功能认知疾病（FCD）描述了在没有有机原因的情况下的认知功能障碍。在医疗保健环境中越来越普遍，但它的主要神经心理学特征尚未在大型患者队列中报告。我们假设纤维肌痛（FM），慢性疲劳综合征（CFS）和功能性神经疾病（FNDS）中的认知谱将提供用于表征FCD的模板。方法我们对FM，CFS和FND中的认知相关结果进行了系统审查。结果我们选择了52项关于FM，95对CFS和39的FM研究的研究。我们在高级主观认知症状之间发现了一般不一致，包括健忘，分心和词语困难，以及无情的客观神经心理学赤字。报告了客观赤字，包括差的选择性和分开的注意力，信息处理缓慢，以分散注意力。在一些研究中，认知性能与疼痛，劳累和疲劳相反。性能有效性测试仅少于少数科目的努力，患有CFS的患者显得提高了对努力的看法。讨论FM，CFS和非认知FND的认知配置文件类似于FCD的拟议特征，表明共同的机制底层。患有类似的调节脑损伤和鞭打的患者中已经报道了类似的结果。我们假设疼痛，疲劳和过度的中断监测产生外部导向的关注。这增加了对分度和减慢信息处理的易感性，干扰认知函数，特别是多任务处理。常规认知过程经历过不稳定的努力。这可以从自动反射到较低有效的受控或显式认知模式的切换，这也提出了一种用于FND中的电动机控制受损的机构。由于记忆完美主义和认知性能的自我监测，这些经历可能会过度解释。

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