Chronic glucocorticoid hypersecretion in Cushing’s syndrome exacerbates cognitive aging

Michaud, Kathy; Forget, Hélène; Cohen, Henrí

doi:10.1016/j.bandc.2009.02.013

Cited by 57 publications

(29 citation statements)

References 78 publications

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“…The presence of WML lesions increases with time, and the percentage of older patients with WML at the age of 82 increases to 94% (23). Taking into account the number of patients whose routine MRI reports described the presence of WML (in remission 73.9%, mean age 44.3G9.3; active 46.7%, mean age 42.9G10.6), it seems that the WML presence in our patient population is higher than expected, maybe in line with the brain-aging effect suggested by some authors in Cushing's syndrome (52).…”

Section: European Journal Of Endocrinologysupporting

confidence: 84%

Cardiovascular risk and white matter lesions after endocrine control of Cushing's syndrome

Santos

Resmini

Gómez‐Anson

et al. 2015

European Journal of Endocrinology

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Objective: Cushing's syndrome (CS) is associated with high cardiovascular risk. White matter lesions (WML) are common on brain magnetic resonance imaging (MRI) in patients with increased cardiovascular risk. Aim: To investigate the relationship between cardiovascular risk, WML, neuropsychological performance and brain volume in CS. Design/methods: Thirty-eight patients with CS (23 in remission, 15 active) and 38 controls sex-, age-and education-level matched underwent a neuropsychological and clinical evaluation, blood and urine tests and 3Tesla brain MRI. WML were analysed with the Scheltens scale. Ten-year cardiovascular risk (10CVR) and vascular age (VA) were calculated according to an algorithm based on the Framingham heart study. Results: Patients in remission had a higher degree of WML than controls and active patients (P!0.001 and PZ0.008 respectively), which did not correlate with cognitive performance in any group. WML severity positively correlated with diastolic blood pressure (rZ0.659, PZ0.001) and duration of hypertension (rZ0.478, PZ0.021) in patients in remission. Both patient groups (active and in remission) had higher 10CVR (PZ0.030, PZ0.041) and VA than controls (PZ0.013, PZ0.039). Neither the 10CVR nor the VA correlated with WML, although both negatively correlated with cognitive function and brain volume in patients in remission (P!0.05). Total brain volume and grey matter volume in both CS patient groups were reduced compared to controls (total volume: active PZ0.006, in remission PZ0.012; grey matter: active PZ0.001, in remission PZ0.003), with no differences in white matter volume between groups. Conclusions: Patients in remission of Cushing's syndrome (but not active patients) have more severe white matter lesions than controls, positively correlated with diastolic pressure and duration of hypertension. Ten-year cardiovascular risk and vascular age appear to be negatively correlated with the cognitive function and brain volume in patients in remission of Cushing's syndrome.

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Section: European Journal Of Endocrinologysupporting

confidence: 84%

Cardiovascular risk and white matter lesions after endocrine control of Cushing's syndrome

Santos

Resmini

Gómez‐Anson

et al. 2015

European Journal of Endocrinology

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“…High cortisol release associated with delirium was previously reported in stroke [8], in postcardiac surgery [9], in the elderly patients with hip fracture [10], in psychological depression, and in Cushing syndrome [11]. In clinical severe sepsis, high cortisol levels have been reported in patients who developed fatal brain dysfunction [12] but it remained unclear if this could be a sole indicator of severe inflammation and disease severity or was due to brain dysfunction.…”

Section: Introductionmentioning

confidence: 99%

Cortisol Is an Associated-Risk Factor of Brain Dysfunction in Patients with Severe Sepsis and Septic Shock

Nguyen

Huyghens

Zhang

et al. 2014

BioMed Research International

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Objectives. To investigate cortisol levels in brain dysfunction in patients with severe sepsis and septic shock. Methods. In 128 septic and sedated patients, we studied brain dysfunction including delirium and coma by the evaluation of Richmond Agitation Sedation Scale (RASS), the Confusion Method Assessment in the ICU (CAM-ICU) after sedation withdrawal and the measurement of serum S100B biomarker of brain injury. Serum cortisol and S100B were measured within 12 hours after ICU admission and daily over the next four days. Results. Brain dysfunction was observed in 50% (64/128) before but in 84% (107/128) of patients after sedation withdrawal, and was more common in the patients older than 57 years (P = 0.009). Both cortisol (P = 0.007) and S100B levels (P = 0.028) were higher in patients with than patients without brain dysfunction. Cortisol levels were associated with ICU mortality (hazard ratio = 1.17, P = 0.024). Multivariate logistic regression showed that cortisol (odds ratio (OR): 2.34, 95% CI (2.01, 3.22), P = 0.02) and the combination effect of cortisol with age (OR: 1.004, 95% CI (1.002, 1.93), P = 0.038) but not S100B were associated with brain dysfunction. Conclusions. Cortisol was an associated-risk factor of brain dysfunction in patients with severe sepsis and septic shock.

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“…96 The mechanisms driving these phenomena have remained unclear, but it is worth noting that they have also been associated with concussion, 29 hypercortisolism, 71 chronic stress, 7 and PTSD, 39 offering some possible insights into convergence across these related conditions and potential mechanistic pathways. Fear (of movement, pain, or the unknown) rounds out the reactions in this primary sequela stage.…”

Section: Integration Of Recent and Emerging Evidencementioning

confidence: 99%

An Integrated Model of Chronic Whiplash-Associated Disorder

Walton

Elliott²

2017

J Orthop Sports Phys Ther

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Chronic glucocorticoid hypersecretion in Cushing’s syndrome exacerbates cognitive aging

Cited by 57 publications

References 78 publications

Cardiovascular risk and white matter lesions after endocrine control of Cushing's syndrome

Cardiovascular risk and white matter lesions after endocrine control of Cushing's syndrome

Cortisol Is an Associated-Risk Factor of Brain Dysfunction in Patients with Severe Sepsis and Septic Shock

An Integrated Model of Chronic Whiplash-Associated Disorder

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