White matter involvement on DTI-MRI in Cushing's syndrome relates to mood disturbances and processing speed: a case-control study.
OBJECTIVE
Cushing's syndrome (CS) is an endocrine disorder due to prolonged exposure to cortisol. Recently, microstructural white matter (WM) alterations detected by diffusion tensor imaging (DTI) have been reported in CS patients, and related to depression, but other functional significances. remain otherwise unclear. We aimed at investigating in more depth mood symptoms in CS patients, and how these relate to cognition (information processing speed), and to WM alterations on DTI.


METHODS
The sample comprised 35 CS patients and 35 healthy controls. Beck Depression Inventory-II (BDI-II) was used to measure depressive symptoms, State-Trait Anxiety Inventory (STAI) to assess anxiety, and processing speed was measured by the Symbol Digit Modalities Test (SDMT). DTI studies were acquired using a 3-Tesla Philips-Achieva MR-facility. Voxelwise statistical analysis of fractional anisotropy (FA), mean, axial and radial diffusivities (MD, AD, RD) data were performed using FMRIB Software Library. Correlation analysis were obtained between mood and processing speed variables, and FA, MD, AD and RD values, taking both CS patients and healthy controls.


RESULTS
Active, controlled and cured CS patients showed greater depression (F = 12.4, p < 0.001), anxious state (F = 4.8, p = 0.005) and anxious trait (F = 9.6, p < 0.001) scores, than controls. Using the entire sample, depression scores correlated negatively to FA and positively to RD values. Although there were no differences in processing speed between groups, SDMT scores correlated positively to both FA and AD values.


CONCLUSIONS
There were greater depressive and anxious symptoms in CS patients than in healthy controls, but no difference in processing speed. However, DTI is related to depression and information processing speed in CS.
INNDACYT, CR Laureà Miró, 107, Sant Feliu de Llobregat, Barcelona, Spain.|Endocrinology/Medicine Departments, Hospital Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
Patricia
P
Pires
Endocrinology/Medicine Departments, Hospital Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.|Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
Alicia
A
Santos
INNDACYT, CR Laureà Miró, 107, Sant Feliu de Llobregat, Barcelona, Spain.|Port d'Informació Científica (PIC), Campus UAB Edifici D, Bellaterra, Barcelona, Spain.
Yolanda
Y
Vives-Gilabert
Endocrinology/Medicine Departments, Hospital Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.|Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
Susan M
http://orcid.org/0000-0001-7052-6436
SM
Webb
Port d'Informació Científica (PIC), Campus UAB Edifici D, Bellaterra, Barcelona, Spain.|Institut de Fisica d'Altes Energies (IFAE), Campus UAB Edifici C, Bellaterra, Barcelona, Spain.
Aitor
A
Sainz-Ruiz
Endocrinology/Medicine Departments, Hospital Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.|Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
Eugenia
E
Resmini
Endocrinology/Medicine Departments, Hospital Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.|Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
Iris
I
Crespo
Neuroradiology Unit, Hospital Sant Pau, IIB-Sant Pau, and UAB, C/ San Antoni Maria Claret 167, 08025, Barcelona, Spain.
Manel
M
de Juan-Delago
Neuroradiology Unit, Hospital Sant Pau, IIB-Sant Pau, and UAB, C/ San Antoni Maria Claret 167, 08025, Barcelona, Spain. BGomezA@santpau.cat.
Beatriz
http://orcid.org/0000-0001-7900-938X
B
Gómez-Anson
D000328:Adult; D016022:Case-Control Studies; D003480:Cushing Syndrome / Q000000981:diagnostic imaging*; D003863:Depression / Q000473:pathology; D056324:Diffusion Tensor Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D066127:White Matter / Q000000981:diagnostic imaging*
Anxiety; Brain white matter; Cushing syndrome; DTI; Depression