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The Function of the Hypothalamic–Pituitary–Adrenal Axis in Alzheimer's Disease

Response to Insulin Hypoglycaemia

Published online by Cambridge University Press:  02 January 2018

John T. O'Brien ,
Isaac Schweitzer ,
David Ames ,
Maree Mastwyk  and
Peter Colman
John T. O'Brien*
Affiliation:
University of Melbourne Department of Psychiatry
Isaac Schweitzer
Affiliation:
University of Melbourne Department of Psychiatry
David Ames
Affiliation:
University of Melbourne Department of Psychiatry
Maree Mastwyk
Affiliation:
University of Melbourne Department of Psychiatry
Peter Colman
Affiliation:
University of Melbourne Department of Endocrinology, University of Melbourne, Royal Melbourne Hospital, Australia
*
Dr John O'Brien, Hellesdon Hospital, Norwich NR6 5BE
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Abstract

Background

To investigate an association between HPA axis dysfunction, depression and cognitive impairment, we assessed subjects with mild Alzheimer's disease (AD).

Method

Sixteen non-depressed subjects with AD according to NINCDS/ADRDA criteria and 18 normal controls underwent the insulin hypoglycaemia (IH) test and the dexamethasone suppression test (DST).

Results

The AD subjects showed a blunted response of adrenocorticotrophic hormone (ACTH) to IH compared with controls (P = 0.019). ACTH response (area under curve) correlated with a score for cognitive ability (CAMCOG) (r = 0.64, P < 0.01). AD subjects had a shorter time to peak cortisol level than controls (P = 0.004), although total cortisol response was normal.

Conclusions

The AD subjects show evidence of adrenal hyper-responsiveness and normal immediate (rate-sensitive) glucocorticoid feedback. An association between HPA axis dysfunction and organic brain pathology in AD subjects may be mediated by cell loss in the hippocampus.

Type
Papers
Information
The British Journal of Psychiatry , Volume 165 , Issue 5 , November 1994 , pp. 650 - 657
Copyright
Copyright © Royal College of Psychiatrists, 1994 

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