Department of Neuroscience, Section Anatomy, University Medical Center Groningen, University of Groningen, 9713 AV Groningen, The Netherlands.
Psychoneuroendocrinology. 2012 Jan;37(1):20-6. doi: 10.1016/j.psyneuen.2011.04.013. Epub 2011 May 25.
Considerable evidence indicates that amyotrophic lateral sclerosis (ALS), a progressive neurodegenerative disease of the motor system, has an enormous impact on the patient's emotional and physical well-being. As previous findings indicated that particularly the rise in cortisol levels immediately after awakening, i.e., the cortisol awakening response (CAR), is associated with indices of physical and emotional well-being, we compared the CAR of 29 admitted ALS patients with that of 12 age-matched caregiver controls. Saliva samples for cortisol measurement were collected immediately, 15, 30 and 45 min after awakening. The severity of ALS progression was quantified using the ALS functional rating scale (ALSFRS) and manual muscle test (MMT). Depressive mood status in ALS patients was determined with the Beck Depression Inventory (BDI) and Hamilton Depression Rating Scale (HDRS). Salivary cortisol levels of ALS patients did not differ from those of caregiver controls at awakening, 15 min or 45 min after awakening, but were significantly lower at 30 min after awakening. Area under the curve analysis confirmed that the CAR was significantly smaller in ALS patients than in caregiver controls. A smaller CAR in ALS patients was significantly correlated to poorer clinical status, as assessed with both the ALSFRS and MMT rating instruments. Further, a smaller CAR significantly correlated with a more severe depressive mood status. No correlations were observed between total cortisol output during the first 45 min post-awakening and clinical or depressive status. In conclusion, our findings indicate that ALS patients show a blunted CAR, correlated with disease and depression severity.
大量证据表明，肌萎缩侧索硬化症（ALS）是一种进行性的运动系统神经退行性疾病，对患者的情绪和身体健康有巨大影响。由于先前的研究结果表明，特别是觉醒后皮质醇水平的升高，即皮质醇觉醒反应（CAR），与身体和情绪健康的指标有关，我们比较了 29 名住院 ALS 患者和 12 名年龄匹配的护理者对照者的 CAR。采集唾液样本用于皮质醇测量，在觉醒后立即、15、30 和 45 分钟时进行。使用肌萎缩侧索硬化功能评定量表（ALSFRS）和手动肌肉测试（MMT）量化 ALS 进展的严重程度。使用贝克抑郁量表（BDI）和汉密尔顿抑郁评定量表（HDRS）评估 ALS 患者的抑郁情绪状态。ALS 患者的唾液皮质醇水平在觉醒时、15 分钟或 45 分钟后与护理者对照组没有差异，但在觉醒后 30 分钟时明显较低。曲线下面积分析证实，ALS 患者的 CAR 明显小于护理者对照组。CAR 较小与更差的临床状况显著相关，通过 ALSFRS 和 MMT 评分仪器评估。此外，CAR 较小与更严重的抑郁情绪状态显著相关。在觉醒后 45 分钟内的总皮质醇输出与临床或抑郁状态之间没有观察到相关性。总之，我们的研究结果表明，ALS 患者表现出 CAR 减弱，与疾病和抑郁严重程度相关。
