Salivary Cortisol Levels May Be a Biomarker for Late-Life Generalized Anxiety Disorder

March 06, 2007

March 6, 2007 (New Orleans) -- Salivary cortisol levels, a measure of hypothalamic-pituitary-adrenal (HPA) function, may be a biomarker of disease and treatment response in late-life generalized anxiety disorder (GAD), researchers reported here at the annual meeting of the American Association for Geriatric Psychiatry.

With an incidence as high as 7% in older adults, GAD is one of the most common psychiatric disorders affecting the elderly, but its pathophysiology remains unknown. Clinical studies have shown that HPA dysfunction is associated with affective disorders. Age-associated HPA problems, such as increased cortisol levels, may make elderly patients more susceptible to affective disorders, as in GAD.

In the current study, salivary cortisol samples were collected on cotton swabs for 2 consecutive days from 35 patients with GAD and 10 control patients aged 60 years and older. Analysis was performed using a commercial enzyme immunoassay kit.

"Samples were taken 6 times each day: upon wake-up, 30 minutes after wake-up, at noon, 4 pm, 8 pm, and bedtime," said lead investigator Rose Mantella, PhD, a postdoctoral geriatric psychiatry fellow at the University of Pittsburgh in Pennsylvania.

Basal cortisol levels for both the GAD and control groups showed a normal diurnal rhythm during the day, peaking in the morning and falling at night. Following this rhythm, cortisol levels for the control group ranged from a minimum of 0.55 ± 0.33 ng/mL ( P = .49) to 3.49 ± .40 ng/mL ( P < .04); levels for the GAD group were 0.68 ± 0.53 ( P = .49) to 5.12 ± 2.24 ( P < .04).

The GAD group showed elevated basal levels compared with the control group. There was also a positive correlation between cortisol levels and severity of GAD, as measured by the GAD Severity Scale and the Penn State Worry Questionnaire.

"Spikes in cortisol levels were associated periods of more stress, but they [the spikes] were very rare," said Dr. Mantella, who was familiar with daily patient schedules. As part of monitoring the daily routine, she also examined patient diaries.

The results suggest a dysregulation of HPA axis function in elderly patients with GAD, as measured by basal salivary cortisol levels.

Dan Blazer, MD, a professor of psychiatry at Duke University Medical Center in Durham, North Carolina, commented, "The results of the study were not unexpected, but they need to be teased out. Since stress levels are higher in GAD, you get higher levels of cortisol. What would really be interesting is to see whether pharmacologic treatment will reduce the cortisol levels in GAD patients."

The study received no commercial funding. The study author and Dr. Blazer report no relevant financial relationships.

AAGP 2007 Annual Meeting: Abstract 26. Presented March 3, 2007.

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