Glucocorticoids and cognitive function: a walkthrough in endogenous and exogenous alterations

Area of Science:

• Neuroendocrinology
• Cognitive Neuroscience
• Endocrinology

Background:

• The hypothalamic-pituitary-adrenal (HPA) axis regulates stress and influences the central nervous system (CNS).
• Glucocorticoids (GCs) impact cognitive functions via glucocorticoid receptors (GR) and mineralocorticoid receptors (MR).
• Disruptions in circulating GC levels can lead to cognitive impairments.

Purpose of the Study:

• To review cognitive dysfunction associated with altered endogenous and exogenous glucocorticoid levels.
• To understand the role of the HPA axis and GCs in cognitive function and dysfunction.

Main Methods:

• Systematic review of human studies published up to 2022.
• Inclusion of prospective and retrospective studies from PubMed.
• Focus on HPA disorders, GCs, and their impact on cognition.

Main Results:

• Cognitive impairment is prevalent in GC-related disorders, particularly affecting memory in the hippocampus and pre-frontal cortex.
• Risk factors for cognitive decline include disease duration, circadian disruption, GC levels, and MR/GR imbalance.
• Persistent cognitive dysfunction may result from GC-induced structural brain alterations, even after remission.

Conclusions:

• Cognitive deficits in GC-related disorders are often unrecognized or misdiagnosed.
• Early recognition and treatment are crucial to mitigate long-term effects on the brain.
• Complete recovery of cognitive function is not guaranteed, indicating potential irreversible CNS damage requiring further research for targeted treatments.