Abstract
Cortisol reactivity to adrenocorticotropic hormone (ACTH) has been associated with neuropsychological processes including attention and memory in children with asthma. While cortisol reactivity to a psychological stressor is often considered a measure of current neuroendocrine functioning, this study examines the association of the cortisol reactivity and subsequent neuropsychological functioning. Using prospective data from the Childhood Asthma Management Program (CAMP), we explored the predictive ability of cortisol reactivity to ACTH and children’s later attention and memory using traditional and an alternative cortisol reactivity (normalized cortisol) measures. Cortisol reactivity was assessed at study entry and 1-year follow-up, and neuropsychological functioning was assessed at 3-year follow-up. Cortisol reactivity was assessed through plasma cortisol concentrations collected at baseline (CORTBASELINE) and 30 min post-ACTH challenge (CORTPOST–ACTH). An alternative measure of cortisol reactivity was developed through post-ACTH stimulation cortisol, normalized by cortisol by baseline (CORTNORM–ACTH). CORTBASELINE positively predicted year 3 attention, while CORTNORM–ACTH negatively predicted attention, suggesting convergence of cortisol variables in prediction of neuropsychological function. Year 1 CORTACTH positively predicted child memory at year 3; Year 1 CORTNORM–ACTH negatively predicted year 3 sustained attentions. These findings demonstrate that HPA reactivity, including the application of normalized cortisol reactivity, can predict subsequent neuropsychological functioning of children with mild to moderate asthma.
Highlights
Further exploration of cortisol activity was accomplished by examining area under the curve (AUC) with respect to ground for CORT and for CORTNORM, with findings indicating that neither value provides substantially different predictive value (CORT AUC = 0.521; 95% CI:0.416, 0.626); CORTNORM AUC = 0.572; 95% CI:0.470, 0.675)
Our findings reveal that children with higher CORTBASELINE and lower CORTNORM−adrenocorticotropic hormone (ACTH), at study entry exhibited higher sustained attention 3 years later
We have previously demonstrated that when analyzing data collected at study entry, child working memory was positively associated with overall cortisol reactivity in response to ACTH stimulation (Annett et al, 2005)
Summary
Dysregulation of the stress response system has been implicated in psychological disorders (Faravelli et al, 2012; Ising et al, 2012; Spijker and van Rossum, 2012; Staufenbiel et al, 2013; Yildirim and Derksen, 2013; Mansueto and Faravelli, 2017; Wielaard et al, 2018; Yirmiya et al, 2018; Ciufolini et al, 2019) and associated with neuropsychological functioning (Lupien et al, 2009; Scassellati et al, 2012; Forns et al, 2014). The stress response system is activated by a perceived. As they do not rely upon the increased production of hormones, while subcortical networks take time to activate because they send signals throughout the body, which stimulates increased production of stress hormones such as cortisol. Cortisol production in the adrenal glands is stimulated by the hypothalamus and pituitary gland, both located in the brain. The hypothalamic-pituitary-adrenal axis is the primary mechanism through which the body responds to a threat to homeostasis (McEwen, 1998). In response to threat perception, a series of hormonal responses are triggered, ending in the production of cortisol which is down regulated via negative feedback from the hippocampus, the brain structure involved in learning and memory. The high concentration of both MR and GR in the hippocampus suggests that the HPA-axis plays a role in learning and memory (Joels et al, 2012)
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