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| Author(s): |
Nayanne Beckmann Bosaipo
Total Authors: 1
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| Document type: | Doctoral Thesis |
| Press: | Ribeirão Preto. |
| Institution: | Universidade de São Paulo (USP). Faculdade de Medicina de Ribeirão Preto (PCARP/BC) |
| Defense date: | 2016-06-28 |
| Examining board members: |
Mário Francisco Pereira Juruena;
Norberto Garcia Cairasco;
Frederico Guilherme Graeff
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| Advisor: | Mário Francisco Pereira Juruena |
| Abstract | |
BACKGROUND: Exposure to early-life stress (ELS) may be associated with depression in adulthood. Evidence shows that changes in the regulatory capacity of the hypothalamicpituitary-adrenal axis (HPA) underlie association. Patients with ELS usually are more clinically ill, showing poorer prognosis and limited response to usual treatments. It is not known yet what the cognitive profile of those patients is and how changes in the HPA axis activity would impact on cognitive functioning. AIM: The aim of this study was to investigate the HPA axis activity through basal cortisol levels and cognitive functions mediated by the hippocampus and the prefrontal cortex in depressed patients with early stress history. METHOD: Study total study sample was 107 subjects, 77 depressed patients and 30 healthy subjects aged between 21 and 60 years of both sexes. Patients had diagnosis confirmed for major depressive episode with symptom severity at least moderate by the time of the evaluations. We used the Childhood Trauma Questionnaire (CTQ) to assess the ELS history splitting the patient sample into two groups, one with early life stress (ELS+) and the other without early stress (ELS-). Participants were assessed for severity of psychiatric symptoms related to depression, such as impulsivity and affective temperament. The neuropsychological evaluation included tests for verbal memory, visuospatial memory, working memory, sustained and divided attention, inhibitory control measures, cognitive flexibility, verbal fluency, and IQ. For the endocrine assessment five samples of salivary cortisol and plasma cortisol were analyzed to evaluate HPA axis functioning. RESULTS Seventy-two percent of depressive patients had ELS. ELS itself influenced earlier onset of depressive disorders in patients (p = 0.03). Most of the affective temperaments are more prominent in patients with mood disorders than health controls. Regarding the assessment of the HPA axis activity, ELS + group showed lack of cortisol circadian rhythm (CR) compared to the control group. We also found increased salivary cortisol levels at 22 pm compared to the EP- group (p = 0.04) and a trend toward the control group (p = 0.06). In neuropsychological performance, patients EP + showed deficits compared to controls in all of the cognitive subdomains evaluated (p <0.05 for all test scores) except visuospatial memory (p = 0.13). In contrast, ELS-patients showed worse performance only in working memory (p = 0.006), attentional switching (p = 0.01) and inhibitory control (p = 0.004) compared to controls. Comparisons between patient groups showed that EP + patients had a deficit in color naming (p = 0.01) and a trend toward delayed verbal memory (p = 0.07). We found moderate positive correlations for EP+ patients between decreased variation in salivary cortisol levels in the CR and impairments in cognitive flexibility (? = 0.61; p = 0.002) and also to inhibitory control ( ? = 0.42, p = 0.048). CONCLUSION: Our findings indicate a distinct endocrine and neuropsychological profile in patients ELS + compared to depressed EP-. The combination of ELS history and depression resulted in early onset of the depression symptoms, comprehensive cognitive impairment in tasks related to the CPF and hippocampus, and failure in maintaining the circadian rhythm of cortisol. (AU) | |
| FAPESP's process: | 12/17623-8 - From early life stress to depression: assessment of HPA axis activity and cognitive function |
| Grantee: | Nayanne Beckmann Bosaipo |
| Support Opportunities: | Scholarships in Brazil - Doctorate |