Document Detail


Hypothalamic-pituitary-adrenal axis dysregulation and memory impairments in type 2 diabetes.
MedLine Citation:
PMID:  17426095     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
CONTEXT: There is evidence of both hypothalamic-pituitary-adrenocortical (HPA) axis and cognitive dysfunction in type 2 diabetes mellitus (T2DM). However, the exact nature and the associations between these abnormalities remain unclear. OBJECTIVES: The aim of the study was to characterize the nature of the HPA dysregulation in T2DM and ascertain whether impaired cognition in T2DM could be attributed to these abnormalities. DESIGN: A cross-sectional study was performed, contrasting matched groups on HPA axis function and cognition by using the combined dexamethasone (DEX)/CRH test and a neuropsychological battery assessing declarative and working memory, attention, and executive function. SETTING: The study was conducted in a research clinic in an academic medical center. PARTICIPANTS: Participants were volunteers functioning in the cognitively normal range. We studied 30 middle-aged individuals with T2DM, on average 7.5 yr since diabetes diagnosis, and 30 age-, gender-, and education-matched controls. MAIN OUTCOME MEASURES: Basal cortisol levels, cortisol levels during the DEX/CRH test, and performance on neuropsychological tests were measured. RESULTS: Individuals with T2DM had elevated basal plasma cortisol levels, higher levels after DEX suppression, and a larger response to CRH (all P <or= 0.005). Among individuals with T2DM, cortisol levels during the DEX/CRH test were positively associated with glycosylated hemoglobin (P = 0.05), independent of age, body mass index, hypertension, and dyslipidemia. Diabetic subjects showed cognitive impairments restricted to declarative memory. Across all subjects, declarative memory was inversely associated with cortisol levels; however, these associations were subsumed by glycemic control (glycosylated hemoglobin). CONCLUSIONS: HPA hyperactivity and declarative memory deficits are present in T2DM. Both alterations may reflect the negative impact of poor glycemic control on the hippocampal formation.
Authors:
Hannah Bruehl; Melanie Rueger; Isabel Dziobek; Victoria Sweat; Aziz Tirsi; Elizabeth Javier; Alyssa Arentoft; Oliver T Wolf; Antonio Convit
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2007-04-10
Journal Detail:
Title:  The Journal of clinical endocrinology and metabolism     Volume:  92     ISSN:  0021-972X     ISO Abbreviation:  J. Clin. Endocrinol. Metab.     Publication Date:  2007 Jul 
Date Detail:
Created Date:  2007-07-09     Completed Date:  2007-08-28     Revised Date:  2007-12-03    
Medline Journal Info:
Nlm Unique ID:  0375362     Medline TA:  J Clin Endocrinol Metab     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2439-45     Citation Subset:  AIM; IM    
Affiliation:
Department of Psychiatry, New York University School of Medicine, 550 First Avenue, New York, New York 10016, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Cognition
Cognition Disorders / diagnosis,  etiology,  physiopathology
Cross-Sectional Studies
Dexamethasone / diagnostic use
Diabetes Mellitus, Type 2 / complications,  physiopathology*
Female
Glucocorticoids / diagnostic use
Humans
Hydrocortisone / blood
Hypothalamo-Hypophyseal System / physiopathology*
Male
Memory Disorders / diagnosis,  etiology,  physiopathology*
Middle Aged
Neuropsychological Tests
Pituitary-Adrenal System / physiopathology*
Grant Support
ID/Acronym/Agency:
DK064087/DK/NIDDK NIH HHS; M01 RR00096/RR/NCRR NIH HHS; P30-AG-08051/AG/NIA NIH HHS
Chemical
Reg. No./Substance:
0/Glucocorticoids; 50-02-2/Dexamethasone; 50-23-7/Hydrocortisone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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