Cognitive function in acromegaly: description and brain volumetric correlates

Abstract

In acromegaly, we reported on increased rates of affective disorders such as dysthymia and depression, as well as structural brain changes. Objective of this study was to determine if cognitive impairments in patients with acromegaly exist and whether such impairments are associated with structural brain alterations defined by magnetic resonance imaging (MRI). In this cross-sectional study, 55 patients with biochemically confirmed acromegaly were enrolled. MRI data were compared with 87 control subjects. Main outcome measures were performance levels in 13 cognitive tests covering the domains of attention, memory and executive function, with performance below the cut-off level of the 16th percentile rated as impaired. In addition, individual global and hippocampal volume changes were defined for each patient in reference to a normative sample. We found that up to 33.3% of the patients were impaired in the attention, up to 24.1% in the memory, and up to 16.7% in the executive function domain. 67.3% of the patients failed to reach the cut-off level in at least one subtest. MRI demonstrated increased global, left and right hippocampal grey matter and white matter, particularly early in the disease course. Rather few positive than expected negative correlations could be established between the hippocampal grey matter gain and cognitive performance. Cognitive dysfunction, particularly attentional deficits, are common in acromegaly, rendering neuropsychological testing essential in the diagnostic work-up.

MECHANISMS IN ENDOCRINOLOGY: Lessons from growth hormone receptor gene-disrupted mice: are there benefits of endocrine defects?

“…However, recently a small study with 12 members of the Ecuadorian cohort of LS patients reported that they performed significantly better in memory tasks and had significantly lower cognitive impairment compared to their unaffected relatives (273). In human acromegaly patients, recent studies have reported cognition deficits, decreased short-term and long-term memory, anxiety and impaired decision making, and decreased activities in pre-frontal and mid-temporal cortices in brain (274,275,276,277). Interestingly, recent reports and multiple meta-analyses directly implicate a higher than normal serum IGF-1 as a disease trait marker in major depressive disorder (MDD) and bipolar disorder (BD) further stimulating the pleiotropy of GH action in cognitive development and maintenance (278,279,280,281).…”

Microstructural brain changes in acromegaly: quantitative analysis by diffusion tensor imaging

“…6 They hypothesized that morphological changes in the brain occur during the first 10 years of hormone excess, and all of these effects on the brain are the result of the longlasting exposure of neuronal or glial cells to systemically elevated hormone levels. 6,15,30 In another study using MRI, Sievers et al 5 found a decrease in the hippocampal volume in patients with acromegaly. They concluded that in addition to the neuropsychological tests, MRI could be used in the diagnosis of cognitive impairment.…”

“…They concluded that in addition to the neuropsychological tests, MRI could be used in the diagnosis of cognitive impairment. 5 In the literature, the most important factors reported in the development of brain alterations are the elapsed time of diagnosis and control of disease. In this study, brain alterations were measured and followed by neurocognitive and psychiatric tests.…”

“…5 In the literature, there is a limited study about structural and metabolic changes in the brains of patients with acromegaly. [5][6][7][8][9] Diffusionweighted imaging and diffusion tensor imaging (DTI) techniques provide microstructural information about biological tissue damage that cannot be obtained with other imaging modalities. 10 DTI has already improved the scientific understanding of many neurologic and psychiatric disorders.…”

The Quality of Life and Psychological, Social and Cognitive Functioning of Patients with Acromegaly

“…Moreover, the effect of the disease on the cognitive function of patients has been pointed out in the literature [23][24][25]. A study using event related potentials (ERPs) conducted by Tanriverdi et al provides electrophysiological evidence for cognitive dysfunction among people with excessive growth hormone secretion [23].…”