http://archpsyc.jamanetwork.com/ en-us Mon, 24 Dec 2012 00:00:00 GMT Tue, 01 Jan 2013 00:49:18 GMT Silverchair editor@archpsyc.jamanetwork.com webmaster@archpsyc.jamanetwork.com http://archpsyc.jamanetwork.com/article.aspx?articleID=482360 Sun, 01 Jul 2007 00:00:00 GMT Lee BK, Glass TA, McAtee MJ, et al. <span class="paragraphSection"><div class="boxTitle">Context</div>The stress responses of the hypothalamic-pituitary-adrenal axis can produce adverse effects on the brain. Previous studies have concluded that an elevated level of cortisol is a risk factor for cognitive dysfunction and decline in aging but have been limited by sex exclusion, restricted cognitive batteries, and small sample sizes.<div class="boxTitle">Objective</div>To examine associations among salivary cortisol metrics and cognitive domain scores in an urban adult population.<div class="boxTitle">Design, Setting, and Participants</div>A cross-sectional analysis was conducted using data from a longitudinal study involving 1140 Baltimore, Maryland, residents aged 50 to 70 years. Four salivary cortisol samples were obtained from 967 participants across 1 study visit (before, during, and after cognitive testing as well as at the end of the visit) from which 7 cortisol metrics were created. We examined associations of cortisol metrics with cognitive performance using multiple linear regression.<div class="boxTitle">Main Outcome Measures</div>Performance on 20 standard cognitive tests was measured and combined to form summary measures in 7 domains (language, processing speed, eye-hand coordination, executive functioning, verbal memory and learning, visual memory, and visuoconstruction).<div class="boxTitle">Results</div>Higher levels of pretest and mean cortisol as well as the area under the curve of cortisol over the study visit were associated with worse performance (<span style="font-style:italic;">P</span> < .05) in 6 domains (language, processing speed, eye-hand coordination, executive functioning, verbal memory and learning, and visual memory). For instance, an interquartile range increase in the area under the curve was equivalent to a decrease in the language score expected from an increase in 5.6 (95% confidence interval, 4.2-7.1) years of age.<div class="boxTitle">Conclusions</div>Elevated cortisol was associated with poorer cognitive function across a range of domains in this large population-based study. We believe the findings are consistent with the hypothesis that hypothalamic-pituitary-adrenal axis dysregulation may be a risk factor for poorer cognitive performance in older persons.</span> 64 7 810 818 10.1001/archpsyc.64.7.810 http://archpsyc.jamanetwork.com/article.aspx?articleID=482360