Lind Karin, Edman Ake, Nordlund Arto, Olsson Tommy, Wallin Anders
Institute of Neuroscience and Physiology, Sahlgrenska Academy, Göteborg University, Mölndal, Sweden.
Dement Geriatr Cogn Disord. 2007;24(5):389-95. doi: 10.1159/000109938. Epub 2007 Oct 17.
It is unknown whether HPA-axis dysfunction is present in patients with mild cognitive impairment (MCI). The aim of the present study was to investigate whether cortisol levels are elevated among patients with MCI and/or whether the individuals have adequate feedback control of their HPA axis.
27 patients with MCI and 15 healthy controls were included in the study. Saliva samplings were performed 5 times a day before intake of 0.5 mg dexamethasone, and 5 times a day after intake of dexamethasone, respectively.
Significantly higher cortisol levels were found 15 min after awakening among patients with MCI in comparison with the controls, both before and after dexamethasone administration (p<0.05). Also, the ratio between cortisol at awakening time and 15 min after awakening was lower in the patient group after dexamethasone administration (p<0.05). There were no significant differences in basal cortisol levels before or after dexamethasone between groups.
The results indicate that there is an HPA-axis disturbance, with normal basal cortisol levels and increased awakening response among patients with MCI. The dissociation between basal values and the awakening response may be of pathophysiological importance for the cognitive impairment.
轻度认知障碍（MCI）患者是否存在下丘脑-垂体-肾上腺（HPA）轴功能障碍尚不清楚。本研究的目的是调查MCI患者的皮质醇水平是否升高和/或个体对其HPA轴是否具有适当的反馈控制。
本研究纳入了27例MCI患者和15名健康对照者。在摄入0.5毫克地塞米松之前和之后，每天分别进行5次唾液采样。
与对照组相比，MCI患者在摄入地塞米松之前和之后，觉醒后15分钟时的皮质醇水平均显著更高（p<0.05）。此外，摄入地塞米松后，患者组中觉醒时与觉醒后15分钟时的皮质醇比值更低（p<0.05）。两组在地塞米松给药前后的基础皮质醇水平无显著差异。
结果表明，MCI患者存在HPA轴紊乱，基础皮质醇水平正常，但觉醒反应增强。基础值与觉醒反应之间的分离可能对认知障碍具有病理生理学意义。
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