UNIVERSITY OF ILLINOIS AT CHICAGO

Department of Psychiatry

Fifth Annual Research Forum – Extravaganza 2014
POSTER TITLE / Cortisol awakening response differs for midlife women with objective vasomotor symptoms versus without vasomotor symptoms
DISEASE/KEY WORDS:
AUTHORS: / Leah H. Rubin1, Lauren L. Drogos2, Mary C. Kapella3, Stacie E. Geller4, & Pauline M. Maki1,2
MENTEE CATEGORY: / Assistant Professor / RESEARCH MENTOR: / Pauline Maki
BACKGROUND: / We previously reported the novel finding that cognitive performance relates significantly to the number of objective vasomotor symptoms (VMS) women experience but not to the number of VMS they report. Recently, we also found that reductions in objective VMS, but not subjective VMS were associated with improvements in cognitive performance. These findings suggest that physiological factors related to VMS, rather than psychological factors, predict poorer cognitive function. One potential mechanism that might mediate the relationship between objective VMS and cognition is cortisol. Increases in cortisol are associated with decrements in cognitive performance and higher VMS frequency. Here we aimed to test the hypothesis that objective VMS will relate to higher cortisol awakening response (CAR) and that higher CAR and higher total daily cortisol will predict worse cognition. Additionally, we aimed to examine whether the relationship between cortisol and cognitive performance differs between women with and without objective VMS.
METHODS: / In an observational study, 40 midlife early post- and perimenopausal women (mean age, 52.1 years) with either self-reported moderate-to-severe hot flashes (n=20; >30 hot flashes/week) or none-to-few hot flashes (n=20; <7 hot flashes/week) completed measures of objective hot flashes with an ambulatory hot flash monitor, subjective hot flashes with a diary and questionnaire, and a standardized neuropsychological test battery. Women were also asked to provide saliva samples for three days. On each of the 3 days, participants provided samples at the following points: waking, 15, 30, and 45 min post-waking and 3, 6, 9, and 12 hours post-waking, according to standard procedures and using standard calculations for both CAR and total cortisol (area under the curve—AUC). In order to examine VMS group differences on the CAR, we conducted a series of mixed effects regressions (MRM). Variables included in the analyses were VMS group (Subjective: mild-to-none vs. moderate-to-severe; Objective: none vs. any) and so-called dummy variables for Time (wake, +15min, +30min, +45min, +180min, +360min, +540min, and +720min), as well as all two-way interactions. To examine the differential associations between cortisol and cognitive performance as a function of VMS group we conducted a series of correlations.
RESULTS: / Objective, but not subjective VMS, were significantly associated with the CAR. Women with objective VMS showed a different pattern of the CAR compared to women without objective VMS. Specifically, women with objective VMS showed higher cortisol levels at 15, 30, and 45 minutes post-waking compared to women without objective VMS (p’s<0.05). Although there were no VMS group differences on AUC, women with objective VMS tended to show higher daily cortisol levels (M=221.9, SE=15.2) compared to women without objective VMS (M=185.6, SE=18.8)(p=0.16, Cohen’s d=0.51). AUC was negatively associated with semantic fluency (r=-0.45, p=0.01) and figural memory (r=-0.43, p=0.03) in only women with objective VMS.
CONCLUSIONS: / Consistent with previous findings, higher exposure to cortisol is negatively associated with cognitive performance. Previous research has shown that CAR is hippocampally-dependent. In sum, these data demonstrate that cortisol maybe one potential mechanism by which VMS negatively impact cognition in midlife women.