ESE Young Investigator Award
Jitske Tiemensma, Nieke Kokshoorn, Nienke Biermasz, Bart-Jan Keijser, Moniek Wassenaar, Huub Middelkoop, Alberto Pereira & Johannes Romijn
Context and objective: Active Cushings disease is associated with cognitive impairments. We hypothesized that previous hypercortisolism in patients with Cushings disease results in irreversible impairments in cognitive functioning. Therefore, our aim was to assess cognitive functioning after long-term cure of Cushings disease.
Design: Cognitive assessment consisted of 11 tests, which evaluated global cognitive functioning, memory, and executive functioning.
Patients and control subjects: We included 74 patients cured of Cushings disease and 74 matched controls (18% male, mean age 52 years). Furthermore, we included 54 patients previously treated for non-functioning pituitary macroadenomas (NFMA), and 54 matched controls (56% male, mean age 61 years). The protocol was approved by the Medical Ethics Committee.
Results: Compared to NFMA patients, patients cured from Cushings disease had lower scores on the Mini Mental State Examination (P=0.001), and on the memory quotient of the Wechsler Memory Scale (P=0.050). Furthermore, patients cured from Cushings disease tended to recall less words on the imprinting trial (P=0.013), immediate recall trial (P=0.012), and delayed recall trial (P=0.003) of the Verbal Learning Test of Rey and also recalled more intrusions on all trials of this test (P=0.002, P=0.003, and P=0.003 respectively). On the Rey Complex Figure Test, patients cured form Cushings disease had lower scores on both trials (P=0.002 and P=0.007) compared to NFMA patients. Patients cured from Cushings disease also made less correct substitutions on the Letter-digit substitution test (P=0.039), and came up with less correct patterns on the Figure Fluency Test (P=0.003) compared to treated NFMA patients.
Conclusions: Cognitive function, reflecting memory and executive functions, is impaired in patients despite long-term cure of Cushings disease. These observations indicate irreversible effects of previous hypercortisolism on cognitive function, and, thus, on the central nervous system. These observations may also be of relevance for patients treated with high dose exogenous glucocorticoids.