Bringing Awareness to the Cognitive Effects of Cushing's Disease   by Melissa neve, M.A., CCC-SLP

While perusing Facebook before work one morning, I read a post from a close friend. She posted a link (http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=49031&fulltextType=RA&fileId) entitled "Cognitive Decline in Patients with Cushing's Syndrome." Her commentary read, "What I want to know is why....? And can it be reversed...? It's okay at home and sometimes even comical.... but not so much elsewhere. He understands and the kids think it is funny when I can't think of what the "refrigerator" is called or I... just stop talking in the middle of a sentence because I plum forgot what I was JUST talking about and say "UM" repeatedly. Or twist my words into something completely different like "fart smones" (*smart phones*). I get extremely annoyed that I can't remember how to spell things, too!! So, if I don't remember that conversation we had 2 days, a week, a month ago, or the fact that I even talked to you, this is why!" I commented that I'd be calling her later, realizing that I had a wealth of material for her to read, as well as worksheets and ideas for tasks to target memory and other areas of cognition.

Then it dawned on me.... I had no idea that Cushing's existed before knowing Rene, much less that this population sometimes evidenced cognitive-linguistic deficits! Rene was diagnosed with Cushing's disease in 2010 and had pituitary surgery that same year. Cushing's occurs when a benign tumor on the pituitary gland produces an excess of the adrenocorticotropic hormone (ACTH). ACTH then travels through the blood into the adrenal glands, which are located on the kidneys, and triggers an excessive amount of production of cortisol. Cortisol is an important steroid hormone which, when too high for too long, can lead to many different symptoms, most regarding the ability to defend the body from infection and metabolism. Symptoms include uncontrollable weight gain, sometimes in irregular distribution, acne/facial redness, excessive hair growth (for women, on the face and/or body), fatigue, weakness, menstrual changes, bruising easily, changes in cognition, and many others.

Rene continues to battle with a lesser degree of her symptoms since her surgery and through continued treatment, though irreversible effects have been made due to her illness. Her thoughts on Facebook led me to do some research. Studies conducted in regards to those with Cushing's have shown that when asked, 62% of Cushing's patients post-treatment reported memory problems and 47% reported decreased executive functioning skills. Extensive cognitive testing revealed that although these patients didn't perform lower on evaluations of global cognitive functioning, they did indeed perform lower than non-Cushing's patients of similar ages, genders, and educational levels on evaluations of immediate and delayed memory skills and executive functioning (organizing, planning, time management, etc.). (http://jcem.endojournals.org/content/95/6/2699.full)

After talking to Rene about my thoughts on her Facebook posting, I feel that there is a population that is being overlooked. Educating other professionals regarding Cushing's disease and its impact on the patients' everyday life is just a start. Contacting local Endocrinologists and encouraging them to ask their patients if they have had any changes in cognition, and initiating cognitive therapy early on to maintain and increase cognitive-linguistic skills would be another step. Reaching out to those involved in online chat pages, Facebook groups, and local support groups would be even better. I will be honest and say that MY first step is going to be starting at the grass roots level... with Rene. :)

Other Resources:
www.cushingsdisease.com
www.cushie.info