title: Long-term cognitive impairments and attentional deficits in patients with Cushing's disease and cortisol-producing adrenal adenoma in remission.
abstract: BACKGROUND
  Cognitive function is impaired in patients with active Cushing's syndrome (CS).
  
  
  OBJECTIVE
  The aim was to study cognitive function in patients with CS in long-term remission.
  
  
  METHODS
  We conducted a cross-sectional, case-controlled, single center study.
  
  
  METHODS
  Fifty-five patients previously treated for Cushing's disease (n = 43) and cortisol-producing adrenal adenoma (n = 12) and 55 controls matched for age, gender, and educational level participated in the study.
  
  
  METHODS
  Working memory, attention, information-processing speed, verbal fluency, and reading speed were studied using standardized neuropsychological testing and alerting, orienting, and executive control using the Attentional Network Test. Fatigue impact scale and the comprehensive psychopathological rating scale were used to evaluate fatigue and affective disorder.
  
  
  RESULTS
  Median (interquartile range) duration of remission was 13 (5-19) yr and the mean ± SD age at follow-up was 54 ± 14 yr. Compared to controls, patients had a higher score on the fatigue impact scale, indicating greater burdens of fatigue, and a higher score on the comprehensive psychopathological rating scale subscales for depression and anxiety. In a multivariate analysis, attention, spatial orienting, alerting, working memory, verbal fluency, and reading speed were all diminished in comparison to controls, independent of scores for affective disorder and fatigue. No overall difference in outcome was seen between patients in long-term remission for Cushing's disease and cortisol-producing adrenal adenoma.
  
  
  CONCLUSIONS
  Patients with CS in remission have impaired cognitive function that cannot be explained by the coexistence of affective disorder or chronic fatigue. The pattern of cognitive and attentional deficits suggests a more global involvement of the brain function than has previously been suggested.
authors: Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, SE-413 45 Göteborg, Sweden. oskar.ragnarsson@medic.gu.se
authors: Oskar
authors: O
authors: Ragnarsson
authors: Peter
authors: P
authors: Berglund
authors: Derek N
authors: DN
authors: Eder
authors: Gudmundur
authors: G
authors: Johannsson
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000150:complications* / Q000378:metabolism / Q000523:psychology*; D000315:Adrenalectomy; D018246:Adrenocortical Adenoma / Q000150:complications* / Q000378:metabolism / Q000523:psychology*; D000328:Adult; D017668:Age of Onset; D000368:Aged; D001143:Arousal / Q000502:physiology; D001289:Attention Deficit Disorder with Hyperactivity / Q000209:etiology* / Q000523:psychology*; D016022:Case-Control Studies; D003072:Cognition Disorders / Q000209:etiology* / Q000523:psychology*; D003346:Corticotropin-Releasing Hormone; D003430:Cross-Sectional Studies; D003907:Dexamethasone; D005221:Fatigue / Q000209:etiology / Q000523:psychology; D005260:Female; D006728:Hormones / Q000097:blood; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D047748:Pituitary ACTH Hypersecretion / Q000150:complications* / Q000523:psychology*; D012923:Social Class
chemical_list: D006728:Hormones; D003907:Dexamethasone; D003346:Corticotropin-Releasing Hormone; D006854:Hydrocortisone