Considerations regarding the clinical utility of cognitive testing in functional neurological disorder: A narrative review

Functional neurological disorder (FND) is a common clinical condition that is associated with a wide range of neurological, mental health, and physical symptoms, as well as reduced quality of life. There is growing recognition of frequent cognitive difficulties across the spectrum of FND presentations, which are related to impairment and disability for many patients. However, uncertainty regarding the potential clinical utility of cognitive testing continues to hold back optimal assessment and treatment. Specific issues that are in need of additional clarity include contributions of cognitive testing beyond the initial FND diagnosis; overall rates of failed performance validity tests in patients with FND; and conflicting notions about whether cognitive impairments based on testing are either incompatible with the diagnosis or ubiquitous in FND. The current manuscript reviews evidence pertaining to each of these issues, outlines contexts in which cognitive testing is indicated or contraindicated, and provides recommendations for how neuropsychologists can use test results to benefit patients and their families.