Hurst revisited: Are symptoms and signs of functional motor and sensory disorders “dependent on idea”?

Abstract

The study confirmed Hurst's finding that non-medical people generally expect sensory loss to go along with paralysis, especially if the examiner suggests it. When present, it usually conforms to functional patterns of sensory loss. Clinical tests for functional and motor disorders appear to behave somewhat differently in patients asked to pretend to have symptoms suggesting that larger more detailed studies would be worthwhile.

I think, therefore I forget – using experimental simulation of dementia to understand functional cognitive disorders

“…It has been traditionally taught that the symptoms of functional neurological disorders are, in part, dependent on the patient's ideas about the symptoms rather than anatomical and pathophysiological rules. 9 Similarities have been observed between simulated and functional paralysis, for example, suggesting to us not that patients with functional disorder are feigning but rather that symptoms in both cases may depend on "top-down" predictions that the brain makes about motor and sensory experience, which in the case of a functional disorder are involuntary.…”

“…16 Experimental simulation has previously demonstrated similarity between simulated and functional paralysis, both groups also demonstrating sensory loss, in patterns (for example, circumferential) that are less common in structural lesions. 9,18 It might therefore be similarly expected that individuals simulating dementia might demonstrate prior beliefs about dementia, which are more characteristic of functional cognitive disorders than of dementia. This study aimed to access prior beliefs about dementia in healthy individuals by asking them to simulate symptoms of mild dementia, with the purpose of clarifying those ideas and identifying behaviors with potential utility in the diagnosis of functional cognitive disorders.…”