On the role of basal cortisol levels in affective and cognitive impairment in patients with chronic cerebral ischemia accompanied with psychosomatic diseases

Aim. The study was aimed to identify the relationship of basal cortisol levels with anxiety, depression, stress resilience, and severity of cognitive impairment in patients with chronic cerebral ischemia accompanied by psychosomatic diseases. Material and methods. The estimation of the basal cortisol levels in the blood and psychometric parameters in 110 patients of neurological department with diagnosed chronic cerebral ischemia was performed. On one hand, these changes were analyzed with respect to age group (46–60, 61–74, or 75–79 years). On the other hand, the data were analyzed with respect to patients’ history of comorbidities (peptic ulcer, postinfarction cardiosclerosis) which can be regarded as psychosomatic illness. Results. In the group of patients with postinfarction cardiosclerosis, cortisol was higher compared to the control, but did not differ from the group of patients with a history of peptic ulcer disease. In these groups higher rates on the scale of the hospital anxiety and depression (HADS) and lower stress resilience were detected. Age-related increase in anxiety and depression, and diminished stress resistance were revealed. Conclusion. Patients with psychosomatic diseases, regardless of their type, were characterized by higher values of cortisol level which were associated with more severe affective and cognitive impairment. According to the regression analysis, cortisol can be considered as a prognostic factor with respect to cognitive dysfunction, anxiety, depression, and stress resilience in patients with chronic cerebral ischemia in middle and old age.

1. Barkanova O.V. Methods of diagnosis of the emotional sphere: psychological workshop. Krasnoyarsk: Litera-print, 2009. 237 p. (in Russian).
2. Gusev E.I., Bogolepova A.N. Depressive disorders in patients with cerebrovascular disease. M: MEDpress-inform. 2014. 208 p. (in Russian).
3. Kupriyanov R.V., Kuz'mina Yu.M. Psychodiagnosis of stress: practical work. Kazan': KNITU, 2012. 232 p. (in Russian).
4. Smirnova M.Yu. Depressive disorders in patients with circulatory encephalopathy: abstract of thesis…candidate of medical sciences. M., 2012. (in Russian).
5. Piliponich A.A., Zakharov V.V., Damulin I.V. Frontal dysfunction in vascular dementia. Klinicheskaya gerontologiya (Clinical Gerontology). 2001. 5. (6). 35–41. (in Russian).
6. Bao A.M., Meynen G., Swaab D.F. The stress system in depression and neurodegeneration: focus on the human hypothalamus. Brain Res. Rev. 2008. 57. (2). 531–553.
7. Bergh C., Udumyan R., Fall K. et al. Stress resilience and physical fitness in adolescence and risk of coronary heart disease in middle age. Heart. 2015. 101. (8). 623–629.
8. Doom J.R., Gunnar M.R. Stress physiology and developmental psychopathology: past, present, and future. Dev. Psychopathol. 2013. 25. (4, Pt. 2). 1359–1373.
9. Duman R.S. Neural plasticity: consequences of stress and actions of antidepressant treatment. Dialogues Clin. Neurosci. 2004. 6. (2). 157–169.
10. Fink G. Stress controversies: post-traumatic stress disorder, hippocampal volume, gastroduodenal ulceration. J. Neuroendocrinol. 2011; 23(2): 107–117.
11. Groeneweg F.L., Karst H., de Kloet E.R., Joels M. Rapid non-genomic effects of corticosteroids and their role in the central stress response. J. Endocrinol. 2011. 209. (2). 153–167.
12. Holland J.M., Schatzberg A.F., O'Hara R. et al. Pretreatment cortisol levels predict posttreatment outcomes among older adults with depression in cognitive behavioral therapy. Psychiatry Res. 2013. 210. (2). 444–450.
13. Holsboer F. Stress, hypercortisolism and corticosteroid receptors in depression: implications for therapy. J. Affect. Disord. 2001. 62. (1–2). 77–91.
14. Kohler S., van Boxtel M.P., van Os J. et al. Depressive symptoms and cognitive decline in community-dwelling older adults. J. Am. Geriatr. Soc. 2010. 58. (5). 873–579.
15. Krieger D.T., Allen W., Rizzo F., Krieger H.P. Characterization of the normal temporal pattern of plasma corticosteroid levels. J. Clin. Endocrinol. Metab. 1971. 32. (2). 266–284.
16. Lenze E.J., Mulsant B.H., Mohlman J. et al. Generalized anxiety disorder in late life: lifetime course and comorbidity with major depressive disorder. Am. J. Geriatr. Psychiatry. 2005. 13. (1). 77–80.
17. Liu D., Diorio J., Tannenbaum B. et al. Maternal care, hippocampal glucocorticoid receptors, and hypothalamic-pituitary-adrenal responses to stress. Science. 1997; 277. (5332). 1659–1662.
18. Mohlman J., Gorman J.M. The role of executive functioning in CBT: a pilot study with anxious older adults. Behav. Res. Ther. 2005. 43. (4). 447–465.
19. Nichols N.R., Zieba M., Bye N. Do glucocorticoids contribute to brain aging? Brain Res. Brain Res. Rev. 2001. 37. (1–3). 273–86.
20. Overmier J.B., Murison R. Restoring psychology's role in peptic ulcer. Appl. Psychol. Health Well Being. 2013. 5. (1). 5–27.
21. Reus V.I., Wolkowitz O.M. Antiglucocorticoid drugs in the treatment of depression. Expert Opin. Investig. Drugs. 2001. 10. (10). 1789–1796.
22. Rosengren A., Hawken S., Ounpuu S. et al. Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case-control study. Lancet. 2004. 364. (9438). 953–962.
23. Rosnick C.B., Rawson K.S., Butters M.A., Lenze E.J. Association of cortisol with neuropsychological assessment in older adults with generalized anxiety disorder. Aging Ment. Health. 2013. 17. (4). 432–440.
24. Sapolsky R.M. The importance of a well-groomed child. Science. 1997. 277. (5332). 1620–1621.
25. Savic D., Knezevic G., Damjanovic S. et al. The role of personality and traumatic events in cortisol levels – where does PTSD fit in? Psychoneuroendocrinology. 2012. 37. (7). 937–947.
26. van Ast V.A., Cornelisse S., Meeter M., Kindt M. Cortisol mediates the effects of stress on the contextual dependency of memories. Psychoneuroendocrinology. 2014. 41. 97–110.
27. Varghese F.P., Brown E.S. The hypothalamic-pituitary-adrenal axis in major depressive disorder: a brief primer for primary care physicians. Prim. Care Companion J. Clin. Psychiatry. 2001. 3. (4):151–155.
28. Zahodne L.B., Stern Y., Manly J.J. Depressive symptoms precede memory decline, but not vice versa, in non-demented older adults. J. Am. Geriatr. Soc. 2014. 62. (1). 130–134.
29. Zigmond A.C., Snaith R.P. The Hospital Anxiety and Depression scale. Acta Psychiatr. Scand. 1983. 67. (6). 361–370.
30. Zilkens R.R., Bruce D.G., Duke J. et al. Severe psychiatric disorders in mid-life and risk of dementia in late- life (age 65–84 years): a population based case-control study. Curr. Alzheimer Res. 2014. 11. (7). 681–693.

Shevchenko A.V. – postgraduate student, neurologist, e-mail: av.shevchenko80@mail.ru

Doronin B.M. – doctor of medical sciences, head of the department of neurology, e-mail: b_doronin@mail.ru

Doronina O.B. – candidate of medical sciences, associate professor of the department of neurology, e-mail: neurocentr@mail.ru

Amstislavskaya T.G. – doctor of biological sciences, head of laboratory of experimental models of emotional pathology, deputy director for science, e-mail: amstislavskaya@yandex.ru