O'Brien J T, Schweitzer I, Ames D, Mastwyk M, Colman P
University of Melbourne Department of Psychiatry, Australia.
Br J Psychiatry. 1994 Nov;165(5):650-7. doi: 10.1192/bjp.165.5.650.
To investigate an association between HPA axis dysfunction, depression and cognitive impairment, we assessed subjects with mild Alzheimer's disease (AD).
Sixteen non-depressed subjects with AD according to NINCDS/ADRDA criteria and 18 normal controls underwent the insulin hypoglycaemia (IH) test and the dexamethasone suppression test (DST).
The AD subjects showed a blunted response of adrenocorticotrophic hormone (ACTH) to IH compared with controls (P = 0.019). ACTH response (area under curve) correlated with a score for cognitive ability (CAMCOG) (r = 0.64, P < 0.01). AD subjects had a shorter time to peak cortisol level than controls (P = 0.004), although total cortisol response was normal.
The AD subjects show evidence of adrenal hyper-responsiveness and normal immediate (rate-sensitive) glucocorticoid feedback. An association between HPA axis dysfunction and organic brain pathology in AD subjects may be mediated by cell loss in the hippocampus.
为了研究下丘脑-垂体-肾上腺（HPA）轴功能障碍、抑郁和认知障碍之间的关联，我们对轻度阿尔茨海默病（AD）患者进行了评估。
根据美国国立神经病学、语言障碍和卒中研究所/阿尔茨海默病及相关疾病协会（NINCDS/ADRDA）标准，16名无抑郁症状的AD患者和18名正常对照者接受了胰岛素低血糖（IH）试验和地塞米松抑制试验（DST）。
与对照组相比，AD患者促肾上腺皮质激素（ACTH）对IH的反应减弱（P = 0.019）。ACTH反应（曲线下面积）与认知能力评分（CAMCOG）相关（r = 0.64，P < 0.01）。尽管总的皮质醇反应正常，但AD患者达到皮质醇峰值水平的时间比对照组短（P = 0.004）。
AD患者表现出肾上腺反应过度和正常的即时（速率敏感）糖皮质激素反馈的证据。AD患者中HPA轴功能障碍与器质性脑病变之间的关联可能由海马体中的细胞丢失介导。
