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...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-08-01
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| Series: | Frontiers in Endocrinology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fendo.2022.934347/full |
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| author | Emilie Pupier Alicia Santos Alicia Santos Nicole Etchamendy Aurélie Lavielle Amandine Ferriere Aline Marighetto Eugenia Resmini Eugenia Resmini Daniela Cota Susan M. Webb Susan M. Webb Antoine Tabarin Antoine Tabarin |
| author_facet | Emilie Pupier Alicia Santos Alicia Santos Nicole Etchamendy Aurélie Lavielle Amandine Ferriere Aline Marighetto Eugenia Resmini Eugenia Resmini Daniela Cota Susan M. Webb Susan M. Webb Antoine Tabarin Antoine Tabarin |
| author_sort | Emilie Pupier |
| collection | DOAJ |
| 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 centersPatients25 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.Clinical Trial Registration numberhttps://clinicaltrials.gov, identifier NCT02603653 |
| first_indexed | 2024-04-13T11:14:20Z |
| format | Article |
| id | doaj.art-66b394f6ecec4aa891d0d46d4f314427 |
| institution | Directory Open Access Journal |
| issn | 1664-2392 |
| language | English |
| last_indexed | 2024-04-13T11:14:20Z |
| publishDate | 2022-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Endocrinology |
| spelling | doaj.art-66b394f6ecec4aa891d0d46d4f3144272022-12-22T02:49:02ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922022-08-011310.3389/fendo.2022.934347934347Impaired quality of life, but not cognition, is linked to a history of chronic hypercortisolism in patients with Cushing’s disease in remissionEmilie Pupier0Alicia Santos1Alicia Santos2Nicole Etchamendy3Aurélie Lavielle4Amandine Ferriere5Aline Marighetto6Eugenia Resmini7Eugenia Resmini8Daniela Cota9Susan M. Webb10Susan M. Webb11Antoine Tabarin12Antoine Tabarin13Department of Endocrinology, Diabetes and Nutrition, CHU of Bordeaux and University of Bordeaux, Pessac, FranceEndocrinology Department, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747) Instituto de Salud Carlos III (ISCIII), Barcelona, SpainDepartment Medicine, Research Center for Pituitary Diseases, Hospital Sant Pau, Institut d'Investigació Biomèdica (IIB)-Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, SpainNeurocentre Magendie, University of Bordeaux, Institut National de la Santé et de la Recherche Médicale (INSERM), Bordeaux, FranceDepartment of Endocrinology, Diabetes and Nutrition, CHU of Bordeaux and University of Bordeaux, Pessac, FranceDepartment of Endocrinology, Diabetes and Nutrition, CHU of Bordeaux and University of Bordeaux, Pessac, FranceNeurocentre Magendie, University of Bordeaux, Institut National de la Santé et de la Recherche Médicale (INSERM), Bordeaux, FranceEndocrinology Department, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747) Instituto de Salud Carlos III (ISCIII), Barcelona, SpainDepartment Medicine, Research Center for Pituitary Diseases, Hospital Sant Pau, Institut d'Investigació Biomèdica (IIB)-Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, SpainNeurocentre Magendie, University of Bordeaux, Institut National de la Santé et de la Recherche Médicale (INSERM), Bordeaux, FranceEndocrinology Department, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747) Instituto de Salud Carlos III (ISCIII), Barcelona, SpainDepartment Medicine, Research Center for Pituitary Diseases, Hospital Sant Pau, Institut d'Investigació Biomèdica (IIB)-Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, SpainDepartment of Endocrinology, Diabetes and Nutrition, CHU of Bordeaux and University of Bordeaux, Pessac, FranceNeurocentre Magendie, University of Bordeaux, Institut National de la Santé et de la Recherche Médicale (INSERM), Bordeaux, FranceContextImpaired 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 centersPatients25 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.Clinical Trial Registration numberhttps://clinicaltrials.gov, identifier NCT02603653https://www.frontiersin.org/articles/10.3389/fendo.2022.934347/fullCushing’s diseasehypercortisolismcognitionmemoryquality of life |
| spellingShingle | Emilie Pupier Alicia Santos Alicia Santos Nicole Etchamendy Aurélie Lavielle Amandine Ferriere Aline Marighetto Eugenia Resmini Eugenia Resmini Daniela Cota Susan M. Webb Susan M. Webb Antoine Tabarin Antoine Tabarin Impaired quality of life, but not cognition, is linked to a history of chronic hypercortisolism in patients with Cushing’s disease in remission Frontiers in Endocrinology Cushing’s disease hypercortisolism cognition memory quality of life |
| 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 |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2022.934347/full |
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