Effects of major depression diagnosis and cortisol levels on indices of neurocognitive function

Cognitive function in soccer athletes determined by sleep disruption and self-reported health, yet not by decision-reinvestment

Background

Sleep disruption (SD) increases sympathetic activity and cortisol secretion, and delays cognitive functions such as reaction-time (RT). Sympathetic activity of disturbed sleepers, is similar to those of so-called decision-reinvesters. Decision-reinvestment refers to traits in individuals with greater tendency to ruminate and reinvest in their decisions, with significant decrease in both motor-control and cognitive performance. Decision-making quality is a crucial attribute to athletic performance which relies on RT. Consequently, SD affects pitch-performance negatively, particularly in decision-reinvesters. This observational pilot-study examined the relationship between SD and cognitive function, perceived health, as well as reinvestment strategies. The hypothesis was that athletes with lower SD perceive their health better, report lower stress levels, perform better in cognitive tasks, and show lower tendency for decision-reinvestment.

Methods

Twenty-one football player recorded their sleep with fit-trackers for 7 nights. Participants self-reported their mental and physical health, decision-reinvestment strategy, sleep behaviour, and perceived stress levels. Athletes then performed a set of cognitive tests to examine memory function (Backwards Corsi), selective attention (STROOP), and cognitive flexibility (Wisconsin Card Sorting Test, WCST). Normality was tested with a Shapiro-Wilk test, and analysed with a Pearson's or Spearman's correlation test.

Results

Significant correlation appeared between extended sleep-interruptions and Backwards Corsi RT, r = 0.66, p = 0.010, as further in total sleep time and wellbeing r = 0.50, p = 0.029. A negative correlation exist in regard of pain scores and Backwards Corsi scores r = -0.57, p = 0.110. Physical health correlated with error-rates in the WCST, r = 0.69, p ≤ 0.001. Also, reinvestment negatively correlated with physical health, r = -0.80, p ≤ 0.001.

Conclusion

Wellbeing relies on total sleep-time. Athletes with extended sleep-interruptions are slower in recalling memory, and those with greater reported pain have lower memory scores. Participants who rate physical health greater, have more error-rates in the WCST; indicating that cognitive flexibility is enhanced in individuals with inferior perceived health. However, individuals with lower physical health scores also have greater tendency to ruminate and reinvest in decisions, suggesting interrelation between reinvestment and physical health.

Neuropsychological Assessment of Cognitive Impairment in Kidney Transplantation (NAsKiT) and its related risk factors: a study protocol

BACKGROUND

Association of cognitive impairment with chronic kidney disease has been reported over the last decade. Individuals show better cognitive performance after kidney transplantation than individuals on dialysis but are more likely to be affected by cognitive impairment than age-matched comparison groups. Better knowledge of the prevalence as well as course and profile of cognitive impairment is important for the design of future studies assessing the clinical impact of cognitive impairment and developing management strategies. The goal of our study is to examine the extent of cognitive impairment before and after transplantation and to derive a distinct profile of cognitive function using standard neurocognitive tests. Furthermore, we aim to assess whether transplantation per se leads to an improvement in cognitive performance.

METHODS

We are conducting a prospective single-center cohort study involving 100 kidney transplant individuals. Individuals who are wait-listed to receive a kidney transplantation or have already received one will be included in this study. Individuals will undergo a battery of detailed neurocognitive tests at baseline (in part before surgery), and then 3 and 12 months afterwards. Furthermore, the enrolled patients will complete a validated German version of the Cognitive Failure Questionnaire for self-assessment (s-CFQ) as well as the Hospital Anxiety and Depression Scale -Deutsche (HADS-D), a self-report screening instrument with two scales that capture anxiety and depression. In addition, a hair sample will be taken at each measurement time point for the determination of hair cortisol levels as a parameter for the cumulative hypothalamic-pituitary-adrenocortical axis activity over the previous three months. The primary outcome measure will be (a) the effect of kidney transplantation on the cognitive performance up to 12 months after transplantation and (b) the course of cognitive performance following kidney transplantation over time.

DISCUSSION

The results of our study have potentially important implications for the prevention and treatment of cognitive impairment in kidney transplant individuals. By increasing our knowledge of the neurocognitive profile and assigning the corresponding deficits, it might be possible to create an individualized training program to positively impact cognitive deficits in kidney transplant patients.

Differential associations between fatigue and psychobiological stress measures in women with depression and women with somatic symptom disorder

OBJECTIVE

Medically unexplained fatigue is a burdensome, widespread symptom, and a frequent complaint in depressive disorders (DDs) as well as somatic symptom disorder (SSD). Heightened stress levels are a likely cause of fatigue, although the temporal associations, as well as the role of the stress-reactive hypothalamic-pituitary-adrenal (HPA) axis, are not yet completely understood. We were interested in the differences between DD and SSD regarding general, mental, and physical fatigue, as well as associations between psychobiological stress measures (representing different time frames) and fatigue in these groups.

METHODS

Fifty-eight women (29 with DD, 29 with SSD) reported subjective recent fatigue and chronic stress levels, as well as levels of depression and somatic complaints using baseline questionnaires. Furthermore, they completed an ambulatory assessment period comprising measurements of fatigue, subjective stress, and salivary cortisol five times a day for 14 consecutive days. Salivary cortisol was obtained as a measure of within-day HPA axis activity, and hair cortisol concentration was obtained as a measure of accumulated HPA axis activity of the preceding three months.

RESULTS

Women with DD reported higher levels of general and mental fatigue than did women with SSD, which was explained by their higher level of depression. Physical fatigue levels did not differ between groups. In both groups, momentary general, mental, and physical fatigue levels were associated with momentary subjective stress but not with chronic stress. Momentary salivary cortisol levels were positively associated with mental fatigue, while hair cortisol concentration was not.

CONCLUSIONS

There are differences in fatigue profiles between DD and SSD, which should be accounted for in future research and practice (e.g., individualized treatment strategies focusing on mental or physical fatigue, depending on which fatigue dimension is prominent).

Chronic exposure to glucocorticoids induces suboptimal decision-making in mice

Anxio-depressive symptoms as well as severe cognitive dysfunction including aberrant decision-making (DM) are documented in neuropsychiatric patients with hypercortisolaemia. Yet, the influence of the hypothalamo-pituitary-adrenal (HPA) axis on DM processes remains poorly understood. As a tractable mean to approach this human condition, adult male C57BL/6JRj mice were chronically treated with corticosterone (CORT) prior to behavioural, physiological and neurobiological evaluation. The behavioural data indicate that chronic CORT delays the acquisition of contingencies required to orient responding towards optimal DM performance in a mouse Gambling Task (mGT). Specifically, CORT-treated animals show a longer exploration and a delayed onset of the optimal DM performance. Remarkably, the proportion of individuals performing suboptimally in the mGT is increased in the CORT condition. This variability seems to be better accounted for by variations in sensitivity to negative rather than to positive outcome. Besides, CORT-treated animals perform worse than control animals in a spatial working memory (WM) paradigm and in a motor learning task. Finally, Western blotting neurobiological analyses show that chronic CORT downregulates glucocorticoid receptor expression in the medial Prefrontal Cortex (mPFC). Besides, corticotropin-releasing factor signalling in the mPFC of CORT individuals negatively correlates with their DM performance. Collectively, this study describes how chronic exposure to glucocorticoids induces suboptimal DM under uncertainty in a mGT, hampers WM and motor learning processes, thus affecting specific emotional, motor, cognitive and neurobiological endophenotypic dimensions relevant for precision medicine in biological psychiatry.

Hypothalamic-Pituitary-Adrenal Axis Activity in Childhood Predicts Emotional Memory Effects and Related Neural Circuitry in Adolescent Girls

Negative emotional experiences can be more difficult to forget than neutral ones, a phenomenon termed the "emotional memory effect." Individual differences in the strength of the emotional memory effect are associated with emotional health. Thus, understanding the neurobiological underpinnings of the emotional memory effect has important implications, especially for individuals at risk for emotional health problems. Although the neural basis of emotional memory effects has been relatively well defined, less is known about how hormonal factors that can modulate emotional memory, such as glucocorticoids, relate to that neural basis. Importantly, probing the role of glucocorticoids in the stress- and emotion-sensitive period of late childhood to adolescence could provide actionable points of intervention. We addressed this gap by testing whether hypothalamic-pituitary-adrenal (HPA) axis activity during a parent-child conflict task at 11 years of age predicted emotional memory and its primary neural circuitry (i.e., amygdala-hippocampus functional connectivity) at 16 years of age in a longitudinal study of 147 girls (104 with complete data). Results showed that lower HPA axis activity predicted stronger emotional memory effects, r(124) = -.236, p < .01, and higher emotional memory-related functional connectivity between the right hippocampus and the right amygdala, β = -.385, p < .001. These findings suggest that late childhood HPA axis activity may modulate the neural circuitry of emotional memory effects in adolescence, which may confer a potential risk trajectory for emotional health among girls.

A Systematic Review of Executive Function and Information Processing Speed in Major Depression Disorder

Background: Major depression is a psychiatric disorder characterized neuropsychologically by poor performance in tasks of memory, attention, processing speed, and executive function. The aim of this systematic review was to examine the evidence regarding the neuropsychological profile of people with major depression and to determine which of two explanatory models—the processing speed hypothesis or the cognitive effort hypothesis—has most empirical support. Methods: We searched three relevant databases and reviewed the reference lists of the articles retrieved. The results obtained with the Trail Making Test and the Stroop Color-Word Test were reviewed for 37 studies published between 1993 and 2020. Results: The empirical evidence supports both hypotheses: cognitive effort and processing speed, suggesting that depression is not only characterized by psychomotor slowing but also involves a specific deficit in executive function. Discussion: We discuss potentially relevant variables that should be considered in future research in order to improve knowledge about the neurocognitive profile of depression. The main limitation of this study derives from the considerable heterogeneity of participants with MD, which makes it difficult to compare and integrate the data.

HPA axis in psychotic major depression and schizophrenia spectrum disorders: Cortisol, clinical symptomatology, and cognition

The Hypothalamic Pituitary Adrenal (HPA) axis has been implicated in the pathophysiology of a variety of mood and cognitive disorders. Neuroendocrine studies have demonstrated HPA axis overactivity in major depression, a relationship of HPA axis activity to cognitive performance, and a potential role of HPA axis genetic variation in cognition. In schizophrenia differential HPA activity has been found, including higher rates of non-suppression to dexamethasone challenge and higher salivary cortisol levels, which have been a premonitory risk factor for conversion to psychosis in adolescents at risk for developing schizophrenia. The present study investigated the simultaneous roles HPA axis activity and clinical symptomatology play in poor cognitive performance. Patients with major depression with psychosis (PMD) or schizophrenia spectrum disorder (SCZ) and healthy controls (HC) were studied. All participants underwent a diagnostic interview and psychiatric ratings, a comprehensive neuropsychological battery, and overnight hourly blood sampling for cortisol. Cognitive performance did not differ between the clinical groups, though they both performed more poorly than the HC's across a variety of cognitive domains. Across all subjects, cognitive performance was negatively correlated with higher cortisol, and PMD patients had higher evening cortisol levels than did SCZ and HCs. Cortisol and clinical symptoms, as well as age, sex, and antipsychotic use predicted cognitive performance. Diathesis stress models and their links to symptomatology, cognition, and HPA function are discussed.

Examining HPA-axis functioning as a mediator of the relationship between depression and cognition across the adult lifespan

Altered HPA-axis functioning is a hypothesized mechanism for worsened cognition in depression. The current study examines the indirect effects of depression on processing speed, executive functioning, and memory as a function of the HPA-axis. 38 individuals with a depression diagnosis and 50 healthy controls (HCs) aged 18-86 underwent neuropsychological testing and at-home diurnal salivary cortisol collection. Depression was assessed via structured clinical interviews and rating scales. Cognitive composite scores were derived from factor analysis. Daytime cortisol exposure was estimated using area under the curve (AUC). Depression was associated with higher cortisol levels and slower processing speed . A significant suppression effect of AUC was present on the relationship between depression and processing speed. Limitations include the cross-sectional design and limited sample heterogeneity. Though poorly modulated HPA-axis is one proposed mechanism of cognitive alterations in depression, our results did not support this conclusion for processing speed. Alternative mechanisms should be considered to inform interventions to target cognitive alterations in depression.

Neurocognitive performance in patients with depression compared to healthy controls: Association of clinical variables and remission state

Cognitive impairment in Major Depressive Disorder (MDD) has been postulated to persist into remission. However, inconsistent definitions of clinical remission, patterns and influencing factors, isolated cognitive tasks, and the lack of appropriately matched controls (HCs) present significant limitations of previous studies. Furthermore, studies investigating cognition in partially remitted patients are particularly scarce. This study compares the cognition of MDD patients (N = 65) and HCs (N = 65), matched by one-to-one recruitment strategy for age, sex, and education (ages 19-60). The neuropsychological (NPS) performance was measured via an extensive NPS-test battery and analysed retrospectively, accounting for demographic and clinical variables. Full remission was defined as HAMD cut off ≤7, partial remission as HAMD 8-18. The findings show entire MDD group and partially remitted MDD with significantly poorer NPS performance compared to HCs, while remitted MDD patients did not differ significantly from HCs. This underscores how critical a clear definition of remission is to compare studies on MDD. The clinical variable 'number of hospitalizations' had a significant effect on cognition, whereas current symptom severity did not correlate with performance on any cognitive domain. Higher number of hospitalizations may be associated with higher burden of illness and greater neurobiological "scar effects".

Evaluation of Autonomic Nervous System, Saliva Cortisol Levels, and Cognitive Function in Major Depressive Disorder Patients

Major depressive disorder (MDD) is associated with changes in autonomic nervous system (ANS) and cognitive impairment. Heart rate variability (HRV) and Pulse pressure (PP) parameters reflect influences of the sympathetic and parasympathetic nervous system. Cortisol exerts its greatest effect on the hippocampus, a brain area closely related to cognitive function. This study aims to examine the effect of HRV, PPG, salivary cortisol levels, and cognitive function in MDD patients by using noninvasive techniques. We have recruited MDD patients, diagnosed based on DSM-V-TR criteria compared with healthy control subjects. Their HRV and PP were measured by electrocardiogram (ECG) and photoplethysmography (PPG). Salivary cortisol levels were collected and measured on the same day. MDD patients exhibited elevated values of mean HR, standard deviation of HR (SDHR), low frequency (LF) power, low frequency/high frequency (LF/HF) ratio, mean PP, standard deviation of pulse pressure (SDPP), and salivary cortisol levels. Simultaneously, they displayed lower values of mean of R-R intervals (mean NN), standard deviation of R-R intervals (SDNN), high frequency (HF) power, and WCST scores. Results have shown that the ANS of MDD patients were dominated by the sympathetic activity and that they have cognitive deficits especially in the domain of executive functioning.

Effects of cortisol on the memory bias for emotional words? A study in patients with depression and healthy participants using the Directed Forgetting task

Mood congruent alterations in information processing such as an impaired memory bias for emotional information and impaired inhibitory functions are prominent features of a major depressive disorder (MDD). Furthermore, in MDD patients hypothalamic-pituitary-adrenal axis dysfunctions are frequently found. Impairing effects of stress or cortisol administration on memory retrieval as well as impairing stress effects on cognitive inhibition are well documented in healthy participants. In MDD patients, no effect of acute cortisol administration on memory retrieval was found. The current study investigated the effect of acute cortisol administration on memory bias in MDD patients (N = 55) and healthy controls (N = 63) using the Directed Forgetting (DF) task with positive, negative and neutral words in a placebo controlled, double blind design. After oral administration of 10 mg hydrocortisone/placebo, the item method of the DF task was conducted. Memory performance was tested with a free recall test. Cortisol was not found to have an effect on the results of the DF task. Interestingly, there was significant impact of valence: both groups showed the highest DF score for positive words and remembered significantly more positive words that were supposed to be remembered and significantly more negative words that were supposed to be forgotten. In general, healthy participants remembered more words than the depressed patients. Still, the depressed patients were able to inhibit intentionally irrelevant information at a comparable level as the healthy controls. These results demonstrate the importance to distinguish in experimental designs between different cognitive domains such as inhibition and memory in our study.

The very low-frequency band of heart rate variability represents the slow recovery component after a mental stress task

The very low-frequency (VLF) band of heart rate variability (HRV) has different characteristics compared with other HRV components. Here we investigated differences in HRV changes after a mental stress task. After the task, the high-frequency (HF) band and ratio of high- to low-frequency bands (LF/HF) immediately returned to baseline. We evaluated the characteristics of VLF band changes after a mental stress task. We hypothesized that the VLF band decreases during the Stroop color word task and there would be a delayed recovery for 2 h after the task (i.e., the VLF change would exhibit a “slow recovery”).

Nineteen healthy, young subjects were instructed to rest for 10 min, followed by a Stroop color word task for 20 min. After the task, the subjects were instructed to rest for 120 min. For all subjects, R-R interval data were collected; analysis was performed for VLF, HF, and LF/HF ratio. HRV during the rest time and each 15-min interval of the recovery time were compared. An analysis of the covariance was performed to adjust for the HF band and LF/HF ratio as confounding variables of the VLF component.

HF and VLF bands significantly decreased and the LF/HF ratio significantly increased during the task compared with those during rest time. During recovery, the VLF band was significantly decreased compared with the rest time. After the task, the HF band and LF/HF ratio immediately returned to baseline and were not significantly different from the resting values. After adjusting for HF and LF/HF ratio, the VLF band had significantly decreased compared with that during rest.

The VLF band is the “slow recovery” component and the HF band and LF/HF ratio are the “quick recovery” components of HRV. This VLF characteristic may clarify the unexplained association of the VLF band in cardiovascular disease prevention.

Hypothalamic-pituitary-adrenal axis activity and cognition in major depression: The role of remission status

OBJECTIVES

Neuropsychological deficits and hypothalamic-pituitary-adrenal (HPA) axis dysfunction have been described in major depressive disorder (MDD). We conducted an exploratory study to investigate the role of remission status in the relationship between HPA axis and cognition in MDD.

METHODS

Ninety-seven MDD patients (44 remitted, 53 non-remitted) and 97 healthy controls (HC) were evaluated. We measured verbal and visual memory, working memory, processing speed, attention, and executive function. Three HPA axis measures were assessed: cortisol awakening response (CAR), diurnal cortisol slope, and cortisol suppression ratio with 0.25mg of dexamethasone (DSTR). Multiple linear regression analyses were performed to study the relationship between cortisol measures and cognition while controlling for potential confounders. We conducted an overall analysis in all participants to compare both MDD-remitted and MDD non-remitted groups with respect to HC. Another analysis including MDD patients only was used to explore a moderating effect by remission status.

RESULTS

MDD patients showed poorer cognitive performance compared with HC, without significant differences between remitters and non-remitters. Cortisol measures did not differ between remitters and non-remitters. Although most HPA axis measures were not associated with cognitive dysfunction, we found significant associations between cognitive performance in MDD-remitters and cortisol measures for visual memory, processing speed and executive function. A significant moderating effect for remission status was found between cortisol diurnal slope (but neither CAR nor DSTR) and performance in processing speed or executive function.

CONCLUSIONS

Remission status in MDD appears to moderate the association between some cognitive domains (processing speed and executive function) and HPA axis activity.

Myo-inositol, Glutamate, and Glutamine in the Prefrontal Cortex, Hippocampus, and Amygdala in Major Depression

BACKGROUND

The brains of patients with depression exhibit many changes in various regions. Recently, proton magnetic resonance spectroscopy has been used to measure brain metabolites, using saturation bands to shape the volume of interest. Our a priori hypothesis was that myo-inositol and glutamate were downregulated in the hippocampus and amygdala in depression.

METHODS

We measured brain metabolites from the medial prefrontal cortex, hippocampus, and amygdala of 22 drug-naïve, first-episode patients with major depressive disorder and 27 healthy control subjects using 3T proton magnetic resonance spectroscopy.

RESULTS

Compared with healthy control subjects, patients showed statistically significant reductions in myo-inositol levels in all three regions and reductions in glutamate levels in the medial prefrontal cortex. Furthermore, we found significant decreases in the ratios of glutamate to creatine plus phosphocreatine in the medial prefrontal cortex and amygdala. Additionally, the ratios of glutamine to creatine plus phosphocreatine were also decreased in all three regions examined, although not all the participants presented reliable data. Finally, glutamate levels in the medial prefrontal cortex and amygdala have significant correlations with executive function and those in the hippocampus with memory function. Hippocampal myo-inositol was significantly related to blood cortisol.

CONCLUSIONS

Our findings indicated abnormal myo-inositol, glutamate, and glutamine levels in the brains of major depressive disorder patients.

A systematic review of sleep disturbance in anxiety and related disorders

Recent research suggests that sleep disturbance may be a transdiagnostic process, and there is increasing interest in examining how sleep disturbance may contribute to anxiety and related disorders. The current review summarizes and synthesizes the extant research assessing sleep in anxiety and related disorders. The findings suggest that sleep disturbance exacerbates symptom severity in the majority of anxiety and related disorders. However, the nature of sleep disturbance often varies as a function of objective versus subjective assessment. Although sleep disturbance is a correlate of most anxiety and related disorders, a causal role for sleep disturbance is less clear. A model of potential mechanisms by which sleep disturbance may confer risk for the development of anxiety and related disorders is discussed. Future research integrating findings from basic sleep research with current knowledge of anxiety and related disorders may facilitate the development of novel treatments for comorbid sleep disturbance and clinical anxiety.

Footprint mismatch of cervical disc prostheses with Chinese cervical anatomic dimensions

Background:

The footprint of most prostheses is designed according to Caucasian data. Total disc replacement (TDR) has been performed widely for cervical degenerative diseases in China. It is essential to analyze the match sizes of prostheses footprints and Chinese cervical anatomic dimensions in our study.

Methods:

The anatomic dimensions of the C4–C7 segments of 138 patients (age range 16–77 years) in a Chinese population were measured by computed tomography scans. We compared the footprints of the most commonly used cervical disc prostheses (Bryan: Medtronic, Minneapolis, MN, USA; Prestige LP: Medtronic, Fridley, Minnesota, USA; Discover: DePuy, Raynham, MA, USA; Prodisc-C: Synthes, West Chester, PA, USA) in China with Chinese cervical anatomic dimensions and assessed the match of their size.

Results:

The mismatch of available dimensions of prostheses and anatomic data of cervical endplates ranged from 17.03% (C4/C5, Prestige LP, Prodisc-C) to 57.61% (C6/C7, Discover) in the anterior-posterior (AP) diameter, and 35.51% (C4/C5, Prodisc-C, Prestige LP) to 94.93% (C6/C7, Bryan) in the center mediolateral (CML) diameter. About 21.01% of endplates were larger than the largest prostheses in the AP diameter and 57.25% in the CML diameter. All available footprints of prostheses expect the Bryan with an unfixed height, can accommodate the disc height (DH), however, 36.23% of the middle DH was less than the smallest height of the prostheses. The average disc sagittal angles (DSAs) of C4–C7 junctions were 5.04°, 5.15°, and 4.13° respectively. Only the Discover brand had a built-in 7° lordotic angle, roughly matching with the DSA.

Conclusions:

There is a large discrepancy between footprints of prostheses and Chinese cervical anatomic data. In recent years, possible complications of TDR related with mismatch sizes are increasing, such as subsidence, displacement, and heterotopic ossification. Manufacturers of prostheses should introduce or produce additional footprints of prostheses for Chinese TDR.

The Role of Employment on Neurocognitive Reserve in Adults With HIV: A Review of the Literature

The benefits of employment are enormous; when employed, people naturally: (a) engage socially with the public and colleagues/co-workers, (b) learn new skills to increase job productivity and competence, (c) establish routines that can prevent lethargy and boredom and may regulate sleep and healthy behaviors, (d) are provided purposeful and meaningful activity that may prevent depression, and (e) gain income to pursue cognitively stimulating interests. All of these and other employment influences can provide an enriched personal and social environment that stimulates positive neuroplasticity and promotes neurocognitive reserve, which are particularly relevant to adults with HIV because (a) approximately 50% of adults with HIV experience observable cognitive impairments that can adversely affect everyday functioning such as medication adherence, and (b) approximately 45% of adults with HIV are unemployed and do not receive the neurocognitive benefits of employment. From these considerations, implications for health care research and nursing practice are provided.

Cognitive functioning and cortisol profiles in first episode major depression

Major Depressive Disorder (MDD) is often associated with high levels of stress and disturbances in the Hypothalamic Pituitary Adrenal (HPA) system, yielding high levels of cortisol, in addition to cognitive dysfunction. Previous studies have shown a relationship between cortisol profile and cognitive functioning in recurrent MDD in general. More specifically, the association between hypercortisolism and cognitive functioning, such as memory and Executive Functioning (EF), and also more recently cortisol suppression has been explored. However, no studies have investigated these relationships in patients diagnosed with first episode MDD. The aim of the present study was to examine the relationship between cortisol levels before and after the Dexamethasone suppression test (DST) and cognitive function in first episode MDD patients. Twenty-one patients meeting the DSM-IV criteria for a first episode of MDD diagnosis were included in the study. The control group was matched for age, gender and education level. Cortisol was measured in saliva collected with Salivette sampling devices. Saliva samples were collected 4 times during a 24 hours period over two consecutive days: at awakening, after 45 minutes, after 7 hours and at 11 pm. Dexamethasone (1.0 mg) was given orally on Day 1 at 11 pm. The neuropsychological test battery consisted of standardized tests measuring executive functioning (EF) and memory functioning. Cortisol levels did not differ significantly between patients and controls on Day 1, except for the last sample before Dexamethasone administration, where the control group showed higher levels. Both groups showed suppression after Dexamethasone. On Day 2 there was a significant difference between groups at the third sample, showing a significantly lower level in the control group, suggesting that the controls have a more effective suppression profile than the patients. There were no significant correlations between cortisol levels before or after Dexamethasone and cognitive measures. The results indicate impairment on HPA-axis functioning in first episode MDD patients, with less suppression functioning compared to healthy controls, but no relationship between cortisol profile and cognitive functioning in EF or Memory.

Chronic stress induces a hyporeactivity of the autonomic nervous system in response to acute mental stressor and impairs cognitive performance in business executives

The present study examined the incidence of chronic stress in business executives (109 subjects: 75 male and 34 female) and its relationship with cortisol levels, cognitive performance, and autonomic nervous system (ANS) reactivity after an acute mental stressor. Blood samples were collected from the subjects to measure cortisol concentration. After the sample collection, the subjects completed the Lipp Inventory of Stress Symptoms for Adults and the Stroop Color-Word Test to evaluate stress and cognitive performance levels, respectively. Saliva samples were collected prior to, immediately after, and five minutes after the test. The results revealed that 90.1% of the stressed subjects experienced stress phases that are considered chronic stress. At rest, the subjects with chronic stress showed higher cortisol levels, and no gender differences were observed. No differences were found between the stressed and non-stressed subjects regarding salivary amylase activity prior to test. Chronic stress also impaired performance on the Stroop test, which revealed higher rates of error and longer reaction times in the incongruent stimulus task independently of gender. For the congruent stimulus task of the Stroop test, the stressed males presented a higher rate of errors than the non-stressed males and a longer reaction time than the stressed females. After the acute mental stressor, the non-stressed male group showed an increase in salivary alpha-amylase activity, which returned to the initial values five minutes after the test; this ANS reactivity was not observed in the chronically stressed male subjects. The ANS responses of the non-stressed vs stressed female groups were not different prior to or after the Stroop test. This study is the first to demonstrate a blunted reactivity of the ANS when male subjects with chronic psychological stress were subjected to an acute mental stressor, and this change could contribute to impairments in cognitive performance.

Anna-Monika Award Lecture, DGPPN Kongress, 2013: the role of the hypothalamic-pituitary-adrenal (HPA) axis in the pathogenesis of psychotic major depression

OBJECTIVES

This Anna Monika Award Lecture updates the role of the hypothalamic-pituitary-adrenal (HPA) axis in the pathogenesis and treatment of psychotic major depression (PMD).

METHODS

Published reports from our group and others on the clinical phenomenology (including cognition), HPA axis activity, and genetics of PMD are reviewed as are published trials of the GR antagonist, mifepristone.

RESULTS

Current prevalence of PMD is 0.4%. PMD patients demonstrate significant elevations in HPA activity (e.g., particularly high rates of dexamethasone non-suppression, high post-dexamethasone cortisol, etc.) as well as significant impairment in cognition (attention, executive function/response inhibition and verbal and visual memory). High cortisol levels correlate with a number of cognitive deficits (e.g., verbal memory). Allelic variants of the glucocorticoid receptor (GR) gene contribute significantly to both cortisol levels and to measures of psychosis; corticotropin-releasing hormone receptor 1 variants contribute to measures of depression and psychosis. GR antagonists have produced rapid improvement in psychotic symptoms, although failed trials indicate a therapeutic blood level that may require a dose of 1,200 mg/day that is much higher than the commonly tested 600 mg/day.

CONCLUSIONS

HPA axis over-activity appears to play a major role in the pathogenesis of PMD and is a target of drug development.

Learning and memory impairments in a neuroendocrine mouse model of anxiety/depression

Cognitive disturbances are often reported as serious incapacitating symptoms by patients suffering from major depressive disorders (MDDs). Such deficits have been observed in various animal models based on environmental stress. Here, we performed a complete characterization of cognitive functions in a neuroendocrine mouse model of depression based on a chronic (4 weeks) corticosterone administration (CORT). Cognitive performances were assessed using behavioral tests measuring episodic (novel object recognition test, NORT), associative (one-trial contextual fear conditioning, CFC), and visuo-spatial (Morris water maze, MWM; Barnes maze, BM) learning/memory. Altered emotional phenotype after chronic corticosterone treatment was confirmed in mice using tests predictive of anxiety or depression-related behaviors. In the NORT, CORT-treated mice showed a decrease in time exploring the novel object during the test session and a lower discrimination index compared to control mice, characteristic of recognition memory impairment. Associative memory was also impaired, as observed with a decrease in freezing duration in CORT-treated mice in the CFC, thus pointing out the cognitive alterations in this model. In the MWM and in the BM, spatial learning performance but also short-term spatial memory were altered in CORT-treated mice. In the MWM, unlike control animals, CORT-treated animals failed to learn a new location during the reversal phase, suggesting a loss of cognitive flexibility. Finally, in the BM, the lack of preference for the target quadrant during the recall probe trial in animals receiving corticosterone regimen demonstrates that long-term retention was also affected in this paradigm. Taken together, our results highlight that CORT-induced anxio-depressive-like phenotype is associated with a cognitive deficit affecting all aspects of memory tested.

Could spirituality and religion promote stress resilience in survivors of childhood trauma?

Trauma is a precursor to many mental health conditions that greatly impact victims, their loved ones, and society. Studies indicate that neurobiological associations with adverse childhood experiences are mediated by interpersonal relationships and play a role in adult behavior, often leading to cycles of intergenerational trauma. There is a critical need to identify cost effective community resources that optimize stress resilience. Faith-based communities may promote forgiveness rather than retaliation, opportunities for cathartic emotional release, and social support, all of which have been related to neurobiology, behavior, and health outcomes. While spirituality and religion can be related to guilt, neurotic, and psychotic disorders, they also can be powerful sources of hope, meaning, peace, comfort, and forgiveness for the self and others. This article provides an overview of religion and spirituality as they relate to the neurobiology of resilience in victims of childhood trauma.

Pretreatment cortisol levels predict posttreatment outcomes among older adults with depression in cognitive behavioral therapy

Previous studies suggest that individuals with elevated levels of cortisol (the "stress hormone") could be particularly resistant to treatment for depression. However, most of these studies have been conducted in the context of antidepressant medications, and no study has examined pretreatment cortisol levels as a predictor of treatment outcomes among older adults with depression in cognitive-behavioral therapy (CBT), despite the relevance of this population for such a research question. The current study includes 54 older adults with depression who provided salivary cortisol samples at baseline and completed measures of depression at pretreatment and posttreatment, following a 12-week course of CBT. Structural equation modeling results suggest that those with higher daily outputs of cortisol and flatter diurnal slopes were less likely to benefit from CBT-a finding which if replicated could have important implications for clinical practice and future research.

Association between cortisol awakening response and memory function in major depression

BACKGROUND

While impaired memory and altered cortisol secretion are characteristic features of major depression, much less is known regarding the impact of antidepressant medication. We examined whether the cortisol awakening response (CAR) is increased in depressed patients with and without medication compared with healthy controls (HC) and whether CAR is associated with memory function in each group.

METHOD

We examined 21 patients with major depression without medication, 20 depressed patients on antidepressant treatment, and 41 age-, sex- and education-matched healthy subjects. We tested verbal (Auditory Verbal Learning Task) and visuospatial (Rey figure) memory and measured CAR on two consecutive days.

RESULTS

Patient groups did not differ in severity of depression. We found a significant effect of group (p = 0.03) for CAR. Unmedicated patients exhibited a greater CAR compared with medicated patients (p = 0.04) with no differences between patient groups and HC. We found a significant effect of group for verbal (p = 0.03) and non-verbal memory (p = 0.04). Unmedicated patients performed worse compared with medicated patients and HC in both memory domains. Medicated patients and HC did not differ. Regression analyses revealed a negative association between CAR and memory function in depressed patients, but not in HC.

CONCLUSIONS

While in unmedicated depressed patients the magnitude of CAR is associated with impaired memory, medicated patients showed a smaller CAR and unimpaired cognitive function compared with HC. Our findings are compatible with the idea that antidepressants reduce CAR and partially restore memory function even if depressive psychopathology is still present.

Effects of acute cortisol administration on response inhibition in patients with major depression and healthy controls

Glucocorticoids (GCs) have repeatedly been shown to impair hippocampus-mediated, declarative memory retrieval and prefrontal cortex-based working memory in healthy subjects. However, recent experimental studies indicated that patients with major depressive disorder (MDD) lack these impairing effects. These missing effects have been suggested to result from dysfunctional brain GC receptors. The purpose of the present study was to investigate whether response inhibition, an executive function relying on the integrity of the prefrontal cortex, would be impaired after cortisol administration in patients with MDD. In a placebo-controlled, double blind crossover study, 50 inpatients with MDD and 54 healthy control participants conducted an emotional go/no-go task consisting of human face stimuli (fearful, happy, and neutral) after receiving a dose of 10 mg hydrocortisone and after placebo. GC administration had an enhancing effect on inhibitory performance in healthy control participants, indicated by faster responses, while no GC effect was revealed for the patients group. Moreover, patients showed an overall worse performance than healthy participants. In conclusion, this study further supports the hypothesis of impaired central glucocorticoid receptor function in MDD patients. Regarding the importance of inhibitory functioning for daily living, further studies are needed to examine the impact of glucocorticoids on response inhibition.

Cortisol levels and risk for psychosis: initial findings from the North American prodrome longitudinal study

BACKGROUND

Studies of biomarkers of hypothalamic-pituitary-adrenal activity indicate that psychotic disorders are associated with elevated cortisol. This study examined cortisol levels in healthy control subjects and individuals who met clinical high-risk (CHR) criteria for psychosis. It was hypothesized that cortisol levels would be 1) elevated in the CHR group relative to control subjects, 2) positively correlated with symptom severity, and 3) most elevated in CHR patients who transition to psychotic level severity.

METHODS

Baseline assessments were conducted at eight centers in the North American Prodrome Longitudinal Study. The present CHR sample included 256 individuals meeting the Scale for Prodromal Symptoms criteria and 141 control subjects, all of whom underwent baseline assessment and measurement of salivary cortisol.

RESULTS

Consistent with previous reports, there was an effect of age on cortisol, with increases through the adolescent/early adult years. Analysis of covariance showed a main effect of diagnostic group, with the CHR group showing higher cortisol. There were modest, positive correlations of cortisol with baseline symptom severity, and analysis of covariance revealed higher baseline cortisol in those who transitioned to psychotic level symptoms when compared with healthy control subjects and CHR subjects who remitted.

CONCLUSIONS

The present findings add to accumulating evidence of heightened cortisol secretion in CHR individuals. The findings also indicate nonspecific associations between cortisol levels and symptom severity, as well as symptom progression. The role of hypothalamic-pituitary-adrenal activity in prediction of conversion to psychosis and its relation with other biomarkers of risk should receive attention in future research.

Neurocognitive function and state cognitive stress appraisal predict cortisol reactivity to an acute psychosocial stressor in adolescents

Stress and associated alterations in hypothalamic-pituitary-adrenal (HPA) function have deleterious influence on the development of multiple mental and physical health problems. Prior research has aimed to identify individuals most at risk for the development of these stress-related maladies by examining factors that may contribute to inter-individual differences in HPA responses to acute stress. The objectives of this study were to investigate, in adolescents, (1) whether differences in neurocognitive abilities influenced cortisol reactivity to an acute stressor, (2) whether internalizing psychiatric disorders influenced this relationship, and (3) whether acute cognitive stress-appraisal mechanisms mediated an association between neurocognitive function and cortisol reactivity. Subjects were 70 adolescents from a community sample who underwent standardized neurocognitive assessments of IQ, achievement, and declarative memory measures at mean age 14 and whose physiological and behavioral responses to a standardized psychosocial stress paradigm (Trier Social Stress Test, TSST) were assessed at mean age 18. Results showed that, among all adolescents, lower nonverbal memory performance predicted lower cortisol reactivity. In addition, internalizing disorders interacted with verbal memory such that the association with cortisol reactivity was strongest for adolescents with internalizing disorders. Finally, lower secondary cognitive appraisal of coping in anticipation of the TSST independently predicted lower cortisol reactivity but did not mediate the neurocognitive-cortisol relationship. Findings suggest that declarative memory may contribute to inter-individual differences in acute cortisol reactivity in adolescents, internalizing disorders may influence this relationship, and cognitive stress appraisal also predicts cortisol reactivity. Developmental, research, and clinical implications are discussed.

Cognitive functioning and cortisol suppression in recurrent major depression

Major Depressive Disorder (MDD) is often associated with high levels of stress and disturbances in the hypothalamic-pituitary-adrenal (HPA) system, yielding high levels of cortisol in addition to cognitive dysfunction. The aim of the present study was to examine the relation between cortisol levels after the dexamethasone suppression test and cognitive function in recurrent unipolar MDD patients. Twenty-four patients meeting the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) criteria for a recurrent MDD diagnosis were included in the study. The control group was matched for age, sex, and education level. Cortisol was measured in saliva collected with Salivette sampling devices. Saliva samples were collected four times during a 24-hr period over two consecutive days: at awakening, after 45 min, after 7 hr, and at 11:00 p.m. One milligram of dexamethasone was given on Day 1 at 11:00 p.m. The neuropsychological test battery consisted of standardized tests measuring cognitive functioning within verbal and visual memory, as well as executive functioning. Cortisol levels did not differ between patients and controls on Day 1. Cortisol levels in patients were higher than in controls at awakening on Day 2 (D2S1), after dexamethasone administration the previous evening. All significant correlations between cognitive measures and cortisol at D2S1 were negative, indicating that low suppression after intake of dexamethasone is related to poor cognitive functioning. Significant relations were found in three of the cognitive tests measuring verbal memory, semantic fluency, and inhibition. The present findings indicate that dysregulation of the HPA-axis is related to poor verbal memory functioning. There was no firm evidence that abnormal cortisol levels were associated with inhibition difficulties.

The neuropsychiatric and neuropsychological features of chronic fatigue syndrome: revisiting the enigma

The aim of this article is to provide a comprehensive and updated review of the key neuropsychiatric and neuropsychological complaints associated with chronic fatigue syndrome (CFS). Neuropsychiatric and neuropsychological difficulties are common in CFS and are linked primarily to disorders of mood, affect and behaviour. The neuropsychiatric complaint most frequently encountered amongst CFS patients is depression and in particular major depressive disorder (MDD). Despite decades of research, the precise aetiological relationship between CFS and MDD remains poorly understood. This has resulted in the development of a number of interesting and polarised hypotheses regarding the aetiological nature of CFS. Recent scientific advances have however begun to unravel a number of interesting inflammatory and immunological explanations that suggest CFS and MDD are distinct yet interrelated conditions. The possibility that the overlap between CFS and MDD might be explained in terms of shared oxidative and nitrosative (IO&NS) pathways is an area of intense research interest and is reviewed in detail in this article. The overlap between CFS and MDD is further differentiated by variations in HPA axis activity between the two disorders. Important immunological differences between MDD and CFS are also reviewed with particular emphasis on antiviral RNase L pathways in CFS. In addition to the presence of neuropsychiatric complaints, CFS is also associated with neuropsychological symptoms such as impaired attention, memory and reaction time. The key neuropsychological problems reported by CFS patients are also included in the review in an effort to understand the significance of cognitive impairment in CFS.

Altered brain function underlying verbal memory encoding and retrieval in psychotic major depression

Psychotic major depression (PMD) is associated with deficits in verbal memory as well as other cognitive impairments. This study investigated brain function in individuals with PMD during a verbal declarative memory task. Participants included 16 subjects with PMD, 15 subjects with non-psychotic major depression (NPMD) and 16 healthy controls (HC). Functional magnetic resonance imaging (fMRI) data were acquired while subjects performed verbal memory encoding and retrieval tasks. During the explicit encoding task, subjects semantically categorized words as either "man-made" or "not man-made." For the retrieval task, subjects identified whether words had been presented during the encoding task. Functional MRI data were processed using SPM5 and a group by condition ANOVA. Clusters of activation showing either a significant main effect of group or an interaction of group by condition were further examined using t-tests to identify group differences. During the encoding task, the PMD group showed lower hippocampus, insula, and prefrontal activation compared to HC. During the retrieval task, the PMD group showed lower recognition accuracy and higher prefrontal and parietal cortex activation compared to both HC and NPMD groups. Verbal retrieval deficits in PMD may be associated with deficient hippocampus function during encoding. Increased brain activation during retrieval may reflect an attempt to compensate for encoding deficits.

Neurocognitive alterations in first degree relatives of suicide completers

BACKGROUND

Suicide aggregates within families and the relatives of suicide completers are at an increased risk for suicide. Though neurocognitive changes are gaining increasing attention as part of the vulnerability for suicide, the literature on neurocognitive alterations among suicide relatives as possible endophenotypes of suicide is sparse.

METHOD

Normothymic first-degree relatives (n=14) of suicide completers without personal histories of suicide attempts were compared to individuals without family histories of suicide (n=14) matched for age-, sex- and education. Participants completed the Wisconsin card sorting test, a well validated test of cognitive control in a changing environment.

RESULTS

First-degree relatives of suicide completers made significantly more perseverative errors and have a lower level of conceptual responses than comparison subjects.

CONCLUSION

Alterations found in first-degree relatives of suicide completers suggest a decreased responsiveness to changing, yet unambiguous, conditions. These neurocognitive impairments are similar to deficits observed among individuals engaging in suicide attempts. Neurocognitive impairments revealed by the Wisconsin card sorting test may represent a neurocognitive endophenotype of suicide.

Role of mineralocorticoid receptors on the hypothalamus-pituitary-adrenal axis in humans

This clinical review will summarize the available data regarding the role of mineralocorticoid receptors (MRs) on the hypothalamus-pituitary-adrenal (HPA) axis control in physiological and pathological conditions and in the memory processes involved in the control and appraisal of a stress event. MRs are predominantly expressed in the limbic structures, with the hippocampus being the main localization, although MRs are also found at the hypothalamic level. It is known that hyppocampal MRs control the proactive feedback involved in the maintenance of the basal HPA activity, mainly at the nadir of the circadian rhythm. In physiological conditions, the administration of pharmacological doses of both MR antagonists and agonists is able to interact with the HPA activity, modifying the quiescent phase-nadir of the circadian rhythm, although some data in the literature do not support these observations. Also, in a physiological condition such as aging, an enhanced HPA axis activity is found in the time window, when MRs are predominantly occupied by cortisol circulating levels, possibly reflecting an MR impairment in this period of life. In pathology, major depression has been correlated to MR qualitative-quantitative alterations which could reflect differences on psychological and physiological responses, possibly predicting psychopathologies. Most of the remarks reported in this review seem to indicate, in agreement with animal data, a role played by MRs in the delicate control of the HPA axis in humans and the possible predisposition to the development of pathologies in case of their alterations.

Major depressive disorder is associated with broad impairments on neuropsychological measures of executive function: a meta-analysis and review

Cognitive impairments are now widely acknowledged as an important aspect of major depressive disorder (MDD), and it has been proposed that executive function (EF) may be particularly impaired in patients with MDD. However, the existence and nature of EF impairments associated with depression remain strongly debated. Although many studies have found significant deficits associated with MDD on neuropsychological measures of EF, others have not, potentially due to low statistical power, task impurity, and diverse patient samples, and there have been no recent, comprehensive, meta-analyses investigating EF in patients with MDD. The current meta-analysis uses random-effects models to synthesize 113 previous research studies that compared participants with MDD to healthy control participants on at least one neuropsychological measure of EF. Results of the meta-analysis demonstrate that MDD is reliably associated with impaired performance on neuropsychological measures of EF, with effect sizes ranging from 0.32 to 0.97. Although patients with MDD also have slower processing speed, motor slowing alone cannot account for these results. In addition, some evidence suggests that deficits on neuropsychological measures of EF are greater in patients with more severe current depression symptoms, and those taking psychotropic medications, whereas evidence for effects of age was weaker. The results are consistent with the theory that MDD is associated with broad impairment in multiple aspects of EF. Implications for treatment of MDD and theories of EF are discussed. Future research is needed to establish the specificity and causal link between MDD and EF impairments.

Morning salivary cortisol and cognitive function in mid-life: evidence from a population-based birth cohort

BACKGROUND

The hormone 'cortisol' has been associated with cognitive deficits in older ages, and also with childhood cognition. The extent to which the associations of cortisol with cognitive deficits in later life reflect associations with childhood cognition ability is unclear. This study aimed to assess associations between adult cortisol levels and subsequent cognitive functions, while considering childhood cognition and other lifetime covariates.

METHOD

Data are from the 1958 British Birth Cohort. Two morning salivary cortisol samples were obtained at 45 years: 45 min after waking (t1) and 3 h later (t2). Standardized tests assessing immediate and delayed verbal memory, verbal fluency and speed of processing were administered at 50 years. Information on cortisol, cognitive outcomes and covariates [e.g., birthweight, lifetime socio-economic position (SEP), education, smoking and drinking habits, body mass index (BMI), menopausal status, and depression/anxiety] was obtained for 4655 participants.

RESULTS

Worse immediate and delayed verbal memory and verbal fluency at 50 years were predicted by elevated t2 cortisol at 45 years. For instance, for 1 standard deviation (s.d.) increase in t2 cortisol, individuals scored -0.05 s.d. lower on verbal memory and fluency tests. Childhood cognition explained about 30% of these associations, but associations with adult cognition remained.

CONCLUSIONS

This study suggests that higher cortisol levels in late morning at 45 years are associated with poorer verbal memory and fluency at 50 years, with a contribution from childhood cognition to these associations.

Parsing trait and state effects of depression severity on neurocognition: Evidence from a 26-year longitudinal study

Cognitive dysfunction in mood disorders falls along a continuum, such that more severe current depression is associated with greater cognitive impairment. It is not clear whether this association reflects transient state effects of current symptoms on cognitive performance, or persistent, trait-like differences in cognition that are related to overall disorder severity. We addressed this question in 42 unipolar and 47 bipolar participants drawn from a 26-year longitudinal study of psychopathology, using measures of attention/psychomotor processing speed, cognitive flexibility, verbal fluency, and verbal memory. We assessed (a) the extent to which current symptom severity and past average disorder severity predicted unique variance in cognitive performance; (b) whether cognitive performance covaried with within-individual changes in symptom severity; and (c) the stability of neurocognitive measures over six years. We also tested for differences among unipolar and bipolar groups and published norms. Past average depression severity predicted performance on attention/psychomotor processing speed in both groups, and in cognitive flexibility among unipolar participants, even after controlling for current symptom severity, which did not independently predict cognition. Within-participant state changes in depressive symptoms did not predict change in any cognitive domain. All domains were stable over the course of six years. Both groups showed generalized impairment relative to published norms, and bipolar participants performed more poorly than unipolar participants on attention/psychomotor processing speed. The results suggest a stable relationship between mood disorder severity and cognitive deficits.

Response time variability and response inhibition predict affective problems in adolescent girls, not in boys: the TRAILS study

The present study examines the relationship between neurocognitive functioning and affective problems through adolescence, in a cross-sectional and longitudinal perspective. Baseline response speed, response speed variability, response inhibition, attentional flexibility and working memory were assessed in a cohort of 2,179 adolescents (age 10-12 years) from the TRacking Adolescents' Individual Lives Survey (TRAILS). Affective problems were measured with the DSM-oriented Affective Problems scale of the Youth Self Report at wave 1 (baseline assessment), wave 2 (after 2.5 years) and wave 3 (after 5 years). Cross-sectionally, baseline response speed, response time variability, response inhibition and working memory were associated with baseline affective problems in girls, but not in boys. Longitudinally, enhanced response time variability predicted affective problems after 2.5 and 5 years in girls, but not in boys. Decreased response inhibition predicted affective problems after 5 years follow-up in girls, and again not in boys. The results are discussed in light of recent insights in gender differences in adolescence and state-trait issues in depression.

Attentional functions in children and adolescents with ADHD, depressive disorders, and the comorbid condition

BACKGROUND

Attention-deficit hyperactivity disorder (ADHD) and depressive disorders (DDs) often co-occur in children and adolescents, but evidence on the respective influence of these disorders on attention parameters is inconsistent. This study examines the influence of DDs on ADHD in a model-oriented approach that includes selectivity and intensity attention parameters.

METHODS

Ten- to fifteen-year-olds with ADHD (n=63), DDs (n=61), ADHD+DDs (n=64), and healthy controls (n=64) completed a battery of tests including five neuropsychological tasks (i.e., alertness, sustained attention, divided attention, go/no-go, and attentional set-shifting).

RESULTS

All clinical groups showed attentional problems, especially in more complex attentional tasks and in the intensity aspects of attention. We observed the most severe attentional impairments in children with ADHD that was independent from a comorbid DD.

CONCLUSION

The clinical groups were significantly different from the healthy control group, especially in more complex attentional tasks and in the intensity aspects of attention. Some differences between ADHD, DDs and ADHD+DDs groups were detected on neuropsychological attentional performance, but the effects were not strong enough to differentiate the clinical groups from each other.

Cognitive correlates of hypothalamic-pituitary-adrenal axis in major depression

Depressive disorder has become a major health problem and is ranked among the leading causes of disability worldwide. Depression-related cognitive impairment contributes to loss of economic productivity and psychosocial functioning and calls for more efficient treatment strategies. Although the pathogenesis of cognitive impairments in patients with major depressive disorder (MDD) is still insufficiently understood, increasing evidence implicates hypothalamus-pituitary-adrenal (HPA) axis as an important neurobiological determinant of cognitive impairment in depression. In this article, major findings of both HPA axis function abnormalities and cognitive impairments in depressed patients are summarized, focusing on their inter-relationship. Novel approaches in pharmacotherapy and psychotherapy have emerged which will be discussed with regard to their ability to reinstate normal HPA axis function in MDD and to treat cognitive impairments in MDD.

HPA axis alterations in mental disorders: impact on memory and its relevance for therapeutic interventions

Dysfunctions in hypothalamic-pituitary-adrenal (HPA) axis have been reported for several mental disorders that are also often characterized by memory disturbances. It is now well established that glucocorticoids influence cognitive processes by enhancing memory consolidation and impairing memory retrieval. There is further evidence for an association between HPA axis related disturbances and memory function in mental disorders. The present selective review provides a brief overview of HPA axis dysfunction and its impact on memory function in major depressive disorder, posttraumatic stress disorder, and borderline personality disorder. Furthermore, the relevance of these findings for therapeutic intervention is discussed.

Cognitive impairment in major depression: association with salivary cortisol

BACKGROUND

Cognitive deficits and elevated cortisol are hallmarks of depression. Cortisol acts via mineralocorticoid and glucocorticoid receptors, which have their highest density in the hippocampus, a brain area closely related to cognitive function. Several studies have separately examined cortisol secretion and cognitive deficits in depression. However, only few studies have assessed their association in the same patients producing inconclusive results.

METHODS

We examined 52 medication-free patients with major depression (37 women, 15 men; mean age 35 +/- 11 years; Hamilton Depression Scale mean score 27 +/- 5) and 50 healthy control subjects, matched for age, gender, and years of education. We applied several neuropsychological tests. Salivary cortisol levels were measured on the same day at 08:00, 12:00, 16:00, and 22:00 hours.

RESULTS

Compared with healthy subjects, patients had significantly higher cortisol levels and were impaired in verbal memory, visuospatial memory, working memory, and selective attention. In depressed patients, but not in healthy control subjects, we found a negative correlation between salivary cortisol levels (area under the curve) and hippocampus-related neuropsychological domains (verbal memory, visuospatial memory) and executive function.

CONCLUSIONS

Cognitive deficits, especially those closely related to hippocampus function, appear to be related to cortisol secretion in depressed patients. Elevated cortisol may downregulate mineralocorticoid and glucocorticoid receptors in the hippocampus, which could, in part, be responsible for cognitive deficits in depressed patients.