title: Cognitive impairment in major depression: association with salivary cortisol.
abstract: BACKGROUND
  Cognitive deficits and elevated cortisol are hallmarks of depression. Cortisol acts via mineralocorticoid and glucocorticoid receptors, which have their highest density in the hippocampus, a brain area closely related to cognitive function. Several studies have separately examined cortisol secretion and cognitive deficits in depression. However, only few studies have assessed their association in the same patients producing inconclusive results.
  
  
  METHODS
  We examined 52 medication-free patients with major depression (37 women, 15 men; mean age 35 +/- 11 years; Hamilton Depression Scale mean score 27 +/- 5) and 50 healthy control subjects, matched for age, gender, and years of education. We applied several neuropsychological tests. Salivary cortisol levels were measured on the same day at 08:00, 12:00, 16:00, and 22:00 hours.
  
  
  RESULTS
  Compared with healthy subjects, patients had significantly higher cortisol levels and were impaired in verbal memory, visuospatial memory, working memory, and selective attention. In depressed patients, but not in healthy control subjects, we found a negative correlation between salivary cortisol levels (area under the curve) and hippocampus-related neuropsychological domains (verbal memory, visuospatial memory) and executive function.
  
  
  CONCLUSIONS
  Cognitive deficits, especially those closely related to hippocampus function, appear to be related to cortisol secretion in depressed patients. Elevated cortisol may downregulate mineralocorticoid and glucocorticoid receptors in the hippocampus, which could, in part, be responsible for cognitive deficits in depressed patients.
authors.affiliation: Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. hinkelma@uke.uni-hamburg.de
authors.forename: Kim
authors.initials: K
authors.lastname: Hinkelmann
authors.forename: Steffen
authors.initials: S
authors.lastname: Moritz
authors.forename: Johannes
authors.initials: J
authors.lastname: Botzenhardt
authors.forename: Kirsten
authors.initials: K
authors.lastname: Riedesel
authors.forename: Klaus
authors.initials: K
authors.lastname: Wiedemann
authors.forename: Michael
authors.initials: M
authors.lastname: Kellner
authors.forename: Christian
authors.initials: C
authors.lastname: Otte
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001288:Attention / Q000502:physiology; D003072:Cognition Disorders / Q000150:complications / Q000378:metabolism* / Q000503:physiopathology; D003865:Major Depressive Disorder / Q000378:metabolism* / Q000503:physiopathology / Q000523:psychology*; D056344:Executive Function / Q000502:physiology; D005260:Female; D006624:Hippocampus / Q000503:physiopathology; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D008297:Male; D008568:Memory / Q000502:physiology; D008875:Middle Aged; D009483:Neuropsychological Tests; D012463:Saliva / Q000378:metabolism; D013997:Time Factors
chemical_list: D006854:Hydrocortisone