BMI, blood sugar are risk factors for cognitive issues in Cushing’s disease
Researchers devised mathematical model to predict cognitive problem risk
Cognitive issues are most common in people with Cushing’s disease who have high cortisol levels in the morning, high blood sugar, and a high body mass index (BMI), a study shows.
Based on these identified risk factors, researchers devised a mathematical model to help predict the risk of cognitive problems for Cushing’s disease patients.
“The nomogram model developed based on these risk factors demonstrated excellent predictive performance and clinical applicability … providing an effective tool for the early identification of high-risk patients,” the study’s researchers wrote. The study, “The impact of prolonged high-concentration cortisol exposure on cognitive function and risk factors: Evidence from Cushing’s disease patients,” was published in the Journal of Alzheimer’s Disease Reports.
Cushing’s disease is caused by a tumor in the pituitary gland. The tumor leads to the excessive production and release of the signaling molecule adrenocorticotropic hormone (ACTH), which stimulates the adrenal glands to produce too much cortisol. High cortisol levels drive the symptoms of Cushing’s disease.
Issues related to cognition, such as problems with memory or attention, are a common symptom. Not everyone with Cushing’s disease has cognitive problems, however and there’s not much data about what factors are associated with a higher or lower risk of this symptom.
What contributes to cognitive risks in Cushing’s?
Here, scientists in China analyzed data from 107 people with Cushing’s disease who were treated at their hospital. Based on the scores of the Montreal Cognitive Assessment, a common measure of overall cognition, more than half (54.2%) were determined to have cognitive impairment.
The researchers used statistical models to look for factors that were more common among those with cognitive impairment and identified four factors associated with it — levels of cortisol in the blood in the morning, the ratio of cortisol levels in the morning versus at night, fasting plasma glucose (a measure of blood sugar), and BMI, which is a ratio of weight to height that’s used as a measure of body fat.
For all these factors, higher values were linked to an increased risk of cognitive impairment. Because high cortisol levels tend to promote weight gain and increased blood sugar, the researchers said all four factors “are closely related to cortisol levels and its effects on the nervous system.”
Based on these factors, they developed a mathematical model called a nomogram model to predict the risk of cognitive impairment for Cushing’s patients.
To test the model’s accuracy, they used a statistical test called the area under the receiver operating characteristic curve, or AUC, which measures how well a model can differentiate between two groups, in this case, patients with or without cognitive impairment. AUC values can range from 0.5 to 1, with higher values reflecting better accuracy. The researchers’ nomogram showed an AUC of up to 0.91, suggesting quite good accuracy for identifying cognitive impairment.
“The developed nomogram model demonstrated excellent predictive performance … highlighting its strong discriminative ability and clinical utility,” wrote the researchers, who emphasized that their study was limited to patients at a single center, so further testing will be needed to validate the model in other settings. Still, they said the findings “offer a scientific basis for managing the cognitive health of Cushing’s disease patients and provide important insights for prevention and treatment strategies for other cortisol-related conditions, such as chronic stress and metabolic syndrome.”
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