Comparative Analysis of Cognitive and Psychiatric Functioning in People With Cushing's Disease in Biochemical Remission and People With Nonfunctioning Adenomas.

Abstract

People with Cushing's disease (CD) often experience both mood/anxiety disorders and cognitive impairments that persist during long-term biochemical remission. The relationship between persistent neurocognitive and psychiatric problems in patients with CD is not well understood. Also, mechanisms other than hypercortisolism are poorly understood, and studies comparing CD with nonfunctioning adenomas (NFA) patients postoperatively are scarce. We compared neuropsychological functioning in two groups: individuals with CD in remission (n = 20; 80% female; 61.6 [44.13] months since remission) and individuals with NFAs (n = 20). Evaluation was performed, on average, 4.9 years following pituitary surgery. We used mediation models to evaluate psychiatric dysfunction as a possible mediator of cognitive outcomes and assessed the influence of demographic and medical factors (age at diagnosis, remission duration, and radiation therapy) on neuropsychological outcomes. Neuropsychological outcomes did not differ significantly between groups; however, up to 30% of patients demonstrated mild impairments in attention, processing speed, executive functioning, and visual memory. Time since remission in the CD group was inversely correlated with processing speed; however, this relationship was no longer significant after controlling for the presence of hypertension and diabetes mellitus. Levels of anxiety, depression, or somatization were reported in up to 40% of people with CD. Further, 70% of people with CD and 35% of people with NFA reported continuous depressive symptoms lasting at least 2 years. In conclusion, neuropsychological screening in clinical practice and longitudinal studies in individuals with NFA and CD are needed to identify patients at risk for long-term neuropsychological dysfunction. Appropriate support and treatment are recommended for persistent cognitive and/or psychiatric dysfunction for both patient groups.