Acute Cortisol Profile Associations With Cognitive Impairment After Severe Traumatic Brain Injury.
David J Barton, Raj G Kumar, Alexandria A Schuster and 3 others
PMID 34689657WHAT IT FOUND
Adults with severe traumatic brain injury who had consistently high serum or cerebrospinal fluid cortisol in the first five days scored significantly lower on memory and executive function tests six months later.
These early hormone profiles may help identify patients at risk for long-term cognitive impairment.
Key findings
01Participants with high serum cortisol trajectories had poorer overall cognition, executive function, and verbal fluency at six months compared to those with declining cortisol levels.
02Participants with high cerebrospinal fluid cortisol trajectories had poorer overall cognition, executive function, attention, and verbal fluency at six months compared to those with low cortisol levels.
03Memory performance did not differ significantly between high and low cortisol trajectory groups for either serum or cerebrospinal fluid.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study only included survivors who were cognitively able to complete neuropsychological testing, potentially excluding patients with the most severe cognitive dysfunction. The observational design cannot prove that high cortisol causes cognitive impairment; it may simply reflect a more severe injury or a chronic stress state. The sample size was relatively small (94 participants), and the study was limited to a single center. Memory deficits were universal across groups, so cortisol levels did not help distinguish memory outcomes, possibly due to a ceiling effect or the non-selective nature of memory impairment after TBI.
Declared interests
The study was supported by grants from the National Institutes of Health and the U.S. Government. No specific commercial conflicts of interest were declared in the provided text.
The easy way to misread this
Do not assume that high cortisol levels directly cause the observed cognitive deficits. The study shows an association, but it is possible that patients with more severe brain injuries have both higher cortisol and worse cognitive outcomes, without cortisol being the primary driver of the impairment.