Dexamethasone Suppression Test and Serum Prolactin in Dementia Disorders

Balldin, Jan; Gottfries, C. G.; Karlsson, Ingvar; Lindstedt, Göran; Långström, Goran; Wålinder, Jan

doi:10.1192/bjp.143.3.277

Cited by 148 publications

(58 citation statements)

References 11 publications

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“…Previous evidence regarding the differences in neuroendocrine function between AD and VD patients indicated contrasting results: while neuroendocrine regulation of growth hormone (GH) appeared more damaged in AD than in multi-infarct dementia patients (40), both AD and VD patients showed a similar behavior of plasma b-endorphin and cortisol circadian rhythms and similar abnormalities of dexamethasone suppression test (41,42).…”

Section: Discussionmentioning

confidence: 87%

Allopregnanolone and dehydroepiandrosterone response to corticotropin-releasing factor in patients suffering from Alzheimer's disease and vascular dementia

Bernardi

Lanzone

Cento

et al. 2000

European Journal of Endocrinology

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Objective: Neurosteroids have been suggested to be involved in the regulation of cognitive performances. A major neurosteroid gamma-aminobutyric acid (GABA) agonist is allopregnanolone: the main source of circulating allopregnanolone is the adrenal cortex. Studies indicated that a disturbance of the central regulation of the hypothalamic-pituitary-adrenocortical axis occurs in both senile (Alzheimer's disease: AD) and vascular dementia (VD). Design: The aim of the present study was to evaluate the levels of circulating allopregnanolone, dehydroepiandrosterone (DHEA) and cortisol and their response to corticotropin-releasing factor (CRF) test in AD and VD. Methods: Three groups of 12 subjects were included in the study: AD, VD and age-matched control subjects. CRF test was performed in all subjects and allopregnanolone, DHEA and cortisol levels were measured every 15 min for 2 h. Results: Mean Ϯ S.E.M. allopregnanolone and DHEA basal levels were significantly lower in AD and VD than in controls, while cortisol levels were significantly higher than in controls (P<0.01). Allopregnanolone and DHEA levels increase in response to CRF test in all subjects but the area under curve (AUC) in patients was significantly lower than in controls (P<0.01). Cortisol secretion appeared to be very sensitive in response to CRF stimulation: in fact, cortisol response to CRF test in AD and VD subjects was higher (both as AUC and as % max increase) than in controls (P<0.01). Conclusions:The present study firstly showed that allopregnanolone levels are reduced both in AD and in VD and that dementia has a preserved stimulated response of allopregnanolone to CRF. Overall, however, the total response of allopregnanolone to CRF remains reduced in respect to controls. Further studies are necessary for a better understanding of the role of neurosteroids in the regulation of cognitive function.

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Section: Discussionmentioning

confidence: 87%

Allopregnanolone and dehydroepiandrosterone response to corticotropin-releasing factor in patients suffering from Alzheimer's disease and vascular dementia

Bernardi

Lanzone

Cento

et al. 2000

European Journal of Endocrinology

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“…The method used is a slight modifica tion -incorporating a transcortin blocker -of an assay previously described in detail by Balldin el al. [6]. This method has been vali dated by gas chromatography-mass spectrometry [15] and has been found to have similar imprecision as the assay described by Balldin et al [6].…”

Section: Dexamethasone Suppression Testmentioning

confidence: 96%

“…Based on the relatively high basal cortisol levels (505 ± 143) found in this study of demented patients, the high frequency of pathological DST, together with the clinical picture of irritability, anxiety, fear-panic and restlessness, we conclude that there is continuous overactivity in the hypothalamus in a substantial proportion of demented patients, a notion that is supported by results of postmortem human brain studies [7], This study lacks a control group. However, among elderly volunteers in the same geographical area, only 1/ 14 (7%) were found to have pathological DST [6]. Fur thermore, results of an investigation on DST in an elderly nondemented population indicate that old age does not affect the DST in healthy humans [16].…”

Section: Discussionmentioning

confidence: 99%

“…The dexamethasone suppression test (DST) [4] has been shown to be pathological in different types of dementia disorders [5,6]. The result of a DST is depen dent on the function in the hypothalamo-pituitary-adrenal axis (HPA axis) and on the condition of the feedback system in which cortisol activates receptors -primarily in the hippocampus -that inhibit hypothalamic activity.…”

Section: Introductionmentioning

confidence: 99%

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Relationship between Mental Impairment and HPA Axis Activity in Dementia Disorders

Balldin¹,

Blennow²,

Bråne³

et al. 1994

Dement Geriatr Cogn Disord

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In 40 patients with Alzheimer's disease (AD, <65 years), 56 patients with senile dementia of the Alzheimer type (SDAT, ≥65 years) and 45 patients with vascular dementia (VAD), basal cortisol levels were estimated and the dexamethasone test (DST) was performed. The degree of dementia was assessed according to DSM-III-R and the GBS scale was used for quantitative measures of functional impairment. There were no significant differences in basal cortisol levels. Especially in the VAD group, scores on functional impairment correlated significantly with post-DST cortisol levels. The results indicate hypothalamic overactivity in demented patients which can be correlated to the degree of dementia. In VAD, and to a certain extent also in SDAT, there appears to be a disconnection between cortical areas, including the hippocampus and the hypothalamus.

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“…tone on the hypothalamus may explain the increased neuropeptide activity in the hypothalamus. Neuroendocrine overactivity in AD and VAD patients is clinically manifested in pathological dexamethasone tests [9].…”

Section: Studies Of Neuroendocrine Functionsmentioning

confidence: 99%

The Neurochemistry of Vascular Dementia

Gottfries

Blennow

Karlsson

et al. 1994

Dement Geriatr Cogn Disord

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Vascular dementia (VAD) is cognitive impairment caused by changes in the blood circulation of the brain. It is not synonymous with multi-infarct dementia. The latter is a subgroup of VAD. Neurochemical investigations of noninfarcted brain tissue from patients with VAD show general changes in VAD brains. The serotonin metabolism is severely reduced and so is the activity of choline acetyltransferase. Monamine oxidase B is significantly increased in the white matter. A severe decrease in myelin components indicates white matter disturbances of such a degree that they must be considered to be of pathogenetic importance. The levels of some neuropeptides in the hypothalamus are increased. This is a finding which is in agreement with clinical findings of a high activity in the hypothalamic-pituitary-adrenal axis in patients with VAD. This high activity is possibly due to a loss of serotonergic inhibitory tone on the hypothalamus in VAD brains.

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Dexamethasone Suppression Test and Serum Prolactin in Dementia Disorders

Cited by 148 publications

References 11 publications

Allopregnanolone and dehydroepiandrosterone response to corticotropin-releasing factor in patients suffering from Alzheimer's disease and vascular dementia

Allopregnanolone and dehydroepiandrosterone response to corticotropin-releasing factor in patients suffering from Alzheimer's disease and vascular dementia

Relationship between Mental Impairment and HPA Axis Activity in Dementia Disorders

The Neurochemistry of Vascular Dementia

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