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Social cognition in Parkinson’s disease and functional movement disorders

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Abstract

Introduction

Functional movement disorders (FMD) can overlap with Parkinson’s disease (PD), and distinguishing between the two clinical conditions can be complex. Framing social cognition (theory of mind) (TOM) disorder, attention deficit, and psychodynamic features of FMD and PD may improve diagnosis.

Methods

Subjects with FMD and PD and healthy controls (HC) were administered tasks assessing TOM abilities and attention. The psychodynamic hypothesis of conversion disorder was explored by a questionnaire assessing dissociative symptoms. A comprehensive battery of neuropsychological tasks was also administered to FMD and PD.

Results

Although both FMD and PD scored lower than HC on all TOM tests, significant correlations between TOM and neuropsychological tasks were found only in PD but not in FMD. Only PD showed a reduction in attentional control. Dissociative symptoms occurred only in FMD.

Discussion

Cognitive-affective disturbances are real in FMD, whereas they are largely dependent on cognitive impairment in PD.

Attentional control is preserved in FMD compared to PD, consistent with the hypothesis that overload of voluntary attentional orientation may be at the basis of the onset of functional motor symptoms. On a psychodynamic level, the confirmation of dissociative symptoms in FMD supports the conversion disorder hypothesis.

Conclusion

FMD and PD can be distinguished on an affective and cognitive level. At the same time, however, the objective difficulty often encountered in distinguishing between the two pathologies draws attention to how blurred the boundary between ‘organic’ and ‘functional’ can be.

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Authors and Affiliations

  1. Department of Psychology, Università Cattolica del Sacro Cuore, 20123, Milan, Italy

    Maria Caterina Silveri, Alice Tondinelli, Francesco Pagnini & Sonia Di Tella

  2. Department of Geriatrics, Orthopedics and Rheumatology, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy

    Maria Caterina Silveri, Maria Rita Lo Monaco, Martina Petracca, Paola Zinzi, Serena Fragapane, Gino Pozzi & Anna Rita Bentivoglio

  3. Institute of Psychiatry, Università Cattolica del Sacro Cuore, 00168, Rome, Italy

    Gino Pozzi

  4. Institute of Neurology, Università Cattolica del Sacro Cuore, 00168, Rome, Italy

    Anna Rita Bentivoglio

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  1. Maria Caterina Silveri
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  2. Maria Rita Lo Monaco
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Correspondence to Maria Rita Lo Monaco.

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All procedures performed in the present study were in accordance with the ethical standards of the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the ethical medical committee of the Università Cattolica del Sacro Cuore. All subjects gave written informed consent.

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Silveri, M.C., Lo Monaco, M.R., Tondinelli, A. et al. Social cognition in Parkinson’s disease and functional movement disorders. Neurol Sci (2024). https://doi.org/10.1007/s10072-024-07452-5

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