Abstract
Cortisol patterns in nursing home residents with dementia are described and examined in relation to cognition and comorbid illnesses. Saliva was sampled 4 times in a 24-hour period (week 1) and at the same times 1 week later (week 2). In general, cortisol levels decreased from morning to evening, with 50% exhibiting a negative slope. In contrast, 38% of the participants had a relatively flat cortisol diurnal rhythm, and 7% exhibited an afternoon increase. The cortisol pattern was consistent between weeks 1 and 2 for 39% with a negative slope, 13% with a flat profile, and for 2% with an afternoon increase pattern. Cortisol rhythm was not statistically significantly related to cognition or illness burden. While this study contributes to the understanding of differences in the diurnal pattern of cortisol for older adults with dementia, more research is needed to understand the etiology of the differences and the biological mechanisms involved.
Keywords: cortisol, hypothalamic-pituitary-adrenal axis, dementia, comorbid illness
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Contributor Information
Christine R. Kovach, University of Wisconsin-Milwaukee, WI, USA, ckovach@uwm.edu .
Diana Lynn Woods, University of California Los Angeles, School of Nursing, CA, USA.
Brent R. Logan, Medical College of Wisconsin, WI, USA.
Hershel Raff, Medical College of Wisconsin, WI, USA, Endocrine Research Laboratory, Aurora St. Luke's Medical Center, WI, USA.
References
- American Psychiatric Association. Practice guideline for the treatment of patients with Alzheimer’s disease and other dementias. Am J Psychiatry. 2007. ; 164, 48A. [PubMed] [Google Scholar]
- Segerstrom SC , Miller GE Psychological stress and the human immune system: A meta-analytic study of 30 years of inquiry. Psychol Bull. 2004;130(4):601-630. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Stone AA, Schwartz JE, Smyth J., et al. Individual differences in the diurnal cycle of salivary free cortisol: a replication of flattened cycles for some individuals. Psychoneuroendocrinology. 2001;26(3):295-306. [DOI] [PubMed] [Google Scholar]
- Santiago LB, Jorge SM, Moreira AC Longitudinal evaluation of the development of salivary cortisol circadian rhythm in infancy. Clin Endocrinol. 2003;44(2):157-161. [DOI] [PubMed] [Google Scholar]
- Raff H., Raff J., Duthie EH, et al. Elevated salivary cortisol in the evening in healthy elderly men and women: Correlation with bone mineral density. J Gerontol A Biol Sci Med Sci. 1999;54(9):M479-M483. [DOI] [PubMed] [Google Scholar]
- Edwards S., Evans P., Hucklegridge F., Clow A. Association between time of awakening and diurnal cortisol secretory activity . Psychoneuroendocrinology. 2001;26(6):613-622. [DOI] [PubMed] [Google Scholar]
- Dekkers JC, Geenen R., Godaert GL, Van Doornen LJ, Bijlsma JW Diurnal rhythm of salivary cortisol levels in patients with recent-onset rheumatoid arthritis. Arthritis Rheum. 2000;43(2):465-467. [DOI] [PubMed] [Google Scholar]
- Fiocco AJ, Wan N., Weekes N., Pim H., Lupien SJ Diurnal cycle of salivary cortisol in older adult men and women with subjective complaints of memory deficits an/or depressive symptoms: Relation to cognitive functioning. Stress. 2006;9(3):143-152. [DOI] [PubMed] [Google Scholar]
- Ferrari E., Arcaini A., Gornati R., et al. Pineal and pituitary-adrenocortical function in physiological aging and in senile dementia. Exp Gerontol. 2000;35(9-10):1239-1250. [DOI] [PubMed] [Google Scholar]
- Ferrari E., Magri F. Role of neuroendocrine pathways in cognitive decline during aging. Ageing Res Rev. 2008;7(3):225-233. [DOI] [PubMed] [Google Scholar]
- Crofford L. Neuroendocrine aspects of fibromyalgia. J Musculoskeletal Pain. 1994;2(3):125-132. [Google Scholar]
- Levine ME, Duffy LK, Bowyer RT Fatigue, sleep and seasonal hormone levels: implications for drinking behavior in northern climates. Drugs & Soc. 1994. ;8(2):61-70. [Google Scholar]
- Goh VH Circadian disturbances after night-shift work onboard a naval ship. Mil. Med. 2000;165(2):101-105. [PubMed] [Google Scholar]
- Peters F., Nicholson NA, Berkhok J. Cortisol responses to daily events in major depression disorder. Psychosom Med. 2003;65(5): 836-841. [DOI] [PubMed] [Google Scholar]
- Morgan CA, Rasmusson AM, Wang S., Hoyt G., Hauger RL, Hazlett G. Neuropeptide-Y, cortisol, and subjective distress in humans exposed to acute stress: Replication and extension of previous report. Biol Psychiatry. 2002;52(2):136-142. [DOI] [PubMed] [Google Scholar]
- Cicchetti D. , Rogosch FA The impact of child maltreatment and psychopathology on neuroendocrine functioning. Dev Psychopathol. 2001;13(4):783-804. [PubMed] [Google Scholar]
- Ice GH, Katz-Stein A., Himes J., Kane RL Diurnal cycles of salivary cortisol in older adults. Psychoneuroendocrinology . 2004;29(3):355-370. [DOI] [PubMed] [Google Scholar]
- Smyth JM, Ockenfels MC, Gorin AA, et al. Individual differences in the diurnal cycle of cortisol. Psychoneuroendocrinology. 1997;22(2):89-105. [DOI] [PubMed] [Google Scholar]
- Burke HM, Davis MC, Otte C., Mohr DC Depression and cortisol responses to psychological stress: A meta-analysis . Psychoneuroendocrinology. 2005;30(2):846-856. [DOI] [PubMed] [Google Scholar]
- Weiner MF, Vobach S., Olsson K., Svetlik D., Risser RC Cortisol secretion and Alzheimer’s disease progression. Biol Psychiatry. 1997;42(11):1030-1038. [DOI] [PubMed] [Google Scholar]
- Ice GH Factors influencing cortisol level and slope among community dwelling older adults in Minnesota. J Cross Cult Gerontol. 2005;20(2):91-108. [DOI] [PubMed] [Google Scholar]
- Sephton SE, Sapolsky RM, Kraemer HC, Spiegel D. Diurnal cortisol rhythm as a predictor of breast cancer survival. J Nat Cancer Inst. 2000;92(12):994-1000. [DOI] [PubMed] [Google Scholar]
- Kovach CR, Noonan PE, Schlidt AM, Reynolds S., Wells T. The Serial Trial Intervention: an innovative approach to meeting needs of individuals with dementia. J Gerontol Nurs. 2006;32(4):18-25. [DOI] [PubMed] [Google Scholar]
- Granger DA, Kivlighan KT, Fortunato C., et al. Integration of salivary biomarkers into developmental and behaviorally-oriented research: Problems and solution for collecting specimens. Physiol Behav. 2007;92(4):583-590. [DOI] [PubMed] [Google Scholar]
- Aardal-Eriksson E., Karlberg BE, Holm AC Salivary cortisol - an alternative to serum cortisol determinations in dynamic function tests. Clin Chem Lab Med. 1998;36(4):215-222. [DOI] [PubMed] [Google Scholar]
- Weibel L. Methodological guidelines for the use of salivary cortisol as biological marker of stress. Presse Med. 2003;32(18): 845-851. [PubMed] [Google Scholar]
- Raff H. Salivary cortisol: A useful measurment in the diagnosis of Cushing’s syndrome and the evaluation of the hypothalamic-pituitary-adrenal axis. The Endocrinologist. 2000; 10:9-17. [Google Scholar]
- Raff H. Utility of salivary cortisol measurements in Cushing’s syndrome and adrenal insufficiency. J Clin Endocrinol Metab. 2009;94(10):3647-3655. [DOI] [PubMed] [Google Scholar]
- Folstein MF, Folstein SE, McHugh PR Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189-198. [DOI] [PubMed] [Google Scholar]
- Miller E., Weissert WG Predicting elderly people’s risk for nursing home placement, hospitalization, functional impairment, and mortality. Med Care Res Rev. 2000;57(3):259-297. [DOI] [PubMed] [Google Scholar]
- Gibson EL, Checkley S., Papadopoulos A., Poon L., Daley S., Wardle J. Increased salivary cortisol reliably induced by a protein-rich midday meal . Psychosom Med. 1999;61(2):214-224. [DOI] [PubMed] [Google Scholar]
- Rosmand R., Holm G., Bjorntorp P. Food-induced cortisol secretion in relation to anthropometric, metabolic and hemodynamic variables in men. Int J Obes. 2000;24(4):416-422. [DOI] [PubMed] [Google Scholar]
- Raff H., Homar PJ, Skoner DP New enzyme immunoassay for salivary cortisol. Clin Chem. 2003;49(1):203-204. [DOI] [PubMed] [Google Scholar]
- Woods DL, Kovach CR, Raff H., Joosse L., Basmadjian A., Hegadoren KM Using saliva to measure endogenous cortisol in nursing home residents with advanced dementia. Res Nurs Health. 2008;31(3):283-294. [DOI] [PubMed] [Google Scholar]
- Baid SK, Sinaii N., Wade M., Rubino D., Nieman LK Radioimmunoassay and tandem mass spectrometry measurement of bedtime salivary cortisol levels: a comparison of assays to establish hypercortisolism. J Clin Endocrinol Metab. 2007;92(8): 3102-3107. [DOI] [PubMed] [Google Scholar]
- Varadhan R. , Walston J., Cappola AR, Carlson MC, Wand GS, Fried LP Higher levels and blunted diurnal variation of cortisol in frail older women. J Geronotol. 2008;63A(2):190-195. [DOI] [PubMed] [Google Scholar]
- Wilkinson CW , Peskind ER, Raskind MA Decreased hypothalamic pituitary adrenal axis sensitivity to cortisol feedback inhibition in human aging. Neuroendocrinology. 1997;65(1):79-90. [DOI] [PubMed] [Google Scholar]
- Lupien SJ, McEwen BS, Gunnar MR, Heim C. Effects of stress throughout the lifespan on the brain, behaviour and cognition . Nat Rev Neurosci. 2009;10(6):434-445. Retrieved on Dec 6, 2010. from http://www.nature.com/nrn/journal/v10/n6/abs/nrn2639.html#top [DOI] [PubMed] [Google Scholar]
- Valenti G. Neuroendocrine hypothesis of aging: the role of corticoadrenal steroids. J Endocrinol Invest. 2004;27(suppl 6):62-63. [PubMed] [Google Scholar]
- Lupien SJ, Wilkinson CW, Briere S., Menard C., Kim NY, Nair NP The modulatory effects of corticosteroids on cognition: studies in young human populations. Psychoneuroendocrinology. 2002. ;27(3):401-416. [DOI] [PubMed] [Google Scholar]
- Karlamangla AS, Singer BH, Chodosh J., McEwen BS, Seeman TE Urinary cortisol excretion as a predictor of incident cognitive impairment. Neurobiol Aging. 2005;26(suppl 1):80-84. [DOI] [PubMed] [Google Scholar]
- Cohen-Mansfield J., Marx MS, Wener P., Freedman L. Temporal patterns of agitated nursing home residents. Int Psychogeriatr. 1992;4(2):197-206. [DOI] [PubMed] [Google Scholar]