Increased Cortisol Levels Linked to Decrease in Attention

August 11, 2003

Pippa Wysong

Aug. 11, 2003 -- Corticosteroids may be responsible for cognitive complaints symptoms in patients who take high doses of the medication chronically.

Elevated cortisol levels have already been recognized for their detrimental effects in conditions such as Cushing's Disease, and recent evidence suggests they have a detrimental effect on conditions such as major depression and Alzheimer's disease.

But not much is known about whether corticosteroid medication may influence memory, attention or mood, said Alan Frol, PhD, a neuropsychologist at the Southwestern Medical Center at Dallas, Texas.

At the recent 111th annual conference of the American Psychological Association (APA), in Toronto, Canada, Dr. Frol, presented findings from a small study comparing cognitive and mood measures of patients who took high doses of corticosteroids to those who did not.

The study included 28 patients with either asthma or rheumatoid arthritis, 14 (50%) of whom took 10 mg or more of corticosteroid medication daily. It is not uncommon for corticosteroid users to have some cognitive complaints, he said.

All participants underwent various standard tests, such as structured clinical interviews for DSM-IV (SCID), to measure mood and various cognitive functions. Patients with major psychiatric conditions, neurologic disease, or substance abuse disorders were excluded.

Patients were divided into two groups of 14; users of high dose corticosteroids, and those who had minimal or no exposure.

Dr. Frol told Medscape Medical News, with the corticosteroid users, "We found there was some mild decrease in terms of their cognitive skills, looking at their attention, working memory and verbal learning memory."

Corticosteroid users also had increased depressive symptoms compared to the controls, though these were at subclinical levels.

The high-dose users did have some complaints about memory, attention and concentration problems. "These were subjective complaints affected by the mood rather than actual cognitive functioning," Dr. Frol said.

The researchers are also investigating whether regular use of corticosteroids or other compounds affect hippocampus volume. Some studies in the medical literature suggest this part of the brain may become smaller with the drug over time. Changes in the hippocampus affect verbal learning and memory, according to Dr. Frol.

Because of this apparent connection to mood, it is possible cortisol could become a target for future treatments, he said.

Past studies have shown that increased levels of glucocorticoids, such as those associated with stress, result in decreased learning and memory, said Rodney Vanderploeg, PhD, neuropsychologist at the James A. Haley Veterans' Hospital in Tampa, Florida.

At the APA, Dr. Vanderploeg presented an unrelated study which showed that subclinical impairments in attention, memory and psychological functioning occurred in people who have normal levels of cortisol, but whose levels sit at the high end of the normal range.

While cognitive effects were evident, Dr. Vanderploeg said, "They were small and clinically insignificant."

Dr. Frol's study was funded by a grant from the National Institutes of Health.

APA 111th Annual Conference: Poster Session A-7, A-8. Presented Aug. 8, 2003.

Reviewed by Gary D. Vogin, MD

Pippa Wysong is a freelance writer for Medscape.


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