Cognitive phenotypes in patients with drug-resistant temporal lobe epilepsy: Relationships with cortisol and affectivity.

IF 3 3区 心理学 Q2 CLINICAL NEUROLOGY Clinical Neuropsychologist Pub Date : 2024-07-04 DOI:10.1080/13854046.2024.2375605
Irene Cano-López, Judit Catalán-Aguilar, Alejandro Lozano-García, Vanesa Hidalgo, Kevin G Hampel, Paula Tormos-Pons, Alicia Salvador, Vicente Villanueva, Esperanza González-Bono
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Abstract

Objective: Drug-resistant temporal lobe epilepsy (TLE) is a neurological disorder characterized by cognitive deficits. This study examined whether patients with TLE and different cognitive phenotypes differ in cortisol levels and affectivity while controlling for demographic and clinical variables. Methods: In this cross-sectional study, 79 adults with TLE underwent neuropsychological evaluation in which memory, language, attention/processing speed, executive function, and affectivity were assessed. Six saliva samples were collected in the afternoon to examine the ability of the hypothalamic-pituitary-adrenal (HPA) axis to descend according to the circadian rhythm (C1 to C6). The cortisol area under the curve concerning ground (AUCg) was computed to examine global cortisol secretion.

Results: Three cognitive phenotypes were identified: memory impairment, generalized impairment, and no impairment. The memory-impairment phenotype showed higher cortisol levels at C4, C5, and C6 than the other groups (p = 0.03, η2 = 0.06), higher cortisol AUCg than the generalized-impairment phenotype (p = 0.004, η2 = 0.14), and a significant reduction in positive affectivity after the evaluation (p = 0.026, η2 = 0.11). Higher cortisol AUCg and reductions in positive affectivity were significant predictors of the memory-impairment phenotype (p < 0.001; Cox and Snell R2 = 0.47).

Conclusions: Patients with memory impairment had a slower decline in cortisol levels in the afternoon, which could be interpreted as an inability of the HPA axis to inhibit itself. Thus, chronic stress may influence hippocampus-dependent cognitive function more than other cognitive functions in patients with TLE.

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耐药性颞叶癫痫患者的认知表型:与皮质醇和情感的关系。
目的:耐药性颞叶癫痫(TLE)是一种以认知障碍为特征的神经系统疾病。本研究在控制人口统计学和临床变量的前提下,探讨了不同认知表型的颞叶癫痫患者在皮质醇水平和情感方面是否存在差异。研究方法在这项横断面研究中,79 名患有 TLE 的成人接受了神经心理学评估,评估内容包括记忆、语言、注意力/处理速度、执行功能和情感。研究人员在下午采集了六份唾液样本,以检测下丘脑-垂体-肾上腺(HPA)轴根据昼夜节律(C1至C6)下降的能力。计算皮质醇在地面曲线下的面积(AUCg),以检查皮质醇的总体分泌情况:结果:发现了三种认知表型:记忆障碍、全身障碍和无障碍。记忆受损表型在 C4、C5 和 C6 的皮质醇水平高于其他组别(p = 0.03,η2 = 0.06),皮质醇 AUCg 高于普遍受损表型(p = 0.004,η2 = 0.14),评估后积极情绪显著降低(p = 0.026,η2 = 0.11)。较高的皮质醇AUCg和积极情绪的降低是记忆受损表型的重要预测因素(p 2 = 0.47):结论:记忆受损患者下午皮质醇水平的下降速度较慢,这可以解释为 HPA 轴无法自我抑制。因此,与其他认知功能相比,慢性应激可能会对依赖海马的认知功能产生更大影响。
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来源期刊
Clinical Neuropsychologist
Clinical Neuropsychologist 医学-临床神经学
CiteScore
8.40
自引率
12.80%
发文量
61
审稿时长
6-12 weeks
期刊介绍: The Clinical Neuropsychologist (TCN) serves as the premier forum for (1) state-of-the-art clinically-relevant scientific research, (2) in-depth professional discussions of matters germane to evidence-based practice, and (3) clinical case studies in neuropsychology. Of particular interest are papers that can make definitive statements about a given topic (thereby having implications for the standards of clinical practice) and those with the potential to expand today’s clinical frontiers. Research on all age groups, and on both clinical and normal populations, is considered.
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