Dehydroepiandrosterone sulfate and psychiatric measures in a frail, elderly residential care population

Background: Previous reports have found low levels of dehydroepiandrosteron e sulfate (DHEA-S) in association with physical illness, and with frailty i n the elderly. In a preliminary study, we also found low DHEA-S associated with increased disability and number of pain sites. How ever, we found the opposite relationship between DHEA-S and cognitive impairment. Therefore, w e conducted a study of a second sample to confirm this unexpected finding a nd the expected inverse correlations between DHEA-S levels and increased di sability and number of pain sites. Methods: Psychiatric symptoms and disorders were correlated with DHEA-S and related steroid levels in a second convenience sample in the nursing home population. Results: This sample confirmed the previous finding of a positive associati on of cognitive impairment with higher DHEA-S levels but the inverse associ ation of DHEA-S levels with the numbers of pain sensations did not reach st atistical significance. Cognitive impairment was also positively associated with higher dehydroepiandrosterone (DHEA) and estradiol levels (women only ). Cortisol levels were inversely associated with depressive symptoms. Conclusions: The anomalous positive correlation between cognitive dysfuncti on and DHEA-S levels, and the inverse col-relation between cortisol levels and depressive symptoms,, suggests that the relationships between psychiatr ic symptomatology and levels of steroids that are part of the hypothalamic- pituitalry adrenal axis are different in the frail elderly population from that of younger and heartier populations. (C) 2000 Society of Biological Ps ychiatry.