Associations between cognitive performance and cortisol reaction to the DEX/CRH test in patients recovered from depression
Associations between cognitive performance and cortisol reaction to the DEX/CRH test in patients recovered from depression
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DOI：
10.1016/j.psyneuen.2012.07.005
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发表时间：
2013-03-01
影响因子：
3.7
通讯作者：
Zwanzger, Peter
中科院分区：
文献类型：
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作者：
Behnken, Andreas;Bellingrath, Silja;Zwanzger, Peter
背景资料：下丘脑-垂体-肾上腺（HPA）轴在抑郁症（MDD）中的过度活跃是情感性精神障碍最可靠的神经生物学特征之一。HPA轴调节的这些改变是否仅限于MDD的急性期，或者在恢复后是否持续存在，仍然不明确。高皮质醇血症和认知功能障碍之间的关系在急性抑郁症患者已被反复观察，它也被证明在一些研究中，离散的认知障碍往往持续在缓解状态的抑郁症。在本研究中，我们感兴趣的是，是否这些微妙的障碍，在抑郁症患者中观察到的认知功能与健康对照subjects.Methods：在20例康复患者和20个匹配的健康对照组，我们评估HPA轴反馈敏感性与联合地塞米松抑制/促肾上腺皮质激素释放激素（DEX/CRH）的挑战试验。此外，研究了以下领域的认知表现：言语记忆（听觉言语学习测试，VLMT），注意力和执行控制（连线测试，TMT-A/B）以及言语流畅性（控制性口头词语联想测试，COWAT）。关于HPA轴活性，在DEX/CRH测试中，在恢复的患者和对照组之间没有观察到总体差异。然而，在恢复的患者中，观察到皮质醇反应与言语记忆（主要效应VLMT试验1-5：p = 0.046）、注意力（主要效应TMT-A：p = 0.015）和执行功能（交互样本 *TMT-B：p = 0.018）之间存在显著关联。Popleton测试性能相关的皮质醇水平增加，在响应challenge.Conclusions：目前的研究结果表明，从MDD恢复的患者是特别容易受到不利影响的微妙HPA轴的干扰对认知性能。(C)2012爱思唯尔有限公司保留所有权利。
Background: Hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis in major depression (MDD) is one of the most reliably reported neurobiological characteristics of affective disorders. Whether these alterations in HPA axis regulation are limited to the acute stage of MDD or whether they persist after recovery, remains ambiguous. A relationship between hypercortisolemia and cognitive dysfunction in acutely depressed patients has been repeatedly observed and it was also demonstrated in a number of studies that a discrete cognitive impairment often persists in the remitted state of depression. In the present study we were interested, whether these subtle impairments in cognitive functioning observed in patients recovered from depression compared to healthy control subjects are associated with HPA axis feedback sensitivity.Methods: In 20 recovered patients and 20 matched healthy controls we assessed HPA axis feedback sensitivity with the combined dexamethasone suppression/corticotropin-releasing-hormone (DEX/CRH) challenge test. Furthermore cognitive performance was investigated with respect to the following domains: verbal memory (Auditory Verbal Learning Test, VLMT), attention and executive control (Trail Making Test, TMT-A/B) as well as verbal fluency (Controlled Oral Word Association Test, COWAT).Results: Recovered patients showed a significantly poorer cognitive performance compared to healthy controls (all p < .05). With regard to HPA-axis activity, no overall difference was observed a in the DEX/CRH test between recovered patients and controls. In recovered patients however, a significant association was observed between cortisol response and verbal memory (main effect VLMT trial 1-5: p = .046), attention (main effect TMT-A: p = .015) and executive functioning in terms of set shifting (interaction samples*TMT-B: p = .018). Poorer test performance was related to increased cortisol levels in response to challenge.Conclusions: The present findings suggest that patients recovered from MDD are especially vulnerable toward detrimental effects of subtle HPA axis disturbances on cognitive performance. (C) 2012 Elsevier Ltd. All rights reserved.