Plasma cortisol and progression of dementia in subjects with Alzheimer-type dementia.
OBJECTIVE
Studies of subjects with dementia of the Alzheimer type have reported correlations between increases in activity of the hypothalamic-pituitary-adrenal (HPA) axis and hippocampal degeneration. In this study, the authors sought to determine whether increases in plasma cortisol, a marker of HPA activity, were associated with clinical and cognitive measures of the rate of disease progression in subjects with Alzheimer-type dementia.


METHODS
Thirty-three subjects with very mild and mild Alzheimer-type dementia and 21 subjects without dementia were assessed annually for up to 4 years with the Clinical Dementia Rating scale and a battery of neuropsychological tests. Plasma was obtained at 8 a.m. on a single day and assayed for cortisol. Rates of change over time in the clinical and cognitive measures were derived from growth curve models.


RESULTS
In the subjects with dementia, but not in those without dementia, higher plasma cortisol levels were associated with more rapidly increasing symptoms of dementia and more rapidly decreasing performance on neuropsychological tests associated with temporal lobe function. No associations were observed between plasma cortisol levels and clinical and cognitive assessments obtained at the single assessment closest in time to the plasma collection.


CONCLUSIONS
Higher HPA activity, as reflected by increased plasma cortisol levels, is associated with more rapid disease progression in subjects with Alzheimer-type dementia.
Csernansky
John G
JG
Alzheimer's Disease Research Center and the Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA. jgc@conte.wustl.edu
Dong
Hongxin
H
Fagan
Anne M
AM
Wang
Lei
L
Xiong
Chengjie
C
Holtzman
David M
DM
Morris
John C
JC
D000367:Age Factors; D000368:Aged; D000544:Alzheimer Disease / Q000097:blood* / Q000175:diagnosis* / Q000523:psychology; D003072:Cognition Disorders / Q000097:blood / Q000175:diagnosis / Q000523:psychology; D018450:Disease Progression; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008137:Longitudinal Studies; D008297:Male; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012720:Severity of Illness Index
D006854:Hydrocortisone