Impaired quality of life, but not cognition, is linked to a history of chronic hypercortisolism in patients with Cushing's disease in remission
Por:
Pupier, E, Santos, A, Etchamendy, N, Lavielle, A, Ferriere, A, Marighetto, A, Resmini, E, Cota, D, Webb, SM, Tabarin, A
Publicada:
8 ago 2022
Resumen:
ContextImpaired cognition and altered quality of life (QoL) may persist despite long-term remission of Cushing's disease (CD). Persistent comorbidities and treatment modalities may account for cognitive impairments. Therefore, the role of hypercortisolism per se on cognitive sequelae remains debatable. ObjectiveTo investigate whether memory and QoL are impaired after long-term remission of CD in patients with no confounding comorbidity. Design and SettingCross-sectional case-control study in two tertiary referral centers Patients25 patients (44.5 +/- 2.4 years) in remission from CD for 102.7 +/- 19.3 Mo and 25 well-matched controls, without comorbidity or treatment liable to impair cognition. Main Outcome Measure(s)Hippocampus- and prefrontal cortex-dependent memory, including memory flexibility and working memory, were investigated using multiple tests including sensitive locally-developed computerized tasks. Depression and anxiety were evaluated with the MADRS and HADS questionnaires. QoL was evaluated with the SF-36 and CushingQoL questionnaires. The intensity of CD was assessed using mean urinary free cortisol and a score for clinical symptoms. ResultsCD patients displayed similar performance to controls in all cognitive tests. In contrast, despite the absence of depression and a minimal residual clinical Cushing score, patients had worse QoL. Most of the SF36 subscales and the CushingQoL score were negatively associated only with the duration of exposure to hypercortisolism (p <= 0.01 to 0.001). ConclusionsPersistent comorbidities can be a primary cause of long-lasting cognitive impairment and should be actively treated. Persistently altered QoL may reflect irreversible effects of hypercortisolism, highlighting the need to reduce its duration.
Filiaciones:
Pupier, E:
CHU Bordeaux, Dept Endocrinol Diabet & Nutr, Pessac, France
Univ Bordeaux, Pessac, France
Santos, A:
Inst Salud Carlos III ISCIII, Ctr Invest Biomed Red Enfermedades Raras, Endocrinol Dept, CIBERER,Unidad 747, Barcelona, Spain
Univ Auton Barcelona UAB, Hosp Sant Pau, Inst Invest Biomed IIB Sant Pau, Res Ctr Pituitary Dis, Barcelona, Spain
Etchamendy, N:
Univ Bordeaux, Inst Natl Sante & Rech Med INSERM, Neuroctr Magendie, Bordeaux, France
Lavielle, A:
CHU Bordeaux, Dept Endocrinol Diabet & Nutr, Pessac, France
Univ Bordeaux, Pessac, France
Ferriere, A:
CHU Bordeaux, Dept Endocrinol Diabet & Nutr, Pessac, France
Univ Bordeaux, Pessac, France
Marighetto, A:
Univ Bordeaux, Inst Natl Sante & Rech Med INSERM, Neuroctr Magendie, Bordeaux, France
Resmini, E:
Inst Salud Carlos III ISCIII, Ctr Invest Biomed Red Enfermedades Raras, Endocrinol Dept, CIBERER,Unidad 747, Barcelona, Spain
Univ Auton Barcelona UAB, Hosp Sant Pau, Inst Invest Biomed IIB Sant Pau, Res Ctr Pituitary Dis, Barcelona, Spain
Cota, D:
Univ Bordeaux, Inst Natl Sante & Rech Med INSERM, Neuroctr Magendie, Bordeaux, France
Webb, SM:
Inst Salud Carlos III ISCIII, Ctr Invest Biomed Red Enfermedades Raras, Endocrinol Dept, CIBERER,Unidad 747, Barcelona, Spain
Univ Auton Barcelona UAB, Hosp Sant Pau, Inst Invest Biomed IIB Sant Pau, Res Ctr Pituitary Dis, Barcelona, Spain
Tabarin, A:
CHU Bordeaux, Dept Endocrinol Diabet & Nutr, Pessac, France
Univ Bordeaux, Pessac, France
Univ Bordeaux, Inst Natl Sante & Rech Med INSERM, Neuroctr Magendie, Bordeaux, France
Green Published, gold, All Open Access, Gold, Green
|