Description
If your cognition was deteriorating, how would you react? While poor insight into cognitive dysfunction is common in neurodegenerative disorders, many people present with fears about declining memory to their family physician, neurologist, or psychiatrist. Although understandably distressing, these subjective cognitive concerns are only weakly associated with objectively measured cognitive deficits [1-3]. This paradoxical phenomenon occurs across multiple patient populations [4-6] and can leave patients feeling invalidated in clinical encounters. In this General Session, we explore SCI in three patient populations: multiple sclerosis (MS), mild traumatic brain injury/concussion (mTBI), and functional cognitive disorder. The three presentations will incorporate case-based exploration and opportunities for questions and discussion. We will highlight the similarities and differences in SCI between these patient populations. We begin by exploring SCI in MS. Among people with MS, more than 70% report subjective cognitive deficits [4], and SCI is associated with worse quality of life, reduced social engagement, and higher rates of unemployment [7, 8]. In this evidence-based presentation, we describe the pattern of SCI and objective cognitive dysfunction in the MS population, explore potential contributors from a biopsychosocial lens, and discuss treatment principles. This talk will be particularly relevant for clinicians caring for people with MS. Next, we explore SCI in mTBI. Although majority of mTBIs tend to resolve within weeks, approximately 10 to 30% of patients report prolonged or chronic postconcussive symptoms, with cognitive impairment being among the most prevalent, persistent, and debilitating [9]. During this presentation, we will describe the pattern of SCI in the context of polysympomatic patients post mTBI, discuss the underlying neurobiology, and highlight emerging treatment strategies. We conclude the session with functional cognitive disorder, a relatively new diagnostic construct whereby persistent problematic cognitive difficulties are accompanied by ‘internal inconsistency’ and are not better explained by another disorder [10, 11]. We discuss how functional cognitive disorder overlaps with the cognitive symptomatology commonly encountered in MS and mTBI, as well as in other conditions (e.g., Long COVID), and review the latest management approaches.
Format
Recorded webinar.
This content was recorded during the APA 2023 Annual Meeting.
Learning Objectives
- Describe subjective cognitive impairment (SCI) and its relationship with objective cognition.
- Analyze the potential contributors to SCI in a patient with multiple sclerosis to develop an appropriate management plan.
- Characterize SCI in a patient with mild traumatic brain injury and develop an approach to management.
- Explore functional cognitive disorder as a transdiagnostic lens for understanding SCI.
Target Audience
Residents/Fellows, Psychiatrists, Psychologists
Estimate Time to Complete
Estimated Duration: 2 hours
Program Start Date: May 1, 2025
Program End Date: May 1, 2028
How to Earn Credit
Participants who wish to earn AMA PRA Category 1 Credit™ may do so after completing all sections of the course including the evaluation. After evaluating the program, course participants will be provided with an opportunity to claim hours of participation and print an official CME certificate (physicians) or certificate of participation (non-physicians) showing the completion date and hours earned.
Continuing Education Credit
In support of improving patient care, the American Psychiatric Association is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
The APA designates this live activity for a maximum of 2 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Faculty and Planner Disclosures
The American Psychiatric Association adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Medical Education. Any individuals in a position to control the content of a CME activity — including faculty, planners, reviewers or others — are required to disclose all relevant financial relationships with ineligible entities (commercial interests). All relevant conflicts of interest have been mitigated prior to the commencement of the activity.
Instructors
- Omar Ghaffar, MD
- Adriano Mollica, PhD
- David Freedman, DPM
Planners
- Vishal Madaan, MD, Chief of Education and Deputy Medical Director at the American Psychiatric Association.
Accessibility for Participants with Disabilities
The American Psychiatric Association is committed to ensuring accessibility of its website to people with disabilities. Please contact the American Psychiatric Association at 202-559-3900, if you require assistance seven (7) business days prior to the start of a live webinar.
Technical Requirements
This internet-based CME activity is best experienced using any of the following:
- The latest and 2nd latest public versions of Google Chrome, Mozilla Firefox, or Safari
- Internet Explorer 11+
This Web site requires that JavaScript and session cookies be enabled. Certain activities may require additional software to view multimedia, presentation, or printable versions of the content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Acrobat Reader, Microsoft PowerPoint, and Windows Media Player.
Optimal System Configuration:
- Browser: Google Chrome (latest and 2nd latest version), Safari (latest and 2nd latest version), Internet Explorer 11.0+, Firefox (latest and 2nd latest version), or Microsoft Edge (latest and 2nd latest version)
- Operating System: Windows versions 8.1+, Mac OS X 10.5 (Leopard) +, Android (latest and 2nd latest version), or iOS/iPad OS (latest and 2nd latest version)
- Internet Connection: 1 Mbps or higher
Minimum Requirements:
- Windows PC: Windows 8.1 or higher; 1 GB (for 32-bit)/2 GB (for 64-bit) or higher RAM; Microsoft DirectX 9 graphics device with WDDM driver; audio playback with speakers for programs with video content
- Macintosh: Mac OS X 10.5 or higher with latest updates installed; Intel, PowerPC G5, or PowerPC G4 (867MHz or faster) processor; 512 MB or higher RAM; audio playback with speakers for programs with video content
For assistance: Contact educme@psych.org for questions about this activity | Contact learningcenter@psych.org for technical assistance