Impaired quality of life, but not cognition, is linked to a history of chronic hypercortisolism in patients with Cushing's disease in remission
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 debatab...
| Authors: | ; ; ; ; ; ; ; ; ; |
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| Format: | Article |
| Status: | Published version |
| Publication date: | 2022 |
| Country: | España |
| Institution: | Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau) |
| Repository: | r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau |
| OAI Identifier: | oai:iibsantpau.fundanetsuite.com:p12255 |
| Online Access: | https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=12255 https://www.scopus.com/inward/record.uri?eid=2-s2.0-85136479418&doi=10.3389%2ffendo.2022.934347&partnerID=40&md5=91ae6e8584d5c71af7d207a7ba35c7c0 |
| Access Level: | Open access |
| Keyword: | Cushing's disease hypercortisolism cognition memory quality of life |
| _version_ | 1878740946961563648 |
|---|---|
| author | Pupier, E |
| author2 | Santos, A Etchamendy, N Lavielle, A Ferriere, A Marighetto, A Resmini, E Cota, D Webb, SM Tabarin, A |
| author2_role | author author author author author author author author author |
| author_browse | Cota, D Etchamendy, N Ferriere, A Lavielle, A Marighetto, A Pupier, E Resmini, E Santos, A Tabarin, A Webb, SM |
| author_facet | Pupier, E Santos, A Etchamendy, N Lavielle, A Ferriere, A Marighetto, A Resmini, E Cota, D Webb, SM Tabarin, A |
| author_role | author |
| collection | r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau |
| description | 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. |
| eu_rights_str_mv | openAccess |
| format | article |
| id | ES_dc4e4349d0db134ddc5dffc2d36d437b |
| institution | Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau) |
| instname_str | Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau) |
| network_acronym_str | ES |
| network_name_str | España |
| oai_identifier_str | oai:iibsantpau.fundanetsuite.com:p12255 |
| publishDate | 2022 |
| publishDateSort | 2022 |
| publisher | FRONTIERS MEDIA SA |
| publisherStr | FRONTIERS MEDIA SA |
| reponame_str | r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau |
| spelling | Impaired quality of life, but not cognition, is linked to a history of chronic hypercortisolism in patients with Cushing's disease in remission Pupier, E Santos, A Etchamendy, N Lavielle, A Ferriere, A Marighetto, A Resmini, E Cota, D Webb, SM Tabarin, A Cushing's disease hypercortisolism cognition memory quality of life 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. FRONTIERS MEDIA SA https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=12255 https://www.scopus.com/inward/record.uri?eid=2-s2.0-85136479418&doi=10.3389%2ffendo.2022.934347&partnerID=40&md5=91ae6e8584d5c71af7d207a7ba35c7c0 |
| spellingShingle | Impaired quality of life, but not cognition, is linked to a history of chronic hypercortisolism in patients with Cushing's disease in remission Pupier, E Cushing's disease hypercortisolism cognition memory quality of life |
| status_str | publishedVersion |
| title | Impaired quality of life, but not cognition, is linked to a history of chronic hypercortisolism in patients with Cushing's disease in remission |
| title_full | Impaired quality of life, but not cognition, is linked to a history of chronic hypercortisolism in patients with Cushing's disease in remission |
| title_fullStr | Impaired quality of life, but not cognition, is linked to a history of chronic hypercortisolism in patients with Cushing's disease in remission |
| title_full_unstemmed | Impaired quality of life, but not cognition, is linked to a history of chronic hypercortisolism in patients with Cushing's disease in remission |
| title_short | Impaired quality of life, but not cognition, is linked to a history of chronic hypercortisolism in patients with Cushing's disease in remission |
| title_sort | Impaired quality of life, but not cognition, is linked to a history of chronic hypercortisolism in patients with Cushing's disease in remission |
| topic | Cushing's disease hypercortisolism cognition memory quality of life |
| topic_facet | Cushing's disease hypercortisolism cognition memory quality of life |
| url | https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=12255 https://www.scopus.com/inward/record.uri?eid=2-s2.0-85136479418&doi=10.3389%2ffendo.2022.934347&partnerID=40&md5=91ae6e8584d5c71af7d207a7ba35c7c0 |