The “Steroid Dementia Syndrome”: A Possible Model of Human Glucocorticoid Neurotoxicity

@article{Wolkowitz2007TheD,
  title={The “Steroid Dementia Syndrome”: A Possible Model of Human Glucocorticoid Neurotoxicity},
  author={Owen M. Wolkowitz and Sonia J. Lupien and Erin D. Bigler},
  journal={Neurocase},
  year={2007},
  volume={13},
  pages={189 - 200}
}
Glucocorticoid medications cause neurotoxicity in animals under certain circumstances, but it is not known if this occurs in humans. We present the case of a 10-year-old boy with no prior psychiatric history and no prior exposure to glucocorticoid medication who received a single 5-week course of glucocorticoids for an acute asthma flare. Beginning during steroid treatment, and persisting for over 3 years after stopping treatment, he showed a significant decline from his pre-morbid academic… 
Behavioral, Psychiatric, and Cognitive Adverse Events in Older Persons Treated with Glucocorticoids
TLDR
Data on BPAEs in older persons treated with GCs, have several unmet needs that need to be further evaluated with appropriately designed studies.
Glucocorticoids. Mood, memory, and mechanisms.
TLDR
This article will focus on the relationships between glucocorticoids and psychiatric symptoms in Cushing's syndrome, major depression, and steroid psychosis/steroid dementia, as well as the effects of exogenously administered glucocORTicoids in normal volunteers.
Glucocorticoids
TLDR
A conceptual model of glucocorticoid actions in the brain that may lead to novel therapeutic opportunities is concluded, and correlational and causal evidence will be reviewed.
Glucocorticoid Dysregulations and Their Clinical Correlates
TLDR
A framework for assessment of patients is proposed that incorporates functional, physiological, and molecular biomarkers to identify subgroups of patients at risk for depressive symptomatology associated with glucocorticoid treatment, and for prevention of side effects, which in many cases can be life‐threatening.
A Systematic Review of the Neuropsychological Sequelae of People Diagnosed with Anti N-Methyl-D-Aspartate Receptor Encephalitis in the Acute and Chronic Phases
  • Della Nicolle, J. Moses
  • Psychology
    Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists
  • 2018
TLDR
The review revealed difficulties with memory, particularly delayed verbal memory, and executive functioning in people diagnosed with anti-NMDAR encephalitis, consistent with the role of NMDA receptors in the limbic system, specifically the hippocampus, which are thought to be essential to aspects of learning and memory.
Neuropsychiatric findings in Cushing syndrome and exogenous glucocorticoid administration.
  • M. Starkman
  • Psychology, Medicine
    Endocrinology and metabolism clinics of North America
  • 2013
Major Depression Cortisol Abnormalities in Major Depression Cortisol ’ s relationship to psychiatric illness
TLDR
This article will focus on the relationships between glucocorticoids and psychiatric symptoms in Cushing’s syndrome, major depression, and steroid psychosis/steroid dementia, as well as the effects of exogenously administered glucocORTicoids in normal volunteers, and develops a conceptual model of glucoc Corticoid actions in the brain that may lead to novel therapeutic opportunities.
Steroid and nonsteroidal anti-inflammatory drugs, cognitive decline, and dementia
Mathematical processing is affected by daily but not cumulative glucocorticoid dose in patients with systemic lupus erythematosus.
TLDR
Daily prednisolone dose ≥9 mg, but not cumulative glucocorticoid dose, had an independent negative impact on mathematical processing in SLE patients.
Association between Anti-inflammatory Drug and Dementia in Patients with Gout: A Nationwide, Population-Based Nested Case-Control Study
TLDR
It is identified that > 90-day corticosteroid administration is a significant dementia risk factor in both female and male patients of all ages, especially in the 50-60-year-old group.
...
...

References

SHOWING 1-10 OF 78 REFERENCES
Glucocorticoid Medication, Memory and Steroid Psychosis in Medical Illness
TLDR
From a clinical prospective, it is important to discuss potential neuropsychiatric side effects with patients before prescribing GC treatment, and a greater understanding of the risk factors for experiencing SP and of its underlying mechanisms will lead to more informed clinical decision making.
[Cognitive impairment after accidental high-dose corticosteroid therapy].
TLDR
The results confirm those of human experimental studies that exogenous steroids can cause serious persisting specific cognitive disorders especially of the declarative, hippocampus-dependent memory.
Do Glucocorticoids Have Adverse Effects on Brain Function?
TLDR
The risk of memory impairment should be carefully considered before initiating treatment with glucocorticoids and their use should be considered in the differential diagnosis of memory loss.
A case of reversible steroid dementia.
  • N. Varney
  • Medicine, Psychology
    Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists
  • 1997
TLDR
The case presented describes a patient who developed dementia-like cognitive changes and an abnormal EEG as a result of steroid treatment and is the first with documented electroencephalographic sequelae and premorbid EEG, CT scan and neuropsychological testing.
Presentation of the Steroid Psychoses
TLDR
Patients receiving daily doses of 40 mg of prednisone or its equivalent, are at greater risk for developing steroid psychosis, and tricyclic antidepressants produced an exacerbation or worsening of the clinical state in all patients to whom they were administered.
Commonly Used Therapeutic Doses of Glucocorticoids Impair Explicit Memory
TLDR
To determine if long-term prednisone treatment of patients with systemic disease without central nervous system involvement was associated with impaired memory, clinical reports and experimental evidence indicated that such treatment could cause memory disturbance in humans were investigated.
Children experience cognitive decline despite reversal of brain atrophy one year after resolution of Cushing syndrome.
TLDR
Despite rapid reversibility of cerebral atrophy, children experience a significant decline in cognitive function 1 yr after correction of hypercortisolism and the effect of glucocorticoid excess on the brain of children appears to be different from adults.
Reversible steroid dementia in patients without steroid psychosis.
TLDR
Six patients developed dementia-like cognitive changes that appeared to result from administration of steroid medications, and all six patients eventually recovered normal mental status following discontinuation or reduction of steroids medications.
Reversible dementia with parkinsonian features associated with budesonide use
A 51-year-old man was referred for neurologic consultation because of increasing forgetfulness, difficulty walking, frequent falls, apathy, and decreased motivation to perform activities of daily
...
...