Abstract

Dr Jon Stone is an NHS Consultant Neurologist and Honorary Senior Lecturer in Neurology in Edinburgh. He has had a research interest in functional disorders in neurology since 1999 starting with his PhD thesis – a case control study of patients with functional limb weakness.

He has published widely in the area including systematic reviews, large cohort studies, imaging studies and treatment studies. He has contributed to new diagnostic criteria for DSM-5 and ICD-11 and been involved in promoting functional disorders in training and research.

He has made a website for patients at www.neurosymptoms.org which has been translated by other neurologists in to 12 other languages. He runs a weekly functional disorders clinic and as of August 2012 is a National Research Strategy (NHS Scotland) Career Research Fellow.

Memory and cognitive ‘symptoms’ exist at high levels in the general population. Around one third of young adults forget why they came in to a room, what they had for breakfast the day before and regularly lose their car keys.

There is an emerging awareness of those patients, especially in the ‘early onset dementia’ clinic who do not have dementia, or any other ‘organic’ cause for their genuine memory symptoms. Studies in Liverpool and Sheffield suggest these patients are anything from 40–80% of attendees. Greater diagnostic accuracy for dementia, increasing public awareness of dementia diagnosis and political/financial incentives for making the diagnosis all arguably make the study of this group increasingly important. The risk of harm in overdiagnosing dementia or not giving any diagnosis to someone with these symptoms is often discussed but rarely studied.

Much of the literature in this area has focused on Subjective Memory Impairment and on Mild Cognitive Impairment with follow up studies mainly interested on how to detect the subgroup who go on to get dementia, not all the rest who stay the same or even improve. This talk will cover what this ‘Non-Dementia’ is in the memory clinic including the following overlapping categories:

1. Memory symptoms as part of anxiety and depression;

2. Isolate functional memory symptoms that are in excess of normal but occur in the absence of anxiety and depression;

3. Memory symptoms that are normal for the population but have become a focus for concern, sometimes with “dementia phobia”

4. Functional memory symptoms occurring in the context of another functional disorder such as chronic fatigue syndrome

5. Memory symptoms related to prescription drugs, especially opiates

6. Retrograde/Functional/Psychogenic Amnesia

7. Prodromal stages of dementia/other neurodegenerative disorders but too early to be diagnosed.

Just as functional motor disorders and seizures are best defined by their positive features there have been attempts to do the same for functional memory disorders.1 ,2 I will review what we do know and what we don't and how the field might move forward.