Do glucocorticoids have adverse effects on brain function?

Glucocorticoids, a class of steroid hormones, can adversely affect the brai n, particularly the hippocampus. The effect is most likely to be indirect a nd in response to either endogenously or exogenously induced hypercortisola emia. While the stress response is clearly adaptive and therapeutic doses o f synthetic glucocorticoids treat many medical disorders effectively, both corticosterone injections and prolonged stress in rodents can result in cha nges in glucocorticoid receptor levels, altered hippocampal dendritic morph ology, and impaired spatial memory. Less compelling but still provocative i s the suggestion that patients with post-traumatic stress disorder or Cushi ng's syndrome have decreased hippocampal volume and memory impairment. Of p articular clinical relevance is the recent documentation of a memory declin e that accompanies standard doses of corticosteroids. Patients with rheumat ic disease who received glucocorticoid therapy for at least a year performe d worse on memory tasks than closely matched patients with rheumatic diseas e who were being treated with alternative therapies such as gold. A separat e longitudinal study found similar memory declines as early as one week aft er treatment began. The risk of memory impairment should be carefully consi dered before initiating treatment with glucocorticoids and their use should be considered in the differential diagnosis of memory loss.