Department of Neurosurgery, University of Duisburg-Essen, Essen.
Department of Neurosurgery, University Hospital Oldenburg.
Exp Clin Endocrinol Diabetes. 2021 Mar;129(3):194-202. doi: 10.1055/a-1247-4651. Epub 2020 Sep 29.
To present a systematic review of the presence and severity of neuropsychological impairment in the six main neuropsychological domains (attention, executive function, language, visuospatial processing, intelligence, and memory) in patients with Cushing's disease (CD) and/or Cushing's Syndrome (CS) at various stages of the illness. The work aims to identify neuropsychological leverage points for focused diagnosis and rehabilitation in CS/CD patients.
A pubmed literature search was performed and augmented by searching the reference lists of review articles identified by this search strategy. After excluding irrelevant hits, we systematically extracted data from 27 studies for each main neuropsychological domain, differentiating between active disease, short- and long-term remission.
The literature gives evidence for neuropsychological impairment in all domains in Cushing patients with active disease. The most consistent impairments concerned memory and visuo-spatial processing, whereas the data are discordant for all other domains. Significant improvement of neuropsychological function - although not returning to normal in all domains - is shown in short-term and long-term remission of the disease. However, the published literature is thin, suffering from repetitive subsample analyses publishing, methodological concerns as lack of control for confounders such as depression.
Memory is the most extensively investigated domain in CS/CD patients and impairment is most prominent in active disease. Patients should be counseled that neuropsychological function will improve with normalization of hypercortisolism and over time. More studies with more stringent methodological criteria, larger patient samples and controlling for confounders are required to enhance our understanding of neuropsychological function in patients with CS/CD.
对库欣病（CD）和/或库欣综合征（CS）患者在疾病的不同阶段的六个主要神经心理学领域（注意力、执行功能、语言、视空间处理、智力和记忆）的神经心理损伤的存在和严重程度进行系统回顾。本研究旨在确定 CS/CD 患者神经心理诊断和康复的重点。
进行了 pubmed 文献检索，并通过搜索该搜索策略确定的综述文章的参考文献进行了补充。在排除不相关的点击后，我们系统地从 27 项研究中提取了每个主要神经心理学领域的数据，将其区分在活动疾病、短期和长期缓解之间。
文献为患有活动性疾病的库欣患者的所有领域的神经心理损伤提供了证据。最一致的损伤涉及记忆和视空间处理，而所有其他领域的数据则不一致。尽管在所有领域都没有恢复正常，但在疾病的短期和长期缓解中，神经心理学功能明显改善。然而，发表的文献很少，受到重复亚样本分析发表的困扰，存在缺乏对混杂因素（如抑郁）进行控制等方法学问题。
记忆是 CS/CD 患者中研究最广泛的领域，在活动疾病中损伤最为明显。应告知患者，随着皮质醇过多症的正常化和随着时间的推移，神经心理学功能将得到改善。需要更多具有更严格方法学标准、更大患者样本和控制混杂因素的研究，以增强我们对 CS/CD 患者神经心理功能的理解。
