Cognitive impairment after accidental high-dose corticosteroid therapy

Abstract

Synthetic glucocorticosteroids can induce various severe mental disorders. Persisting cognitive disorder represents a rare complication of corticoid therapy involving memory, concentration, attention, or occupational performance. We observed the effects of a 20-day self-induced high-dose corticosteroid treatment on the cognitive functions in a 54-year-old patient. Having excluded dementia due to other organic causes, we examined the patient neuropsychologically immediately at the end of the steroid therapy and at follow-up (1, 2, 4, and 6 months). The initial tests showed seriously impaired functioning of concentration, attention, learning, and memory as well as of common ability to solve problems. The follow-up tests up to 6 months revealed an improvement of concentration and attention, but there were still serious deficits of the declarative memory with a high confabulating tendency. Our results confirm those of human experimental studies that exogenous steroids can cause serious persisting specific cognitive disorders especially of the declarative, hippocampus-dependent memory.

The “Steroid Dementia Syndrome”: A Possible Model of Human Glucocorticoid Neurotoxicity

“…Neurocognitive sequellae of steroid treatment of the magnitude, type and persistence seen in this case are seemingly rare (Hall et al, 1979;Lewis & Smith, 1983;Varney et al, 1984;Reckart, & Eisendrath, 1990;Varney, 1997;Lagomasino & Stern, 2001;Alderson, & Novack, 2002;Wilner, de Varennes, Gregoire, Lupien, & Pruessner, 2002;Arndt, Kunert, & Sass, 2004;Sacks & Shulman, 2005). Subtle or short-lived cognitive impairments that last less than several weeks or months after stopping corticosteroids may be more common (Varney et al, 1984;Wolkowitz & Rapaport, 1989;Wolkowitz et al, 1997;Varney, 1997;Prodan, Monnot, Ross, & Coleman, 2006).…”

Glucocorticosteroids in football: use and misuse: Figure 1

“…Declarative, hippocampus dependent memory seems to be particularly affected-impaired functioning of concentration, attention, learning, and memory as well as melancholic depression and anxiety have been reported. [60][61][62] Moreover, steroid resistance or steroid induced suppression of the HPA axis with inhibition of pituitary gonadotropin, growth hormone, or thyrotropin has been described by several authors. 15 50 63 As glucocorticosteroids induce an increase of blood glucose, decrease of the glucose tolerance level is another common problem of glucocorticosteroid therapy and an essential characteristic of Cushing's disease: glucocorticosteroids induce insulin resistance, which leads to an increase in hepatic gluconeogenesis.…”

Hochdosiskortisontherapie und Kognition

“…Obwohl nach Absetzen der Therapie zumeist rasch reversibel, können die Defizite gelegentlich auch über Monate bis Jahre persistieren. Einen dramatischen Fall einer solchen länger anhaltenden kognitiven Dysfunktion nach längerer Steroidexposition berichteten kürzlich Arndt et al [1], die bei einer Patientin im Anschluss an eine selbstapplizierte Hochdosiskortisonbehandlung über 20 Tage zunächst ein manisches Syndrom und, nach Abklingen dieser Symptomatik, in der Folge schwere, über Monate hinweg bestehende Gedächtnisstörungen fanden.…”