Cognitive Consequences of Endocrine Dysfunction in IDU

描述（由申请人提供）：性类固醇受体在整个大脑中无处不在的分布表明性腺激素是认知功能的重要调节剂。 在注射吸毒者（IDU）中记录了下丘脑-垂体-性腺轴的内分泌异常，可能是由于直接药物作用和相关合并症的综合作用。我们的总体假设是，由于继发于IDU相关性腺功能减退的CNS改变，IDU患者存在认知功能障碍，并且通过给予性类固醇替代治疗可以改善标准化认知测试的不良表现。为了检验我们的假设，我们提出了以下具体目标：（1）记录IDU人群的性腺激素环境，并了解该环境与认知能力和生活质量（QOL）的关系。（#2）使用标准化认知测试，基于IDU和HIV状态来表征定义人群中的认知表现和QOL模式。（#3）评价性激素替代疗法（男性睾酮或女性雌激素）对性腺功能减退IDU亚组的认知能力和QOL的安全性和有效性。我们提出两项研究：一项评价与其性腺激素环境相关的认知表现模式的IDU横断面研究，以及一项随机、安慰剂对照临床试验，其中将给予性腺功能减退的IDU性激素替代治疗，以确定对认知表现和QOL的影响。我们组建了一个多学科团队，在研究IDU人群、内分泌异常和性类固醇影响的认知任务表现方面具有丰富的经验。我们将更好地了解药物使用和认知之间的关系，并扩大我们的了解性类固醇对认知能力的影响，在一个未充分研究的人群。

DESCRIPTION (provided by applicant): The ubiquitous distribution of sex steroid receptors throughout the brain suggests that gonadal hormones are important modulators of cognitive function. Endocrine abnormalities in the hypothalamic-pituitary-gonadal axis have been documented in injection drug users (IDU) and are likely due to a combination of direct drug effects and associated co-morbidities. Our overall hypothesis is that there is cognitive dysfunction in IDU due to CNS alterations secondary to hypogonadism associated with IDU, and that poor performance on standardized cognitive tests can be improved by administering sex steroid replacement. To test our hypothesis we propose the following specific aims: (#1) To document the gonadal hormonal milieu in a population of IDU, and to understand the relationship of that milieu to cognitive performance and quality of life (QOL). (#2) To characterize patterns of cognitive performance and QOL in a defined population based on IDU and HlV status using standardized cognitive testing. (#3) To evaluate the safety and efficacy of sex hormone replacement therapy (either testosterone in men or estrogen in women) on cognitive performance and QOL in a subgroup of hypogonadal IDU. We propose two studies: a cross-sectional study of IDU to evaluate patterns of cognitive performance in relation to their gonadal hormone milieu and, a randomized, placebo-controlled, clinical trial in which hypogonadal IDU will be administered sex hormone replacement to determine the effects on cognitive performance and QOL. We have assembled a multidisciplinary team with extensive experience in studying IDU populations, endocrine abnormalities, and performance on cognitive tasks influenced by sex steroids. We will obtain a better understanding of the relationship between drug use and cognition, and also expand our understanding of the effects of sex steroids on cognitive performance, in an under-studied population.