Heald A, Parr C, Gibson C, O'driscoll K, Fowler H
Department of Endocrinology and Diabetes, Hope Hospital, Salford, United Kingdom.
Exp Clin Endocrinol Diabetes. 2006 Oct;114(9):490-7. doi: 10.1055/s-2006-924332.
It has been proposed that exposure to high levels of endogenous steroids in untreated pituitary Cushing's disease damages hippocampal structures leading to impairment in learning and memory processes. We hypothesised that patients with treated pituitary Cushing's disease would perform significantly worse on tests of cognitive ability than those with nonfunctioning pituitary adenomas.
Sixteen adults with pituitary Cushing's disease (PCD) and 16 adults with non-functioning pituitary adenomas (NFA) undertook the following comprehensive neuropsychological assessments: National Adult Reading Test (NART: premorbid abilities), California Verbal Learning Test (CVLT 2 UK: learning and recall), Stroop (executive functioning), Trail-Making Test (TMT: executive functioning and attention), Adult Memory and Information Processing Battery (AMIPB: Information Processing Speed and Story Recall subtests).
There was no significant difference in premorbid IQ scores (NFA mean=101 SD=13; PCD mean=102, SD=13), in verbal learning nor any significant difference in the percentage of verbal material retained in story recall (AMIPB). Performance on higher executive tasks Stroop and TMT and on measures of information processing was similar. However, there were significant decrements between some mean scores for both groups and published normative data with a clear association between higher HADS depression scores and impaired objective memory and attention which was not specific to PCD.
We found no difference in cognitive function between patients with PCD and NFA. The results suggest a discrepancy between patients' subjective perception of functional cognitive impairments and objective findings on psychometric testing and point to the influence of affective symptoms on cognitive performance, particularly in Cushing's disease.
有人提出，未经治疗的垂体库欣病患者体内高水平的内源性类固醇会损害海马结构，导致学习和记忆过程受损。我们假设，接受治疗的垂体库欣病患者在认知能力测试中的表现会比无功能垂体腺瘤患者差得多。
16名成年垂体库欣病（PCD）患者和16名成年无功能垂体腺瘤（NFA）患者接受了以下全面的神经心理学评估：国家成人阅读测试（NART：病前能力）、加利福尼亚言语学习测试（CVLT 2 UK：学习与回忆）、斯特鲁普测试（执行功能）、连线测试（TMT：执行功能与注意力）、成人记忆与信息处理成套测验（AMIPB：信息处理速度和故事回忆子测验）。
病前智商得分无显著差异（NFA组均值 = 101，标准差 = 13；PCD组均值 = 102，标准差 = 13），言语学习方面无显著差异，故事回忆（AMIPB）中保留的言语材料百分比也无显著差异。在更高层次的执行任务斯特鲁普测试和连线测试以及信息处理测量方面的表现相似。然而，两组的一些平均得分与已发表的常模数据之间存在显著差异，较高的医院焦虑抑郁量表（HADS）抑郁得分与客观记忆和注意力受损之间存在明显关联，这并非PCD所特有。
我们发现PCD患者和NFA患者在认知功能上没有差异。结果表明，患者对功能性认知障碍的主观感知与心理测量测试的客观结果之间存在差异，并指出情感症状对认知表现的影响，尤其是在库欣病中。
