Subtle Cognitive Impairments in Patients with Long-Term Cure of Cushing’s Disease
Context and Objective: Active Cushing’s disease is associated with cognitive impairments. We hypothesized that previous hypercortisolism in patients with Cushing’s disease results in irreversible impairments in cognitive functioning. Therefore, our aim was to assess cognitive functioning after long-...
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| Published in | The journal of clinical endocrinology and metabolism Vol. 95; no. 6; pp. 2699 - 2714 |
|---|---|
| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Bethesda, MD
Oxford University Press
01.06.2010
Copyright by The Endocrine Society Endocrine Society |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0021-972X 1945-7197 1945-7197 |
| DOI | 10.1210/jc.2009-2032 |
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| Abstract | Context and Objective: Active Cushing’s disease is associated with cognitive impairments. We hypothesized that previous hypercortisolism in patients with Cushing’s disease results in irreversible impairments in cognitive functioning. Therefore, our aim was to assess cognitive functioning after long-term cure of Cushing’s disease.
Design: Cognitive assessment consisted of 11 tests, which evaluated global cognitive functioning, memory, and executive functioning.
Patients and Control Subjects: We included 74 patients cured of Cushing’s disease and 74 controls matched for age, gender, and education. Furthermore, we included 54 patients previously treated for nonfunctioning pituitary macroadenomas (NFMA) and 54 controls matched for age, gender, and education.
Results: Compared with NFMA patients, patients cured from Cushing’s disease had lower scores on the Mini Mental State Examination (P = 0.001), and on the memory quotient of the Wechsler Memory Scale (P = 0.050). Furthermore, patients cured from Cushing’s disease tended to recall fewer words on the imprinting (P = 0.013), immediate recall (P = 0.012), and delayed recall (P = 0.003) trials of the Verbal Learning Test of Rey. On the Rey Complex Figure Test, patients cured from Cushing’s disease had lower scores on both trials (P = 0.002 and P = 0.007) compared with NFMA patients. Patients cured from Cushing’s disease also made fewer correct substitutions on the Letter-Digit Substitution Test (P = 0.039) and came up with fewer correct patterns on the Figure Fluency Test (P = 0.003) compared with treated NFMA patients.
Conclusions: Cognitive function, reflecting memory and executive functions, is impaired in patients despite long-term cure of Cushing’s disease. These observations indicate irreversible effects of previous hypercortisolism on cognitive function and, thus, on the central nervous system. These observations may also be of relevance for patients treated with high-dose exogenous glucocorticoids.Cognitive function, reflecting memory, and executive functions are impaired in patients despite long-term cure of Cushing’s disease. |
|---|---|
| AbstractList | Active Cushing's disease is associated with cognitive impairments. We hypothesized that previous hypercortisolism in patients with Cushing's disease results in irreversible impairments in cognitive functioning. Therefore, our aim was to assess cognitive functioning after long-term cure of Cushing's disease.
Cognitive assessment consisted of 11 tests, which evaluated global cognitive functioning, memory, and executive functioning.
We included 74 patients cured of Cushing's disease and 74 controls matched for age, gender, and education. Furthermore, we included 54 patients previously treated for nonfunctioning pituitary macroadenomas (NFMA) and 54 controls matched for age, gender, and education.
Compared with NFMA patients, patients cured from Cushing's disease had lower scores on the Mini Mental State Examination (P = 0.001), and on the memory quotient of the Wechsler Memory Scale (P = 0.050). Furthermore, patients cured from Cushing's disease tended to recall fewer words on the imprinting (P = 0.013), immediate recall (P = 0.012), and delayed recall (P = 0.003) trials of the Verbal Learning Test of Rey. On the Rey Complex Figure Test, patients cured from Cushing's disease had lower scores on both trials (P = 0.002 and P = 0.007) compared with NFMA patients. Patients cured from Cushing's disease also made fewer correct substitutions on the Letter-Digit Substitution Test (P = 0.039) and came up with fewer correct patterns on the Figure Fluency Test (P = 0.003) compared with treated NFMA patients.
Cognitive function, reflecting memory and executive functions, is impaired in patients despite long-term cure of Cushing's disease. These observations indicate irreversible effects of previous hypercortisolism on cognitive function and, thus, on the central nervous system. These observations may also be of relevance for patients treated with high-dose exogenous glucocorticoids. Context and Objective: Active Cushing’s disease is associated with cognitive impairments. We hypothesized that previous hypercortisolism in patients with Cushing’s disease results in irreversible impairments in cognitive functioning. Therefore, our aim was to assess cognitive functioning after long-term cure of Cushing’s disease. Design: Cognitive assessment consisted of 11 tests, which evaluated global cognitive functioning, memory, and executive functioning. Patients and Control Subjects: We included 74 patients cured of Cushing’s disease and 74 controls matched for age, gender, and education. Furthermore, we included 54 patients previously treated for nonfunctioning pituitary macroadenomas (NFMA) and 54 controls matched for age, gender, and education. Results: Compared with NFMA patients, patients cured from Cushing’s disease had lower scores on the Mini Mental State Examination (P = 0.001), and on the memory quotient of the Wechsler Memory Scale (P = 0.050). Furthermore, patients cured from Cushing’s disease tended to recall fewer words on the imprinting (P = 0.013), immediate recall (P = 0.012), and delayed recall (P = 0.003) trials of the Verbal Learning Test of Rey. On the Rey Complex Figure Test, patients cured from Cushing’s disease had lower scores on both trials (P = 0.002 and P = 0.007) compared with NFMA patients. Patients cured from Cushing’s disease also made fewer correct substitutions on the Letter-Digit Substitution Test (P = 0.039) and came up with fewer correct patterns on the Figure Fluency Test (P = 0.003) compared with treated NFMA patients. Conclusions: Cognitive function, reflecting memory and executive functions, is impaired in patients despite long-term cure of Cushing’s disease. These observations indicate irreversible effects of previous hypercortisolism on cognitive function and, thus, on the central nervous system. These observations may also be of relevance for patients treated with high-dose exogenous glucocorticoids. Active Cushing's disease is associated with cognitive impairments. We hypothesized that previous hypercortisolism in patients with Cushing's disease results in irreversible impairments in cognitive functioning. Therefore, our aim was to assess cognitive functioning after long-term cure of Cushing's disease.CONTEXT AND OBJECTIVEActive Cushing's disease is associated with cognitive impairments. We hypothesized that previous hypercortisolism in patients with Cushing's disease results in irreversible impairments in cognitive functioning. Therefore, our aim was to assess cognitive functioning after long-term cure of Cushing's disease.Cognitive assessment consisted of 11 tests, which evaluated global cognitive functioning, memory, and executive functioning.DESIGNCognitive assessment consisted of 11 tests, which evaluated global cognitive functioning, memory, and executive functioning.We included 74 patients cured of Cushing's disease and 74 controls matched for age, gender, and education. Furthermore, we included 54 patients previously treated for nonfunctioning pituitary macroadenomas (NFMA) and 54 controls matched for age, gender, and education.PATIENTS AND CONTROL SUBJECTSWe included 74 patients cured of Cushing's disease and 74 controls matched for age, gender, and education. Furthermore, we included 54 patients previously treated for nonfunctioning pituitary macroadenomas (NFMA) and 54 controls matched for age, gender, and education.Compared with NFMA patients, patients cured from Cushing's disease had lower scores on the Mini Mental State Examination (P = 0.001), and on the memory quotient of the Wechsler Memory Scale (P = 0.050). Furthermore, patients cured from Cushing's disease tended to recall fewer words on the imprinting (P = 0.013), immediate recall (P = 0.012), and delayed recall (P = 0.003) trials of the Verbal Learning Test of Rey. On the Rey Complex Figure Test, patients cured from Cushing's disease had lower scores on both trials (P = 0.002 and P = 0.007) compared with NFMA patients. Patients cured from Cushing's disease also made fewer correct substitutions on the Letter-Digit Substitution Test (P = 0.039) and came up with fewer correct patterns on the Figure Fluency Test (P = 0.003) compared with treated NFMA patients.RESULTSCompared with NFMA patients, patients cured from Cushing's disease had lower scores on the Mini Mental State Examination (P = 0.001), and on the memory quotient of the Wechsler Memory Scale (P = 0.050). Furthermore, patients cured from Cushing's disease tended to recall fewer words on the imprinting (P = 0.013), immediate recall (P = 0.012), and delayed recall (P = 0.003) trials of the Verbal Learning Test of Rey. On the Rey Complex Figure Test, patients cured from Cushing's disease had lower scores on both trials (P = 0.002 and P = 0.007) compared with NFMA patients. Patients cured from Cushing's disease also made fewer correct substitutions on the Letter-Digit Substitution Test (P = 0.039) and came up with fewer correct patterns on the Figure Fluency Test (P = 0.003) compared with treated NFMA patients.Cognitive function, reflecting memory and executive functions, is impaired in patients despite long-term cure of Cushing's disease. These observations indicate irreversible effects of previous hypercortisolism on cognitive function and, thus, on the central nervous system. These observations may also be of relevance for patients treated with high-dose exogenous glucocorticoids.CONCLUSIONSCognitive function, reflecting memory and executive functions, is impaired in patients despite long-term cure of Cushing's disease. These observations indicate irreversible effects of previous hypercortisolism on cognitive function and, thus, on the central nervous system. These observations may also be of relevance for patients treated with high-dose exogenous glucocorticoids. Context and Objective: Active Cushing’s disease is associated with cognitive impairments. We hypothesized that previous hypercortisolism in patients with Cushing’s disease results in irreversible impairments in cognitive functioning. Therefore, our aim was to assess cognitive functioning after long-term cure of Cushing’s disease. Design: Cognitive assessment consisted of 11 tests, which evaluated global cognitive functioning, memory, and executive functioning. Patients and Control Subjects: We included 74 patients cured of Cushing’s disease and 74 controls matched for age, gender, and education. Furthermore, we included 54 patients previously treated for nonfunctioning pituitary macroadenomas (NFMA) and 54 controls matched for age, gender, and education. Results: Compared with NFMA patients, patients cured from Cushing’s disease had lower scores on the Mini Mental State Examination (P = 0.001), and on the memory quotient of the Wechsler Memory Scale (P = 0.050). Furthermore, patients cured from Cushing’s disease tended to recall fewer words on the imprinting (P = 0.013), immediate recall (P = 0.012), and delayed recall (P = 0.003) trials of the Verbal Learning Test of Rey. On the Rey Complex Figure Test, patients cured from Cushing’s disease had lower scores on both trials (P = 0.002 and P = 0.007) compared with NFMA patients. Patients cured from Cushing’s disease also made fewer correct substitutions on the Letter-Digit Substitution Test (P = 0.039) and came up with fewer correct patterns on the Figure Fluency Test (P = 0.003) compared with treated NFMA patients. Conclusions: Cognitive function, reflecting memory and executive functions, is impaired in patients despite long-term cure of Cushing’s disease. These observations indicate irreversible effects of previous hypercortisolism on cognitive function and, thus, on the central nervous system. These observations may also be of relevance for patients treated with high-dose exogenous glucocorticoids.Cognitive function, reflecting memory, and executive functions are impaired in patients despite long-term cure of Cushing’s disease. Context and Objective: Active Cushing’s disease is associated with cognitive impairments. We hypothesized that previous hypercortisolism in patients with Cushing’s disease results in irreversible impairments in cognitive functioning. Therefore, our aim was to assess cognitive functioning after long-term cure of Cushing’s disease. Design: Cognitive assessment consisted of 11 tests, which evaluated global cognitive functioning, memory, and executive functioning. Patients and Control Subjects: We included 74 patients cured of Cushing’s disease and 74 controls matched for age, gender, and education. Furthermore, we included 54 patients previously treated for nonfunctioning pituitary macroadenomas (NFMA) and 54 controls matched for age, gender, and education. Results: Compared with NFMA patients, patients cured from Cushing’s disease had lower scores on the Mini Mental State Examination (P = 0.001), and on the memory quotient of the Wechsler Memory Scale (P = 0.050). Furthermore, patients cured from Cushing’s disease tended to recall fewer words on the imprinting (P = 0.013), immediate recall (P = 0.012), and delayed recall (P = 0.003) trials of the Verbal Learning Test of Rey. On the Rey Complex Figure Test, patients cured from Cushing’s disease had lower scores on both trials (P = 0.002 and P = 0.007) compared with NFMA patients. Patients cured from Cushing’s disease also made fewer correct substitutions on the Letter-Digit Substitution Test (P = 0.039) and came up with fewer correct patterns on the Figure Fluency Test (P = 0.003) compared with treated NFMA patients. Conclusions: Cognitive function, reflecting memory and executive functions, is impaired in patients despite long-term cure of Cushing’s disease. These observations indicate irreversible effects of previous hypercortisolism on cognitive function and, thus, on the central nervous system. These observations may also be of relevance for patients treated with high-dose exogenous glucocorticoids. CONTEXT AND OBJECTIVE:Active Cushingʼs disease is associated with cognitive impairments. We hypothesized that previous hypercortisolism in patients with Cushingʼs disease results in irreversible impairments in cognitive functioning. Therefore, our aim was to assess cognitive functioning after long-term cure of Cushingʼs disease. DESIGN:Cognitive assessment consisted of 11 tests, which evaluated global cognitive functioning, memory, and executive functioning. PATIENTS AND CONTROL SUBJECTS:We included 74 patients cured of Cushingʼs disease and 74 controls matched for age, gender, and education. Furthermore, we included 54 patients previously treated for nonfunctioning pituitary macroadenomas (NFMA) and 54 controls matched for age, gender, and education. RESULTS:Compared with NFMA patients, patients cured from Cushingʼs disease had lower scores on the Mini Mental State Examination (P = 0.001), and on the memory quotient of the Wechsler Memory Scale (P = 0.050). Furthermore, patients cured from Cushingʼs disease tended to recall fewer words on the imprinting (P = 0.013), immediate recall (P = 0.012), and delayed recall (P = 0.003) trials of the Verbal Learning Test of Rey. On the Rey Complex Figure Test, patients cured from Cushingʼs disease had lower scores on both trials (P = 0.002 and P = 0.007) compared with NFMA patients. Patients cured from Cushingʼs disease also made fewer correct substitutions on the Letter-Digit Substitution Test (P = 0.039) and came up with fewer correct patterns on the Figure Fluency Test (P = 0.003) compared with treated NFMA patients. CONCLUSIONS:Cognitive function, reflecting memory and executive functions, is impaired in patients despite long-term cure of Cushingʼs disease. These observations indicate irreversible effects of previous hypercortisolism on cognitive function and, thus, on the central nervous system. These observations may also be of relevance for patients treated with high-dose exogenous glucocorticoids. |
| Author | Kokshoorn, Nieke E. Middelkoop, Huub A. M. Romijn, Johannes A. Wassenaar, Moniek J. E. Pereira, Alberto M. Tiemensma, Jitske Biermasz, Nienke R. Keijser, Bart-Jan S. A. |
| AuthorAffiliation | Departments of Endocrinology and Metabolism (J.T., N.E.K., N.R.B., B.-J.S.A.K., M.J.E.W., A.M.P., J.A.R.) and Neurology (H.A.M.M.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands |
| AuthorAffiliation_xml | – name: Departments of Endocrinology and Metabolism (J.T., N.E.K., N.R.B., B.-J.S.A.K., M.J.E.W., A.M.P., J.A.R.) and Neurology (H.A.M.M.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands |
| Author_xml | – sequence: 1 givenname: Jitske surname: Tiemensma fullname: Tiemensma, Jitske email: J.Tiemensma@lumc.nl organization: 1Departments of Endocrinology and Metabolism (J.T., N.E.K., N.R.B., B.-J.S.A.K., M.J.E.W., A.M.P., J.A.R.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands – sequence: 2 givenname: Nieke E. surname: Kokshoorn fullname: Kokshoorn, Nieke E. organization: 1Departments of Endocrinology and Metabolism (J.T., N.E.K., N.R.B., B.-J.S.A.K., M.J.E.W., A.M.P., J.A.R.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands – sequence: 3 givenname: Nienke R. surname: Biermasz fullname: Biermasz, Nienke R. organization: 1Departments of Endocrinology and Metabolism (J.T., N.E.K., N.R.B., B.-J.S.A.K., M.J.E.W., A.M.P., J.A.R.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands – sequence: 4 givenname: Bart-Jan S. A. surname: Keijser fullname: Keijser, Bart-Jan S. A. organization: 1Departments of Endocrinology and Metabolism (J.T., N.E.K., N.R.B., B.-J.S.A.K., M.J.E.W., A.M.P., J.A.R.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands – sequence: 5 givenname: Moniek J. E. surname: Wassenaar fullname: Wassenaar, Moniek J. E. organization: 1Departments of Endocrinology and Metabolism (J.T., N.E.K., N.R.B., B.-J.S.A.K., M.J.E.W., A.M.P., J.A.R.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands – sequence: 6 givenname: Huub A. M. surname: Middelkoop fullname: Middelkoop, Huub A. M. organization: 2Neurology (H.A.M.M.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands – sequence: 7 givenname: Alberto M. surname: Pereira fullname: Pereira, Alberto M. organization: 1Departments of Endocrinology and Metabolism (J.T., N.E.K., N.R.B., B.-J.S.A.K., M.J.E.W., A.M.P., J.A.R.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands – sequence: 8 givenname: Johannes A. surname: Romijn fullname: Romijn, Johannes A. organization: 1Departments of Endocrinology and Metabolism (J.T., N.E.K., N.R.B., B.-J.S.A.K., M.J.E.W., A.M.P., J.A.R.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands |
| BackLink | http://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=22884021$$DView record in Pascal Francis https://www.ncbi.nlm.nih.gov/pubmed/20371667$$D View this record in MEDLINE/PubMed |
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| Copyright | Copyright © 2010 by The Endocrine Society 2010 Copyright © 2010 by The Endocrine Society 2015 INIST-CNRS |
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| Issue | 6 |
| Keywords | Endocrinopathy Human Obesity Cognitive disorder Adrenal cortex diseases Nutrition Cure Nutrition disorder Cushing syndrome Patient Metabolic diseases Hyperadrenocorticism Long term Adrenal gland diseases Endocrinology Nutritional status |
| Language | English |
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| PublicationTitle | The journal of clinical endocrinology and metabolism |
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| Publisher | Oxford University Press Copyright by The Endocrine Society Endocrine Society |
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| References | Stroop (2020071613495278800_R27) 1935; 18 Whelan (2020071613495278800_R4) 1980; 168 Michaud (2020071613495278800_R9) 2009; 71 Peace (2020071613495278800_R36) 1998; 49 León-Carrión (2020071613495278800_R10) 2009; 70 Luteijn (2020071613495278800_R31) 1983 Schulz (2020071613495278800_R41) 2005; 365 Zigmond (2020071613495278800_R33) 1983; 67 Benton (2020071613495278800_R30) 1976 Martignoni (2020071613495278800_R5) 1992; 17 Bourdeau (2020071613495278800_R14) 2005; 34 Rey (2020071613495278800_R24) 1958 Peace (2020071613495278800_R35) 1997; 19 Yehuda (2020071613495278800_R38) 2002; 346 Lezak (2020071613495278800_R21) 1995 Wolkowitz (2020071613495278800_R39) 2009; 1179 Mauri (2020071613495278800_R6) 1993; 87 Wechsler (2020071613495278800_R23) 1945 Dorn (2020071613495278800_R18) 2000; 9 Starkman (2020071613495278800_R8) 2001; 63 Rey (2020071613495278800_R25) 1941; 28 Grattan-Smith (2020071613495278800_R34) 1992; 86 Forget (2020071613495278800_R19) 2002; 27 Regard (2020071613495278800_R29) 1982; 55 Starkman (2020071613495278800_R17) 2003; 53 Elst (2020071613495278800_R28) 2006; 28 Aken (2020071613495278800_R3) 2005; 90 Folstein (2020071613495278800_R22) 1975; 12 Starkman (2020071613495278800_R11) 1992; 32 Hook (2020071613495278800_R20) 2007; 13 Bodnoff (2020071613495278800_R13) 1995; 15 Biermasz (2020071613495278800_R42) 2004; 89 Brown (2020071613495278800_R16) 2009; 1179 Dekkers (2020071613495278800_R43) 2006; 91 Forget (2020071613495278800_R7) 2000; 6 McEwen (2020071613495278800_R37) 2008; 583 Foy (2020071613495278800_R12) 1987; 48 Fietta (2020071613495278800_R15) 2009; 63 Dekkers (2020071613495278800_R2) 2007; 92 Reitan (2020071613495278800_R26) 1956 Spinhoven (2020071613495278800_R32) 1997; 27 Colao (2020071613495278800_R1) 1999; 84 Schulz (2020071613495278800_R40) 2005; 365 |
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| Snippet | Context and Objective: Active Cushing’s disease is associated with cognitive impairments. We hypothesized that previous hypercortisolism in patients with... CONTEXT AND OBJECTIVE:Active Cushingʼs disease is associated with cognitive impairments. We hypothesized that previous hypercortisolism in patients with... Active Cushing's disease is associated with cognitive impairments. We hypothesized that previous hypercortisolism in patients with Cushing's disease results in... |
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| SubjectTerms | ACTH-Secreting Pituitary Adenoma - complications ACTH-Secreting Pituitary Adenoma - psychology ACTH-Secreting Pituitary Adenoma - surgery Adrenals. Adrenal axis. Renin-angiotensin system (diseases) Adrenocorticotropic hormone Adult Aged Anxiety - psychology Biological and medical sciences Central nervous system Clinical trials Cognition Disorders - etiology Cognition Disorders - psychology Cognitive ability Depression - psychology Endocrinopathies Executive function Feeding. Feeding behavior Female Fundamental and applied biological sciences. Psychology Gender Humans Imprinting Male Medical sciences Memory Memory - physiology Memory, Short-Term - physiology Middle Aged Nervous system diseases Neuropsychological Tests Non tumoral diseases. Target tissue resistance. Benign neoplasms Pituitary Pituitary ACTH Hypersecretion - complications Pituitary ACTH Hypersecretion - psychology Pituitary ACTH Hypersecretion - surgery Pituitary Function Tests Psychiatric Status Rating Scales Survivors Treatment Outcome Vertebrates: anatomy and physiology, studies on body, several organs or systems Vertebrates: endocrinology Wechsler Scales |
| Title | Subtle Cognitive Impairments in Patients with Long-Term Cure of Cushing’s Disease |
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