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Patterns of cognitive change over time and relationship to age following successful treatment of Cushing's disease

Published online by Cambridge University Press:  13 December 2006

JULIE N. HOOK
Affiliation:
Department of Psychiatry, University of Michigan Health Systems, Ann Arbor, Michigan Julie N. Hook PhD is now an Assistant Professor at Rush University
BRUNO GIORDANI
Affiliation:
Department of Psychiatry, University of Michigan Health Systems, Ann Arbor, Michigan
DAVID E. SCHTEINGART
Affiliation:
Department of Internal Medicine, University of Michigan Health Systems, Ann Arbor, Michigan
KENNETH GUIRE
Affiliation:
Department of Biostatistics and Natural Sciences, University of Michigan, Ann Arbor, Michigan
JODIE GILES
Affiliation:
Department of Psychiatry, University of Michigan Health Systems, Ann Arbor, Michigan
KELLEY RYAN
Affiliation:
Department of Psychiatry, University of Michigan Health Systems, Ann Arbor, Michigan
STEPHEN S. GEBARSKI
Affiliation:
Department of Radiology, University of Michigan Health Systems, Ann Arbor, Michigan
SCOTT A. LANGENECKER
Affiliation:
Department of Psychiatry, University of Michigan Health Systems, Ann Arbor, Michigan
MONICA N. STARKMAN
Affiliation:
Department of Psychiatry, University of Michigan Health Systems, Ann Arbor, Michigan

Abstract

Chronically elevated levels of cortisol have been associated with changes in cognitive functioning and brain morphology. Using Cushing's disease as a model to assess the effects of high levels of cortisol on cognitive functioning, 27 patients with Cushing's disease were examined at baseline and three successive follow-up periods up to 18 months after successful surgical treatment. At all follow-up periods, patients were administered cognitive tests as well as measures of plasma and urinary free cortisol. Structural MRIs and a depression measure were taken at baseline and one-year follow-up. Results showed that there is a specific pattern of significant cognitive and morphological improvement following successful treatment. Verbal fluency and recall showed recovery, although brief attention did not. Age of participants was a significant factor as to when recovery of function occurred; younger patients regained and sustained their improvement in cognitive functioning more quickly than older participants. Improvement in verbal recall also was associated with a decrease in cortisol levels as well as an increase in hippocampal formation volume one year after treatment. Overall, these findings suggest that at least some of the deleterious effects of prolonged hypercortisolemia on cognitive functioning are potentially reversible, up to at least 18 months post treatment. (JINS, 2007, 13, 21–29.)

Type
Research Article
Copyright
© 2007 The International Neuropsychological Society

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References

Benton, A.L. (1968). Differential behavioral effects in frontal lobe disease. Neuropsychologia, 6, 5360.CrossRefGoogle Scholar
Boivin, M.J., Giordani, B., Berent, S., Amato, D.A., Lehtinen, S., Koeppe, R.A., Buchtel, H.A., Foster, N.L., & Kuhl, D.E. (1992). Verbal fluency and Positron Emission Tomographic mapping of regional cerebral glucose metabolism. Cortex, 28, 231239.CrossRefGoogle Scholar
Bourdeau, I., Bard, C., Noel, B., Leclerc, I., Cordeau, M.P., Belair, M., Lesage, J., Lafontaine, L., & Lacroix, A. (2002). Loss of brain volume in endogenous Cushing's syndrome and its reversibility after correction of hypercortisolism. Journal of Clinical Endocrinology & Metabolism, 87, 19491954.Google Scholar
Brown, E.S. & Chandler, P.A. (2001). Mood and cognitive changes during systemic corticosteroid therapy. Primary Care Companion Journal of Clinical Psychiatry, 3, 1721.CrossRefGoogle Scholar
Brown, E.S., Femina, P.V., & McEwen, B.S. (2004). Association of depression with medical illness: Does cortisol play a role? Biological Psychiatry, 55, 19.Google Scholar
Buschke, H. & Fuld, P.A. (1974). Evaluation of storage, retention, and retrieval in disordered memory and learning. Neurology, 11, 10191025.CrossRefGoogle Scholar
Cameron, O.G., Starkman, M.N., & Schteingart, D.E. (1995). The effect of elevated systemic cortisol levels on plasma catecholamines in Cushing's syndrome patients with and without depressed mood. Journal of Psychiatric Research, 29, 347360.CrossRefGoogle Scholar
Cook, S.C. & Wellman, C.L. (2004). Chronic stress alters dendritic morphology in rat medial prefrontal cortex. Journal of Neurobiology, 60, 236248.CrossRefGoogle Scholar
Cyr, J.J., McKenna-Foley, J.M., & Peacock, E. (1985). Factor structure of the SCL-90-R: Is there one? Journal of Personality Assessment, 49, 571578.Google Scholar
Derogatis, L.R. (1977). SCL-90 Administration. Scoring & Procedures Manual-I for the R (revised) Version. Baltimore: Johns Hopkins University School of Medicine.
Dorn, L.D. & Cerrone, P. (2000). Cognitive function in patients with Cushing Syndrome: A longitudinal perspective. Clinical Nursing Research, 9, 420440.CrossRefGoogle Scholar
Forget, H., Lacroix, A., & Cohen, H. (2002). Persistent cognitive impairment following surgical treatment of Cushing's syndrome. Psychoneuroendocrinology, 27, 367383.CrossRefGoogle Scholar
Forget, H., Lacroix, A., Somma, M., & Cohen, H. (2000). Cognitive decline in patients with Cushing's syndrome. Journal of International Neuropsychological Society, 6, 2029.CrossRefGoogle Scholar
Free, S.L., Bergin, P.S., Fish, D.R., Cook, M.J., Shorvon, S.D., & Stevens, J.M. (1995). Methods for normalization of hippocampal volumes measures with MR. American Journal of Neuroradiology, 16, 637643.Google Scholar
Kelly, W.F. (1996). Psychiatric aspects of Cushing's syndrome. Quarterly Journal of Medicine, 89, 543551.CrossRefGoogle Scholar
Kimura, D. (1984). Neuropsychology test procedures. London, Ontario: DK Consultants.
Ling, M.H.M., Perry, P.J., & Tsuang, M.T. (1981). Side effects of corticosteroid therapy. Archives of General Psychiatry, 38, 471477.CrossRefGoogle Scholar
Little, R.J., An, H., Johanns, J., & Giordani, B. (2000). A comparison of subset selection and analysis of covarinance for the adjustment of confounders. Psychological Methods, 5, 459476.CrossRefGoogle Scholar
Lupien, S.J., Lecours, A.R., Lussier, I., Schwartz, G., Nair, N., & Meaney, M.J. (1994). Basal cortisol levels and cognitive deficits in human aging. Journal of Neuroscience, 14, 28932903.CrossRefGoogle Scholar
Lyons, D.M., Lopez, J.M., Yang, C., & Schatzberg, A.F. (2000). Stress-level cortisol treatment impairs inhibitory control of behavior in monkeys. Journal of Neuroscience, 20, 78167821.CrossRefGoogle Scholar
MacLullich, A.M.J., Deary, I.J., Starr, J.M., Ferguson, K.J., Wardlaw, J.M., & Seckl, J.R. (2005). Plasma cortisol levels, brain volumes and cognition in healthy elderly men. Psychoneuroendocrinology, 30, 505515.CrossRefGoogle Scholar
Magni, G., Schifano, F., & de Leo, D. (1986). Assessment of depression in an elderly medical population. Journal of Affective Disorders, 11, 121124.CrossRefGoogle Scholar
Martignoni, E., Costa, A., Sinforiani, E., Liuzzi, A., Chidini, P., Mauri, M., Bono, G., & Nappi, G.P. (1992). The brain as a target for adrenocortical steroids: Cognitive implications. Psychoneuroendocrinology, 17, 343354.CrossRefGoogle Scholar
Martin, R.C., Loring, D.W., Meador, K.J., & Lee, G.P. (1988). Differential forgetting in patients with temporal lobe dysfunction. Archives of Clinical Neuropsychology, 3, 351358.Google Scholar
Mauri, M., Sinforiani, E., Bono, G., Vignati, F., Berselli, M.E., Attanasio, R., & Nappi, G. (1993). Memory impairment in Cushing's disease. Acta Neurologica Scandanvia, 87, 5255.CrossRefGoogle Scholar
Newcomer, J.W., Craft, S., Hershey, T., Askins, K., & Bardgett, M.E. (1994). Glucocorticoid-induced impairment in declarative memory performance in adult humans. The Journal of Neuroscience, 14, 20472053.CrossRefGoogle Scholar
Newcomer, J.W., Selke, G., Melson, A.K., Hershey, T., Craft, S., Richards, K., & Alderson, A. (1999). Decreased memory performance in healthy humans induced by stress-level cortisol treatment. Archives of General Psychiatry, 56, 527533.CrossRefGoogle Scholar
O'Brien, J.T., Ames, D., Schweitzer, I., Colman, P., Desmond, P., & Tress, B. (1996). Clinical and magnetic resonance imaging correlates of hypothalamic-pituitary-adrenal axis function in depression and Alzheimer's disease. British Journal of Psychiatric Research, 34, 383392.Google Scholar
Pomara, N., Greenberb, W.M., Branford, M.D., & Doraiswamy, P.M. (2003). Therapeutic implications of HPA axis abnormalities in Alzheimer's disease: Review and update. Psychopharmacology Bulletin, 37, 120134.Google Scholar
Reul, J.M. & deKloet, E.R. (1985). Two receptor systems for corticosterone in rat brain: Microdistribution and differential occupation. Endocrinology, 117, 25052511.CrossRefGoogle Scholar
Reul, J.M. & deKloet, E.R. (1986). Anatomical resolution of two types of corticosterone receptor sites in rat brain with in vitro autoradiography and computerized image analysis. Journal of Steroid Biochemistry, 24, 269272.CrossRefGoogle Scholar
Ruff, R.M., Light, R.H., & Parker, S.B. (1996). Benton controlled word association test: Reliability and updated norms. Archives of Clinical Neuropsychology, 11, 329338.CrossRefGoogle Scholar
SAS/STAT Software, Version 8 of the SAS System for Unix. Copyright© 2006 SAS Institute Inc., Cary, NC.
Sass, K.J., Spencer, D.D., Kim, J.H., Westerveld, M., Novelly, R.A., & Lencz, T. (1990). Verbal memory impairment correlates with hippocampal pyramidal cell density. Neurology, 40, 16941697.CrossRefGoogle Scholar
Starkman, M.N., Gebarski, S.S., Berent, S., & Schteingart, D.E. (1992). Hippocampal formation volume, memory dysfunction, and cortisol levels in patients with Cushing's syndrome. Biological Psychiatry, 32, 756765.CrossRefGoogle Scholar
Starkman, M.N., Giordani, B., Berent, S., Schork, M.A., & Schteingart, D.E. (2001). Elevated cortisol levels in Cushing's disease are associated with cognitive decrements. Psychosomatic Medicine, 63, 985993.CrossRefGoogle Scholar
Starkman, M.N., Giordani, B., Gebarski, S.S., Berent, S., Schork, M.A., & Schteingart, D.E. (1999). Decrease in cortisol reverses human hippocampal atrophy following treatment of Cushing's disease. Biological Psychiatry, 46, 15951602.CrossRefGoogle Scholar
Starkman, M.N., Giordani, B., Gebarski, S.S., & Schteingart, D.E. (2003). Improvement in learning associated with increase in hippocampal formation volume. Biological Psychiatry, 53, 233238.CrossRefGoogle Scholar
Wechsler, D. (1981). Wechsler WAIS-R Manual. Psychological Corporation: New York.
Wolf, O.T., Convit, A., Thorn, E., & de Leon, M.J. (2002). Salivary cortisol day profiles in elderly with mild cognitive impairment. Psychoneuroendocrinology, 27, 777789.CrossRefGoogle Scholar

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