title: Mild cognitive deficits in patients with primary adrenal insufficiency.
abstract: BACKGROUND
  The brain is a major target organ for cortisol considering its high density of glucocorticoid receptors. Several states of hypothalamus-pituitary-adrenal dysregulation point towards impairments in cognitive functioning. However, there is a very limited body of research on the effects of hypocortisolism on cognitive functioning.
  
  
  OBJECTIVE
  To evaluate cognitive functioning in patients with hypocortisolism (i.e., primary adrenal insufficiency (PAI)) and to examine the possible effect of postponing early-morning hydrocortisone intake on cognitive functioning.
  
  
  METHODS
  Thirty-one patients with PAI on regular morning hydrocortisone intake and 31 healthy matched controls underwent nine neuropsychological tests, evaluating memory and executive functioning. In addition, the effect of normal timing and postponement of morning hydrocortisone intake on neuropsychological tests were assessed in an additional 29 patients with PAI.
  
  
  RESULTS
  Compared to controls, patients with PAI performed worse on auditory and visual memory tasks (all P ≤ 0.024) and executive functioning tasks (all P ≤ 0.012). In contrast, patients performed better on a concentration and an attention task (both P<0.05). Postponement of hydrocortisone intake in the morning did not affect the outcomes of neuropsychological tests.
  
  
  CONCLUSIONS
  Patients on long-term hydrocortisone replacement for PAI show mild cognitive deficits compared to controls. There was no effect of postponement of regular hydrocortisone intake on cognition.
authors.affiliation: Psychological Science, University of California, Merced, CA, USA. Electronic address: jtiemensma@ucmerced.edu.
authors.forename: Jitske
authors.initials: J
authors.lastname: Tiemensma
authors.affiliation: Department of Medicine, Division of Endocrinology and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Cornelie D
authors.initials: CD
authors.lastname: Andela
authors.affiliation: Department of Medicine, Division of Endocrinology and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Nienke R
authors.initials: NR
authors.lastname: Biermasz
authors.affiliation: Department of Medicine, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Romijn
authors.affiliation: Department of Medicine, Division of Endocrinology and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Alberto M
authors.initials: AM
authors.lastname: Pereira
mesh_terms: D000224:Addison Disease / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology*; D000328:Adult; D003071:Cognition / Q000187:drug effects; D060825:Cognitive Dysfunction / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D056344:Executive Function / Q000187:drug effects; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use*; D008297:Male; D008568:Memory / Q000187:drug effects; D008875:Middle Aged; D009483:Neuropsychological Tests; D014705:Verbal Behavior / Q000187:drug effects; D014851:Wakefulness / Q000187:drug effects
chemical_list: D006854:Hydrocortisone
keywords: Addison’s disease; Cognitive functioning; Glucocorticoids; Hydrocortisone substitution; Primary adrenal insufficiency