Salivary Cortisol Levels Are Associated with Craving and Cognitive Performance in Cocaine-Abstinent Subjects: A Pilot Study

Abstract

Cortisol is a glucocorticoid hormone secreted by the adrenal cortex upon the activation of the hypothalamic-pituitary-adrenal (HPA) axis. Assessment of cortisol in saliva has emerged as a reliable way of evaluating HPA function. We examined the relationships between salivary cortisol levels with both craving and cognitive performance, as a possible biomarker of cocaine addiction. Cognitive performance (attention, declarative and working memory, executive functions and recognition of emotions) was assessed in 14 abstinent cocaine-dependent subjects in outpatient treatment and 13 control participants. Three salivary samples were collected at home by all the participants in the morning, afternoon and at bedtime. Patients showed higher levels of cortisol in the morning, as well as higher area under the curve with respect to the ground (AUCg). Regarding cognitive performance, cocaine-abstinent subjects showed worse performance in attention (d2 test), verbal memory (Spanish Complementary Verbal Learning Test, TAVEC) and executive tests (Tower of Hanoi and phonological fluency test) with respect to the control group. Morning cortisol levels and the AUCg index were negatively associated with the age of onset of drug consumption and the AUCg index was also positively associated with craving in our patients’ group. Moreover, morning cortisol levels, as well as the AUCg index, were negatively associated with verbal memory performance. Therefore, our pilot study suggests that salivary cortisol measurements could be a good avenue to predict craving level, as well as cognitive status, especially the declarative memory domain.

Biomarkers of Relapse in Cocaine Use Disorder: A Narrative Review

“…Ligabue et al observed that increased cortisol levels at inpatient treatment entry were predictive of early treatment dropout before the scheduled 14 days of inpatient stay [ 68 ]. Furthermore, Sampedro-Piquero et al showed that a higher salivary morning cortisol concentration was associated with CUD severity factors (duration of the disorder and craving scores) [ 69 ].…”

“…Ligabue et al highlighted a negative relationship between the salivary cortisol concentration and retention in a withdrawal program in cocaine users [ 68 ], suggesting a dysregulation of the HPA axis. Furthermore, a significant positive correlation between morning cortisol levels and craving levels in abstinent cocaine users has been demonstrated [ 69 ]. Additionally, the cortisol level could be an interesting biomarker to predict the risk of relapse in CUD patients and in cocaine users, as salivary cortisol would probably be easier to measure than plasma cytokines.…”

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