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De Alcubierre D, Ferrari D, Mauro G, Isidori AM, Tomlinson JW, Pofi R. Glucocorticoids and cognitive function: a walkthrough in endogenous and exogenous alterations. J Endocrinol Invest 2023; 46:1961-1982. [PMID: 37058223 PMCID: PMC10514174 DOI: 10.1007/s40618-023-02091-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/05/2023] [Indexed: 04/15/2023]
Abstract
PURPOSE The hypothalamic-pituitary-adrenal (HPA) axis exerts many actions on the central nervous system (CNS) aside from stress regulation. Glucocorticoids (GCs) play an important role in affecting several cognitive functions through the effects on both glucocorticoid (GR) and mineralocorticoid receptors (MR). In this review, we aim to unravel the spectrum of cognitive dysfunction secondary to derangement of circulating levels of endogenous and exogenous glucocorticoids. METHODS All relevant human prospective and retrospective studies published up to 2022 in PubMed reporting information on HPA disorders, GCs, and cognition were included. RESULTS Cognitive impairment is commonly found in GC-related disorders. The main brain areas affected are the hippocampus and pre-frontal cortex, with memory being the most affected domain. Disease duration, circadian rhythm disruption, circulating GCs levels, and unbalanced MR/GR activation are all risk factors for cognitive decline in these patients, albeit with conflicting data among different conditions. Lack of normalization of cognitive dysfunction after treatment is potentially attributable to GC-dependent structural brain alterations, which can persist even after long-term remission. CONCLUSION The recognition of cognitive deficits in patients with GC-related disorders is challenging, often delayed, or mistaken. Prompt recognition and treatment of underlying disease may be important to avoid a long-lasting impact on GC-sensitive areas of the brain. However, the resolution of hormonal imbalance is not always followed by complete recovery, suggesting irreversible adverse effects on the CNS, for which there are no specific treatments. Further studies are needed to find the mechanisms involved, which may eventually be targeted for treatment strategies.
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Affiliation(s)
- D De Alcubierre
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - D Ferrari
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - G Mauro
- Department of Physiology and Pharmacology, Sapienza University of Rome, Rome, Italy
| | - A M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - J W Tomlinson
- Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford, UK
| | - R Pofi
- Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford, UK.
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Corticosteroids and Cognition: A Meta-Analysis. Neuropsychol Rev 2019; 29:288-312. [DOI: 10.1007/s11065-019-09405-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 04/10/2019] [Indexed: 12/21/2022]
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Read J, Fosse R, Moskowitz A, Perry B. The traumagenic neurodevelopmental model of psychosis revisited. ACTA ACUST UNITED AC 2014. [DOI: 10.2217/npy.13.89] [Citation(s) in RCA: 148] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Claflin DI, Greenfield LR, Hennessy MB. Modest elevation of corticosterone in preweanling rats impairs subsequent trace eyeblink conditioning during the juvenile period. Behav Brain Res 2014; 258:19-26. [PMID: 24140564 PMCID: PMC3884574 DOI: 10.1016/j.bbr.2013.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 10/01/2013] [Accepted: 10/03/2013] [Indexed: 01/12/2023]
Abstract
The hippocampus is known to be especially sensitive to the deleterious effects of glucocorticoids. Previously, we administered exogenous corticosterone, the major stress-related glucocorticoid in rats, to young developing rats using subcutaneous pellets which produced high pharmacological levels of circulating corticosterone as well as a sex-specific learning deficit for males on a hippocampus-mediated associative learning task, trace eyeblink conditioning [1]. The present study evaluated the effects of corticosterone administered at a physiologically-relevant level by a more consistent release method, osmotic mini-pumps. Pumps were implanted subcutaneously in 15-day-old rats to deliver either corticosterone or the vehicle control (PEG) at a rate of 1 μl/h over 3 days. On Day 28, learning was assessed using trace eyeblink conditioning. The results of the present experiment revealed that a small elevation in corticosterone (11.77 μg/dl versus 6.02 μg/dl for controls) within the normal physiological range impaired learning as determined by a significantly lower percentage and amplitude of total conditioned responses (CRs) and lower amplitude of adaptive responses relative to the control group. There were no significant differences in response timing, although the corticosterone group tended to produce CRs which began and peaked a little later than controls. These findings indicate that even modest elevations of corticosterone for several days can produce later impairments on this hippocampally mediated learning task.
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Affiliation(s)
- Dragana I Claflin
- Department of Psychology, Wright State University, 335 Fawcett Hall, 3640 Colonel Glenn Hwy, Dayton, OH 45435, USA.
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Henckens MJAG, van Wingen GA, Joëls M, Fernández G. Time-dependent effects of cortisol on selective attention and emotional interference: a functional MRI study. Front Integr Neurosci 2012; 6:66. [PMID: 22973203 PMCID: PMC3428804 DOI: 10.3389/fnint.2012.00066] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Accepted: 08/10/2012] [Indexed: 01/08/2023] Open
Abstract
Acute stress is known to induce a state of hypervigilance, allowing optimal detection of threats. Although one may benefit from sensitive sensory processing, it comes at the cost of unselective attention and increased distraction by irrelevant information. Corticosteroids, released in response to stress, have been shown to profoundly influence brain function in a time-dependent manner, causing rapid non-genomic and slow genomic effects. Here, we investigated how these time-dependent effects influence the neural mechanisms underlying selective attention and the inhibition of emotional distracters in humans. Implementing a randomized, double-blind, placebo-controlled design, 65 young healthy men received 10 mg hydrocortisone either 60 min (rapid effects) or 270 min (slow effects), or placebo prior to an emotional distraction task, consisting of color-naming of either neutral or aversive words. Overall, participants responded slower to aversive compared to neutral words, indicating emotional interference with selective attention. Importantly, the rapid effects of corticosteroids increased emotional interference, which was associated with reduced amygdala inhibition to aversive words. Moreover, they induced enhanced amygdala connectivity with frontoparietal brain regions, which may reflect increased influence of the amygdala on an executive network. The slow effects of corticosteroids acted on the neural correlates of sustained attention. They decreased overall activity in the cuneus, possibly indicating reduced bottom-up attentional processing, and disrupted amygdala connectivity to the insula, potentially reducing emotional interference. Altogether, these data suggest a time-specific corticosteroid modulation of attentive processing. Whereas high circulating corticosteroid levels acutely increase emotional interference, possibly facilitating the detection of threats, a history of elevation might promote sustained attention and thereby contribute to stress-recovery of cognitive function.
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Affiliation(s)
- Marloes J. A. G. Henckens
- Donders Institute for Brain, Cognition and Behaviour, Radboud University NijmegenNijmegen, Netherlands
- Department of Neuroscience and Pharmacology, Rudolf Magnus Institute, University Medical Center UtrechtUtrecht, Netherlands
| | - Guido A. van Wingen
- Donders Institute for Brain, Cognition and Behaviour, Radboud University NijmegenNijmegen, Netherlands
- Department of Psychiatry, Academic Medical Center, University of AmsterdamAmsterdam, Netherlands
| | - Marian Joëls
- Department of Neuroscience and Pharmacology, Rudolf Magnus Institute, University Medical Center UtrechtUtrecht, Netherlands
| | - Guillén Fernández
- Donders Institute for Brain, Cognition and Behaviour, Radboud University NijmegenNijmegen, Netherlands
- Department of Cognitive Neuroscience, Radboud University Nijmegen Medical CentreNijmegen, Netherlands
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Do KQ, Conus P, Cuenod M. Redox dysregulation and oxidative stress in schizophrenia: nutrigenetics as a challenge in psychiatric disease prevention. JOURNAL OF NUTRIGENETICS AND NUTRIGENOMICS 2011; 3:267-89. [PMID: 21474958 DOI: 10.1159/000324366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Kim Q Do
- Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland.
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Yehuda R, Golier JA, Bierer LM, Mikhno A, Pratchett LC, Burton CL, Makotkine I, Devanand DP, Pradhaban G, Harvey PD, Mann JJ. Hydrocortisone responsiveness in Gulf War veterans with PTSD: effects on ACTH, declarative memory hippocampal [(18)F]FDG uptake on PET. Psychiatry Res 2010; 184:117-27. [PMID: 20934312 DOI: 10.1016/j.pscychresns.2010.06.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Accepted: 06/22/2010] [Indexed: 10/19/2022]
Abstract
Neuroendocrine, cognitive and hippocampal alterations have been described in Gulf War (GW) veterans, but their inter-relationships and significance for posttraumatic stress disorder (PTSD) have not been described. Hydrocortisone (Hcort) was administered to GW veterans with (PTSD+ n=12) and without (PTSD- n=8) chronic PTSD in a randomized, placebo-controlled, double-blind challenge. Changes in plasma ACTH, memory, and hippocampal [(18)F]FDG uptake on positron emission tomography were assessed. The low-dose dexamethasone suppression test was also administered. The PTSD+ group showed greater cortisol and ACTH suppression, reflecting greater peripheral glucocorticoid receptor (GR) responsiveness, and did not show an Hcort-induced decrement in delayed recall or retention. The groups had comparable relative regional hippocampal [(18)F]FDG uptake at baseline, but only the PTSD- group had an Hcort-associated decrease in hippocampal [(18)F]FDG uptake. Asymmetry in hippocampal hemispheric volumes differed between PTSD+ and PTSD- groups. This asymmetry was associated with cortisol, ACTH, retention and functional hippocampal asymmetry before, but not after, Hcort administration. Differences in brain metabolic responses between GW veterans with and without PTSD may reflect differences in peripheral and central GR responsiveness.
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Affiliation(s)
- Rachel Yehuda
- James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA.
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Brown ES. Effects of glucocorticoids on mood, memory, and the hippocampus. Treatment and preventive therapy. Ann N Y Acad Sci 2009; 1179:41-55. [PMID: 19906231 DOI: 10.1111/j.1749-6632.2009.04981.x] [Citation(s) in RCA: 148] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Corticosteroids, such as prednisone and dexamethasone, are commonly prescribed medications that suppress the immune system and decrease inflammation. Common side effects of long-term treatment with corticosteroids include weight gain, osteoporosis, and diabetes mellitus. This paper reviews the literature on psychiatric and cognitive changes during corticosteroid therapy and potential treatment options. Hypomania and mania are the most common mood changes during acute corticosteroid therapy, although depression has also been reported. However, depression is reported to be more common than mania during long-term treatment with corticosteroids. A decline in declarative and working memory is also reported during corticosteroid therapy. Corticosteroids are associated with changes in the temporal lobe, detected by structural, functional, and spectroscopic imaging. The mood and cognitive symptoms are dose dependent and frequently occur during the first few weeks of therapy. Other risk factors are not well characterized. Controlled trials suggest that lithium and phenytoin can prevent mood symptoms associated with corticosteroids. Lamotrigine and memantine also have been shown to reverse, at least partially, the declarative memory effects of corticosteroids. Uncontrolled trials suggest that antipsychotics, anti-seizure medications, and perhaps some antidepressants can also be useful for normalizing mood changes associated with corticosteroids. Thus, both the symptoms and treatment response are similar to those of bipolar disorder. Moreover, corticosteroid-induced mood and cognitive alterations have been shown to be reversible with dose reduction or discontinuation of treatment.
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Affiliation(s)
- E Sherwood Brown
- Psychoneuroendocrine Research Program, Department of Psychiatry, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA.
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Betensky JD, Robinson DG, Gunduz-Bruce H, Sevy S, Lencz T, Kane JM, Malhotra AK, Miller R, McCormack J, Bilder RM, Szeszko PR. Patterns of stress in schizophrenia. Psychiatry Res 2008; 160:38-46. [PMID: 18514323 PMCID: PMC2487675 DOI: 10.1016/j.psychres.2007.06.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2006] [Revised: 04/03/2007] [Accepted: 06/01/2007] [Indexed: 10/22/2022]
Abstract
Although it is widely recognized that stress plays a key role in the pathophysiology of schizophrenia, little is known regarding the particular types of stress patients experience. Less is known about the interplay among stressful events, personality mediators, and emotional responses. In this study, we investigated 10 stress dimensions in 29 patients with schizophrenia and 36 healthy volunteers using the Derogatis Stress Profile (DSP), and the relationship between these dimensions and symptoms in patients. Overall, patients had an approximate 0.75 standard deviation increase in stress compared with healthy volunteers. Significant increases in stress among patients compared with healthy volunteers were observed specifically in areas related to domestic environment, driven behavior, and depression, but not in health, attitude posture, time pressure, relaxation potential, role definition, hostility, or anxiety. More DSP-rated depression among patients correlated significantly with greater negative symptom severity. Patients with a shorter duration of antipsychotic drug exposure had significantly greater hostility than did patients with a longer duration of exposure, but did not differ in any other dimension. Continued investigation of domestic environmental stressors, driven behavior, and depression may be useful in identifying high-risk groups, and understanding symptom exacerbation and precipitants of relapse in patients already diagnosed with schizophrenia.
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Affiliation(s)
- Julia D. Betensky
- Department of Psychiatry Research, The Zucker Hillside Hospital, North-Shore - Long Island Jewish Health System, 75-59 263 Street, Glen Oaks, NY, 11004, United
| | - Delbert G. Robinson
- Department of Psychiatry Research, The Zucker Hillside Hospital, North-Shore - Long Island Jewish Health System, 75-59 263 Street, Glen Oaks, NY, 11004, United
- Feinstein Institute for Medical Research, Manhasset, NY, US
- Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, US
| | - Handan Gunduz-Bruce
- Yale University School of Medicine, VA Medical Center, Psychiatry Service 116A, 950 Campbell Avenue, West Haven, CT, 06516, United States
| | - Serge Sevy
- Department of Psychiatry Research, The Zucker Hillside Hospital, North-Shore - Long Island Jewish Health System, 75-59 263 Street, Glen Oaks, NY, 11004, United
- Feinstein Institute for Medical Research, Manhasset, NY, US
- Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, US
| | - Todd Lencz
- Department of Psychiatry Research, The Zucker Hillside Hospital, North-Shore - Long Island Jewish Health System, 75-59 263 Street, Glen Oaks, NY, 11004, United
- Feinstein Institute for Medical Research, Manhasset, NY, US
- Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, US
| | - John M. Kane
- Department of Psychiatry Research, The Zucker Hillside Hospital, North-Shore - Long Island Jewish Health System, 75-59 263 Street, Glen Oaks, NY, 11004, United
- Feinstein Institute for Medical Research, Manhasset, NY, US
- Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, US
| | - Anil K. Malhotra
- Department of Psychiatry Research, The Zucker Hillside Hospital, North-Shore - Long Island Jewish Health System, 75-59 263 Street, Glen Oaks, NY, 11004, United
- Feinstein Institute for Medical Research, Manhasset, NY, US
- Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, US
| | - Rachel Miller
- Department of Psychiatry Research, The Zucker Hillside Hospital, North-Shore - Long Island Jewish Health System, 75-59 263 Street, Glen Oaks, NY, 11004, United
| | - Joanne McCormack
- Department of Psychiatry Research, The Zucker Hillside Hospital, North-Shore - Long Island Jewish Health System, 75-59 263 Street, Glen Oaks, NY, 11004, United
| | - Robert M. Bilder
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, Lynda and Stewart Resnick Neuropsychiatric Hospital, David Geffen School of Medicine at UCLA, Room C8-849, 760 Westwood Plaza, Los Angeles, CA, 90095, United States
| | - Philip R. Szeszko
- Department of Psychiatry Research, The Zucker Hillside Hospital, North-Shore - Long Island Jewish Health System, 75-59 263 Street, Glen Oaks, NY, 11004, United
- Feinstein Institute for Medical Research, Manhasset, NY, US
- Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, US
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Walker E, Mittal V, Tessner K. Stress and the hypothalamic pituitary adrenal axis in the developmental course of schizophrenia. Annu Rev Clin Psychol 2008; 4:189-216. [PMID: 18370616 DOI: 10.1146/annurev.clinpsy.4.022007.141248] [Citation(s) in RCA: 421] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Diathesis-stress models of schizophrenia and other psychotic disorders have dominated theorizing about etiology for over three decades. More recently, with advances in our understanding of the biological processes mediating the effects of stress, these models have incorporated mechanisms to account for the adverse impact of stress on brain function. This review examines recent scientific findings on the role of the hypothalamic-pituitary-adrenal (HPA) axis, one of the primary neural systems triggered by stress exposure, in the expression of vulnerability for schizophrenia. The results indicate that psychotic disorders are associated with elevated baseline and challenge-induced HPA activity, that antipsychotic medications reduce HPA activation, and that agents that augment stress hormone (cortisol) release exacerbate psychotic symptoms. The cumulative findings are discussed in light of a neural diathesis-stress model that postulates that cortisol has the potential to increase activity of dopamine pathways that have been implicated in schizophrenia and other psychotic disorders.
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Affiliation(s)
- Elaine Walker
- Department of Psychology, Emory University, Atlanta, Georgia 30322, USA.
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Kohno T, Shiga T, Kusumi I, Matsuyama T, Kageyama H, Katoh C, Koyama T, Tamaki N. Left temporal perfusion associated with suspiciousness score on the Brief Psychiatric Rating Scale in schizophrenia. Psychiatry Res 2006; 147:163-71. [PMID: 16959474 DOI: 10.1016/j.pscychresns.2006.01.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2005] [Revised: 01/25/2006] [Accepted: 01/29/2006] [Indexed: 11/21/2022]
Abstract
We evaluated the relationship between regional cerebral blood flow (rCBF) and clinical symptoms in patients with schizophrenia. Single photon emission computed tomography with N-isopropyl-p-[123I]iodoamphetamine (123I-IMP) was used to study 29 patients with schizophrenia. Clinical symptoms were assessed using the Brief Psychiatric Rating Scale (BPRS). We examined the correlation between rCBF and each BPRS item score using Statistical Parametric Mapping software. Corrected P-values < 0.05 were considered as statistically significant. The suspiciousness score on the BPRS was positively correlated with rCBF in the left inferior temporal gyrus. There was no significant correlation between rCBF and any other items of the BPRS. There was no significant correlation between rCBF and chlorpromazine-equivalent dosage. This analysis permits the quantitative assessment of the severity of persecutory delusions in relation to left temporal perfusion in patients with schizophrenia.
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Affiliation(s)
- Tomoya Kohno
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-ku, Sapporo 060-8638, Japan.
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Brown ES, J Woolston D, Frol A, Bobadilla L, Khan DA, Hanczyc M, Rush AJ, Fleckenstein J, Babcock E, Cullum CM. Hippocampal volume, spectroscopy, cognition, and mood in patients receiving corticosteroid therapy. Biol Psychiatry 2004; 55:538-45. [PMID: 15023583 DOI: 10.1016/j.biopsych.2003.09.010] [Citation(s) in RCA: 179] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2003] [Revised: 09/19/2003] [Accepted: 09/24/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND Hippocampal volume reduction, declarative memory deficits, and cortisol elevations are reported in persons with major depressive disorder; however, data linking cortisol elevations with hippocampal atrophy are lacking. Prescription corticosteroid-treated patients offer an opportunity to examine corticosteroid effects on hippocampal volume and biochemistry and memory in humans. METHODS Seventeen patients on long-term prescription corticosteroid therapy and 15 controls of similar age, gender, ethnicity, education, height, and medical history were assessed with magnetic resonance imaging and proton magnetic resonance spectroscopy, the Rey Auditory Verbal Learning Test, Stroop Color Word Test and other neurocognitive measures, the Hamilton Rating Scale for Depression, Young Mania Rating Scale, and Brief Psychiatric Rating Scale. RESULTS Compared with controls, corticosteroid-treated patients had smaller hippocampal volumes and lower N-acetyl aspartate ratios, lower scores on the Rey Auditory Verbal Learning Test and Stroop Color Word Test, and higher Hamilton Rating Scale for Depression and Brief Psychiatric Rating Scale scores. CONCLUSIONS Patients receiving chronic corticosteroid therapy have smaller hippocampal volumes, lower N-acetyl aspartate ratios, and declarative memory deficits compared with controls. These findings support the idea that corticosteroid exposure appears to be associated with changes in hippocampal volume and functioning in humans.
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Affiliation(s)
- E Sherwood Brown
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas 75390-8849, USA
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