Attention
Attention is a basic cognitive system whose normal functioning is essential for the optimal functioning of the rest of the hierarchically superordinate cognitive functions.
Similar to emotional processing and perceptual reasoning, neurobiological theories of attention disorders in patients with FND are based on a model of predictive processing, where functional symptoms are the result of a strong influence of abnormal prior information, accompanied by an abnormal distribution of attention, and this mechanism can explain motor, sensory, cognitive and interoceptive phenomena (Drane et al., 2020; Teufel et al., 2018; Věchetová et al., 2023).
Attention and the FND
In patients with motor functional neurological disorder, a characteristic temporary (complete) improvement of motor symptoms can be observed when the patient shifts attention away from the affected body part and a characteristic (complete) worsening of symptoms can be observed when the patient shifts attention back to the affected body part (Parees et al., 2013; Věchetová et al., 2023).
Patients with FND often report cognitive symptoms such as problems with memory, concentration, sustained and selective attention (Teodoro et al., 2017), which may represent associated functional symptoms per se or may be due to an abnormal focus of attention on motor symptoms and the body. All of these can lead to an overload of working memory and result in poorer well-being, pain and fatigue (Věchetová et al., 2023).
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de Vroege, L., Koppenol, I., Kop, W. J., Riem, M. M., and van der Feltz-Cornelis, C. M. (2021). Neurocognitive functioning in patients with conversion disorder/functional neurological disorder. Journal of Neuropsychology, 15(1), 69-87.
Věchetová, G., Nikolai, T., Slovák, M., Forejtová, Z., Vranka, M., Straková, E., ... Attention impairment in motor functional neurological disorders: a neuropsychological study. Journal of neurology, 269(11), 5981-5990.
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Teodoro, T., Edwards, M. J., and Isaacs, J. D. (2018). A unifying theory for cognitive abnormalities in functional neurological disorders, fibromyalgia and chronic fatigue syndrome: a systematic review. Journal of Neurology, Neurosurgery & Psychiatry, 89(12), 1308-1319.