title: Cognitive function in patients with primary adrenal insufficiency (Addison's disease).
abstract: BACKGROUND
  Patients with primary adrenal insufficiency (AI) need to replace glucocorticoids and mineralocorticoids that act on glucocorticoid (GR) and mineralocorticoid receptors (MR). Both receptors are highly expressed in the hippocampus and are closely associated with cognitive function, which might be impaired by insufficient or increased GR and MR stimulation. However, little is known about cognitive function in patients with AI.
  
  
  METHODS
  It was examined whether patients with AI exhibit worse cognitive function compared to sex-, age-, and education-matched controls. Cognitive function (executive function, concentration, verbal memory, visual memory, working memory, and autobiographical memory) was assessed in 30 patients with AI (mean age 52.4 yrs. ±14.4, n=21 women, mean duration of illness 18.2 yrs. ±11.1) and 30 matched controls. We also measured depressive symptoms, body mass index (BMI), and blood pressure.
  
  
  RESULTS
  Patients with AI showed more depressive symptoms, had a greater BMI and lower systolic blood pressure compared to controls. Adjusted analyses controlling for these variables revealed that patients with AI performed significantly worse in verbal learning (F=7.8, p=.007). Executive function, concentration, working memory, verbal memory, visuospatial memory, and autobiographical memory did not differ between groups.
  
  
  CONCLUSIONS
  No clinically relevant cognitive impairment was found in patients with AI compared to matched controls. Even long-term glucocorticoid and mineralocorticoid substitution over almost two decades appears to have only subtle effects on cognition in patients with AI.
authors.affiliation: Department of Psychiatry and Psychotherapy, Charité University Medical Center, Campus Benjamin Franklin, Berlin, Germany. Electronic address: Katharina.Schultebraucks@charite.de.
authors.forename: Katharina
authors.initials: K
authors.lastname: Schultebraucks
authors.affiliation: Department of Psychiatry and Psychotherapy, Charité University Medical Center, Campus Benjamin Franklin, Berlin, Germany.
authors.forename: Katja
authors.initials: K
authors.lastname: Wingenfeld
authors.affiliation: Department of Psychology, Humboldt-University, Berlin, Germany.
authors.forename: Jana
authors.initials: J
authors.lastname: Heimes
authors.affiliation: Clinical Endocrinology, Charité University Medical Center, Campus Mitte, Berlin, Germany; Endocrinology in Charlottenburg, Berlin, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Quinkler
authors.affiliation: Department of Psychiatry and Psychotherapy, Charité University Medical Center, Campus Benjamin Franklin, Berlin, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Otte
mesh_terms: D000224:Addison Disease / Q000503:physiopathology / Q000523:psychology*; D000328:Adult; D000368:Aged; D001288:Attention; D016022:Case-Control Studies; D003071:Cognition; D003863:Depression / Q000503:physiopathology / Q000523:psychology*; D056344:Executive Function; D005260:Female; D006801:Humans; D008297:Male; D008568:Memory; D061212:Memory, Episodic; D008570:Memory, Short-Term; D008875:Middle Aged; D009483:Neuropsychological Tests; D014706:Verbal Learning
keywords: Addison's disease; Cognition; Cortisol; Fludrocortisone; Mineralocorticoid and glucocorticoid receptor; Primary adrenal insufficiency