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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.