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Saelzler UG, Verhaeghen P, Panizzon MS, Moffat SD. Intact circadian rhythm despite cortisol hypersecretion in Alzheimer's disease: A meta-analysis. Psychoneuroendocrinology 2021; 132:105367. [PMID: 34340133 DOI: 10.1016/j.psyneuen.2021.105367] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 07/15/2021] [Accepted: 07/22/2021] [Indexed: 12/26/2022]
Abstract
Hypersecretion of the glucocorticoid steroid hormone cortisol by individuals with Alzheimer's disease (AD) has been suspected for several decades, during which time dozens of examinations of this phenomenon have been conducted and published. The goals of this investigation were to summarize this sizeable body of literature, test whether participant and methodological characteristics modify the magnitude of the AD-associated basal cortisol hypersecretion, and examine whether cortisol circadian rhythmicity is maintained among individuals with AD. To this end, the present meta-analysis and systematic review examined over 300 comparisons of indices of basal HPA-axis functioning between individuals with AD and cognitively normal older adults. AD was associated with basal cortisol elevations (g = 0.45) but the magnitude of the effect was not systematically impacted by any of the participant characteristics considered or the time-of-day of the cortisol sampling. Further, there was no evidence of group differences among direct indices of circadian rhythmicity such as the cortisol awakening response or the diurnal cortisol slope. These results suggest that basal hypersecretion of cortisol, but not circadian dysrhythmia, is characteristic of individuals with AD. Mechanistically, the observed hypersecretion is consistent with the theorized AD-driven deterioration of the hippocampus and subsequent reduction in hypothalamic-pituitary-adrenal axis inhibition. Further investigation is warranted to elucidate the role and timing of cortisol elevations in the progression of AD.
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Affiliation(s)
- Ursula G Saelzler
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, San Diego, CA 92093, USA.
| | - Paul Verhaeghen
- Department of Psychology, Georgia Institute of Technology, 648 Cherry St. NW, Atlanta GA 30313, USA.
| | - Matthew S Panizzon
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, San Diego, CA 92093, USA.
| | - Scott D Moffat
- Department of Psychology, Georgia Institute of Technology, 648 Cherry St. NW, Atlanta GA 30313, USA.
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Notarianni E. Cortisol: Mediator of association between Alzheimer's disease and diabetes mellitus? Psychoneuroendocrinology 2017; 81:129-137. [PMID: 28458232 DOI: 10.1016/j.psyneuen.2017.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 04/17/2017] [Accepted: 04/17/2017] [Indexed: 01/21/2023]
Abstract
Numerous epidemiologic studies have identified an independent association between Alzheimer's disease (AD) and diabetes mellitus (DM), which remains unexplained. This review contends that the association is mediated by mild hypercortisolemia that is manifested in AD by early stages, as empirical evidence indicates that hypercortisolemia is diabetogenic even at subclinical levels. Subclinical Cushing's syndrome is discussed as the paradigm. It is proposed that hypercortisolemia increases the risk of pre-diabetes and DM during early AD and the preceding decades. That hypercortisolemia is exhibited during the AD prodromal stage has yet to be determined, but may be inferred from concurrent metabolic parameters as documented in the literature. Studies refuting association between AD and DM also are evaluated, and the relationship between AD and DM is deduced to be more complex than directly causal, with DM of longstanding duration having a protective role. Association between DM and AD may require reappraisal by APOE ε4 carrier status, in view of newly identified roles of APOE ε4 in pre-diabetes. That association of APOE ε4 with DM in AD may have been underestimated in epidemiologic studies also is highlighted. At the core of arguments and mechanisms presented in this review is the circadian rhythm of cortisol secretion, which is the main determinant of glycemic control in humans. Alterations to that rhythm and to the hypothalamic-pituitary-adrenal axis occurring in AD are examined. Consequently the cause of hypercortisolemia in AD, and therefore of association between AD and DM, is proposed to be adrenal hyper-responsiveness to adrenocorticotropic hormone.
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Affiliation(s)
- Elena Notarianni
- St Hilda's College, University of Oxford, Cowley Place, Oxford OX4 1DY, UK; Department of Biosciences, Durham University, South Road, Durham DH1 3LE, UK.
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Belvederi Murri M, Pariante C, Mondelli V, Masotti M, Atti AR, Mellacqua Z, Antonioli M, Ghio L, Menchetti M, Zanetidou S, Innamorati M, Amore M. HPA axis and aging in depression: systematic review and meta-analysis. Psychoneuroendocrinology 2014; 41:46-62. [PMID: 24495607 DOI: 10.1016/j.psyneuen.2013.12.004] [Citation(s) in RCA: 213] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 12/01/2013] [Accepted: 12/02/2013] [Indexed: 12/31/2022]
Abstract
One of the most consistent findings in the biology of depression is an altered activity of the hypothalamic-pituitary-adrenal (HPA) axis. However, data concerning this issue have never been examined with a focus on the older population. Here we present a systematic review and meta-analysis, based on studies investigating levels of cortisol, adrenocorticotropic hormone (ACTH) and corticotropin-releasing hormone (CRH) in depressed participants older than 60 and compared with healthy controls. We found 20 studies, for a total of 43 comparisons on different indices of HPA axis functioning. Depression had a significant effect (Hedges' g) on basal cortisol levels measured in the morning (0.89), afternoon (0.83) and night (1.39), but a smaller effect on cortisol measured continuously (0.51). The effect of depression was even higher on post-dexamethasone cortisol levels (3.22), whereas it was non-significant on morning ACTH and CRH levels. Subgroup analyses indicated that various methodological and clinical factors can influence the study results. Overall, older participants suffering from depression show a high degree of dysregulation of HPA axis activity, with differences compared with younger adults. This might depend on several mechanisms, including physical illnesses, alterations in the CNS and immune-endocrinological alterations. Further studies are needed to clarify the implications of altered HPA axis activity in older patients suffering from depression. Novel pharmacological approaches might be effective in targeting this pathophysiological feature, thus improving the clinical outcomes.
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Affiliation(s)
- Martino Belvederi Murri
- Institute of Psychiatry, Department of Psychological Medicine, King's College London, London, UK; Department of Neurosciences Division of Psychiatry, University of Parma, Parma, Italy.
| | - Carmine Pariante
- Institute of Psychiatry, Department of Psychological Medicine, King's College London, London, UK
| | - Valeria Mondelli
- Institute of Psychiatry, Department of Psychological Medicine, King's College London, London, UK
| | - Mattia Masotti
- Section of Psychiatry, Department of Neuroscience, Oftalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy
| | - Anna Rita Atti
- Department of Biomedical and NeuroMotor Sciences - Psychiatry, University of Bologna, Italy
| | - Zefiro Mellacqua
- Institute of Psychiatry, Department of Psychosis Studies, King's College London, London, UK
| | - Marco Antonioli
- Department of Biomedical and NeuroMotor Sciences - Psychiatry, University of Bologna, Italy
| | - Lucio Ghio
- Section of Psychiatry, Department of Neuroscience, Oftalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy
| | - Marco Menchetti
- Section of Psychiatry, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Italy
| | | | - Marco Innamorati
- Department of Neurosciences Division of Psychiatry, University of Parma, Parma, Italy
| | - Mario Amore
- Section of Psychiatry, Department of Neuroscience, Oftalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy
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Skare S, Pew B, Dysken M. The dexamethasone suppression test in dementia: a review of the literature. J Geriatr Psychiatry Neurol 1990; 3:124-38. [PMID: 2282129 DOI: 10.1177/089198879000300302] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
To examine the utility of the dexamethasone suppression test (DST) in the differential diagnosis of depression in elderly demented patients, we reviewed the literature and focused on four components of this question: (1) cortisol nonsuppression rates in dementia; (2) cortisol nonsuppression and dementia severity; (3) cortisol nonsuppression in demented versus depressed patients; and (4) cortisol nonsuppression following antidepressant treatment. A combined analysis of 27 articles showed cortisol nonsuppression in 60% of patients with concurrent dementia and depression, in 47% of patients with depression only, in 41% of patients with dementia only, in 46% of patients with multi-infarct dementia, in 36% of patients with primary degenerative dementia, and in 10% of controls. The abnormal DST rate in demented patients was not significantly different from the abnormal DST rate in depressed patients. Eight of 12 studies (67%) did not find a significant relationship between DST results and dementia severity dementia patients without depression. Twelve of 13 studies (92%) did not find a relationship between age and DST outcome. The data we reviewed do not support the use of the DST in discriminating between depression and dementia or between dementia subtypes.
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Affiliation(s)
- S Skare
- Minneapolis VA Medical Center, MN
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Brown GM. Neuroendocrine probes as biological markers of affective disorders: new directions. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 1989; 34:819-23. [PMID: 2684381 DOI: 10.1177/070674378903400816] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Numerous endocrine abnormalities are found in depressive illness and, among these, several have been proposed as useful markers in diagnosis, prediction of treatment response, monitoring treatment outcome or in understanding of etiology. This paper reviews five endocrine systems--the hypothalamic-pituitary-adrenal axis, hypothalamic-pituitary-thyroid axis, growth hormone regulation, prolactin regulation and pineal function, in which such abnormalities have been reported. The dexamethasone suppression test (DST) results are affected by a variety of other diseases and confounding conditions. Furthermore, variability in dexamethasone availability has recently been shown to be an important factor, influencing post-DST cortisol levels. Refined tests, taking into account all these factors, or alternative tests of hypothalamic-pituitary-adrenal function may lead to improved clinical utility. Pineal function is now the focus of considerable investigation. Low nocturnal output of melatonin is found in unipolar and bipolar affective disorder and is normalized by treatment with antidepressant drugs which block re-uptake of noradrenaline. These findings support the hypothesis of noradrenergic abnormality in depression. In seasonal affective disorder there is evidence for a phase delay in the melatonin rhythm which may be a key factor in the seasonal disorder. Effective light therapy causes a phase advance in the abnormal melatonin rhythm. Whether the normalization of the melatonin rhythm is instrumental in producing the antidepressant effect is yet to be determined. There are wide spread neuroendocrine abnormalities in depressive illness. These abnormalities encompass many different pituitary hormones, as well as the pineal.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- G M Brown
- McMaster University, Hamilton, Ontario
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