Exp Clin Endocrinol Diabetes 2021; 129(03): 194-202
DOI: 10.1055/a-1247-4651
Review

Neuropsychological Functioning in Patients with Cushing’s Disease and Cushing’s Syndrome

Sonja Siegel
1   Department of Neurosurgery, University of Duisburg-Essen, Essen
,
Cedric Fabian Kirstein
1   Department of Neurosurgery, University of Duisburg-Essen, Essen
,
Agnieszka Grzywotz
1   Department of Neurosurgery, University of Duisburg-Essen, Essen
,
Bernd Otto Hütter
1   Department of Neurosurgery, University of Duisburg-Essen, Essen
,
Karsten Henning Wrede
1   Department of Neurosurgery, University of Duisburg-Essen, Essen
,
Victoria Kuhna
2   Department of Neurosurgery, University Hospital Oldenburg
,
Ilonka Kreitschmann-Andermahr
1   Department of Neurosurgery, University of Duisburg-Essen, Essen
› Author Affiliations
Funding: This work did not receive any public or private funding.

Abstract

Purpose 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.

Methods 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.

Results 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.

Conclusions 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.

Supplementary Material



Publication History

Received: 25 March 2020
Received: 24 July 2020

Accepted: 19 August 2020

Article published online:
29 September 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
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