Cognitive decline in patients with Cushing's syndrome

Chronic exposure to elevated glucocorticoid levels in Gushing's syndrome (C S), is associated with deficits in cognitive function and in emotion. The h ippocampus plays a crucial rule in the behavioral manifestations of the syn drome as it is richest in glucocorticoid receptors and is thus particularly vulnerable to glucocorticoid excess. The wide distribution of glucocortico id receptors throughout the cerebral cortex, however, suggests that several cognitive functions can also be affected by the dysregulation of glucocort icoids. In this study, we investigated how an excess of glucocorticoid horm ones affects cognitive processes. Nineteen patients with chronic hypercorti solemia due to CS were compared to healthy controls matched for age, sex, e ducation, and occupation in tests of processing of visual and spatial infor mation, memory, reasoning and concept formation, language and verbal functi ons, and attention. Multivariate and univariate analyses revealed overall d ifferences in tests of treatment of visual and spatial information, reasoni ng and concept formation as well as in verbal and language performance, wit h poorer performance from CS patients. Differences were also observed in no nverbal aspects of memory and in attention tasks. The results suggest that chronic exposure to elevated levels of cortisol is associated with deficits in several areas of cognition, particularly those involving processing of selective attention and visual components. This study also shows that hormo nes play an important role in the modulation of cognitive function and that their influence on cerebral structure and function merits closer scrutiny.