Impact of disease activity on cognitive and psychological outcomes in acromegaly: A prospective study

To investigate the cognitive and psychological aspects of acromegaly and to assess how disease activity may affect these outcomes.

This prospective study included patients with acromegaly who consecutively admitted to Pituitary Center between June 2021 and July 2023. Cognitive functions were assessed using a series of standardized tests targeting memory, attention, executive function, verbal fluency, and visuospatial skills. Additionally, Beck Depression Inventory (BDI), Beck Anxiety Inventory, and Acromegaly Quality of Life Questionnaire (AcroQoL) assessments were conducted. These evaluations were performed preoperatively and at the 9th month postoperatively following transsphenoidal surgery (TSS) to assess the anticipated changes in neuropsychological functions based on disease activity.

A total of 19 patients with acromegaly were included. Remission was achieved through TSS alone in 9 patients, while 10 patients required postoperative somatostatin receptor ligands. Cognitive functions (Montreal Cognitive Assessment Test) were better in the remission phase compared to the initial active disease phase (23.36 ± 3.46 vs 24.93 ± 3.73; p = 0.035). Cognitive flexibility and selective attention (Stroop Test) were impaired during the active period of the disease (17.79 ± 12.31 vs 12.29 ± 8.23; p = 0.016). Memory functions (Wechsler Memory Scale-Logical Memory Test: immediate recall, delayed recall, recognition) showed improvement from the active phase to remission (p = 0.016, p = 0.003, p = 0.008; respectively). BDI scores were significantly higher in the active phase compared to remission (7.36 ± 3.48 vs 5.43 ± 3.03; p = 0.009). Additionally, AcroQoL scores were lower during the active disease phase than in the remission phase (65.30 ± 17.75 vs 80.43 ± 13.61; p = 0.007).

Acromegaly may impair cognitive and psychological functions, which appear to improve with effective treatment.