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Clinical and Magnetic Resonance Imaging Correlates of Hypothalamic–Pituitary–Adrenal Axis Function in Depression and Alzheimer's Disease

Published online by Cambridge University Press:  02 January 2018

John T. O'Brien ,
David Ames ,
Isaac Schweitzer ,
Peter Colman ,
Patricia Desmond  and
Brian Tress
John T. O'Brien*
Affiliation:
Newcastle General Hospital
David Ames
Affiliation:
Department of Psychiatry, Royal Melbourne Hospital
Isaac Schweitzer
Affiliation:
Department of Psychiatry, Royal Melbourne Hospital
Peter Colman
Affiliation:
Department of Diabetes and Endocrinology, Royal Melbourne Hospital
Patricia Desmond
Affiliation:
Department of Radiology, University of Melbourne, Royal Melbourne Hospital, Victoria 3050 Australia
Brian Tress
Affiliation:
Department of Radiology, University of Melbourne, Royal Melbourne Hospital, Victoria 3050 Australia
*
Dr John T. O'Brien, Brighton Clinic, Newcastle General Hospital, Westgate Road, Newcastle upon Tyne NE4 6BE. Fax: 0191 272 0816
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Abstract

Background

An age-related dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis is well recognised in animals, but still remains controversial in humans. There is increasing interest that raised corticosteroid levels, due to activation of the HPA axis, may cause both depressive symptoms and cognitive impairments. Steroid effects on cognition may be via the hippocampus, a major site of corticosteroid action and an important structure involved in learning and memory.

Method

To investigate this further, we examined the relationship between the dexamethasone suppression test, cognitive function, depressive symptoms and hippocampal atrophy on magnetic resonance imaging (MRI) in 32 normal controls, 49 subjects with NINCDS/ADRDA Alzheimer's disease and 51 patients with DSM–III–R Major Depression.

Results

Controlling for differences in dexamethasone concentrations, post-dexamethasone cortisol levels were related to advancing age in controls and depressed subjects. However, among subjects with Alzheimer's disease, post-dexamethasone cortisol levels were independently associated with both minor depressive symptoms and hippocampal atrophy on MRI.

Conclusion

An association between advancing age and increased HPA axis dysregulation is supported for controls and depressed subjects. In Alzheimer's disease, HPA axis changes were associated with depressive symptoms and hippocampal atrophy. Longitudinal studies are now needed to determine the causal direction of these associations.

Type
Papers
Information
The British Journal of Psychiatry , Volume 168 , Issue 6 , June 1996 , pp. 679 - 687
Copyright
Copyright © 1996 The Royal College of Psychiatrists 

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Footnotes

This paper is based on a dissertation submitted by Dr John O'Brien which was awarded the 1995 Research Prize and Bronze Medal by the Royal College of Psychiatrists.

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