title: Can variation in hypothalamic-pituitary-adrenal (HPA)-axis activity explain the relationship between depression and cognition in bipolar patients?
abstract: BACKGROUND
  Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis is thought to be associated with more mood symptoms and worse cognitive functioning. This study examined whether variation in HPA axis activity underlies the association between mood symptoms and cognitive functioning.
  
  
  RESULTS
  In 65 bipolar patients cognitive functioning was measured in domains of psychomotor speed, speed of information processing, attentional switching, verbal memory, visual memory, executive functioning and an overall mean score. Severity of depression was assessed by the Inventory of Depressive Symptomatology-self rating version. Saliva cortisol measurements were performed to calculate HPA axis indicators: cortisol awakening response, diurnal slope, the evening cortisol level and the cortisol suppression on the dexamethasone suppression test. Regression analyses of depressive symptoms and cognitive functioning on each HPA axis indicator were performed. In addition we calculated percentages explanation of the association between depressive symptoms and cognition by HPA axis indicators. Depressive symptoms were associated with dysfunction in psychomotor speed, attentional switching and the mean score, as well as with attenuation in diurnal slope value. No association was found between HPA axis activity and cognitive functioning and HPA axis activity did not explain the associations between depressive symptoms and cognition.
  
  
  CONCLUSIONS
  As our study is the first one in this field specific for bipolar patients and changes in HPA-axis activity did not seem to explain the association between severity of depressive symptoms and cognitive functioning in bipolar patients, future studies are needed to evaluate other factors that might explain this relationship.
authors.affiliation: Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands. m.j.van.der.werf@umcg.nl
authors.forename: Marieke J
authors.initials: MJ
authors.lastname: van der Werf-Eldering
authors.forename: Rixt F
authors.initials: RF
authors.lastname: Riemersma-van der Lek
authors.forename: Huibert
authors.initials: H
authors.lastname: Burger
authors.forename: Esther A E
authors.initials: EA
authors.lastname: Holthausen
authors.forename: André
authors.initials: A
authors.lastname: Aleman
authors.forename: Willem A
authors.initials: WA
authors.lastname: Nolen
mesh_terms: D000328:Adult; D000339:Affect / Q000502:physiology; D001714:Bipolar Disorder / Q000503:physiopathology* / Q000523:psychology*; D002940:Circadian Rhythm / Q000502:physiology; D003071:Cognition / Q000502:physiology*; D003863:Depression / Q000503:physiopathology* / Q000523:psychology*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000503:physiopathology*; D012463:Saliva / Q000378:metabolism
chemical_list: D006854:Hydrocortisone