Subtle cognitive impairments and psychological complaints in patients with prolactinoma despite biochemical control.

Abstract

Purpose: To assess cognitive functioning and psychological complaints in patients with biochemically controlled prolactinoma.

Methods: Cross-sectional study comparing otherwise healthy patients treated for prolactinoma to age-, gender-, and education-level-matched controls. The cognitive assessment included eight tests assessing memory, verbal fluency, processing speed, selective attention, and executive functioning. Additionally, patients completed seven validated questionnaires on psychological complaints. Generalized estimating equations were performed. P-values <0.050 were considered significant.

Results: Sixty patients (controlled on dopamine agonists, n=30; in surgical remission, n=30), among whom 41 (68.3%) female, aged 42.3±11.7 years old, were compared to 60 matched controls. Patients scored significantly lower on assessments for verbal memory (fewer words on Verbal Learning Test of Rey: β=-1.8, 95%CI -2.7, -1.0), selective attention (fewer correct digits on Digit Deletion Test (β=-8.8, 95%CI -16.2, -0.2), longer time on Trial Making Test A (β=5.2, 95%CI 3.2, 7.2)), and processing speed (fewer correct substitutions on Digit-Symbol Substitution Test: β-4.2, 95%CI -8.2, -0.2). Furthermore, patients reported higher degrees of apathy (Apathy Scale: β=2.4, 95%CI 0.6, 4.1), irritability (Irritability Scale: β=2.2, 95%CI 0.3, 4.1), fatigue (Fatigue Severity Scale: β=6.7, 95%CI 2.7, 10.8), and anxiety and depressive symptoms (Hospital Anxiety and Depression Scale, anxiety: β=1.1, 95%CI 0.1, 2.1; depression: β=1.7, 95%CI 0.8, 2.7). Tests assessing executive functioning and task switching were comparable in patients and matched controls.

Conclusions: Compared to matched controls, patients treated for prolactinoma showed subtle cognitive impairments (i.e., memory, attention, and processing speed) and reported more psychological complaints. Physicians should be aware of these impairments, and address them adequately.