Objective: Cushing’s syndrome occurs when the body is exposed to high levels of cortisol over a long period of time, also called hypercortisolism. Studies have showed that brain abnormalities may occur from the hypercortisolism, which in turn may mediate changes in cognition, mood and quality of life. While most patients show improvement of symptoms from hypercortisolism after treatment (surgery and/ or medication), some still report mental fatigue and cognitive deficits in remission, such as impaired mental efficiency, verbal fluency, reading speed, attentional processing and memory. Although it is known that patients might struggle with behavioral impairments after treatment, they have so far not been referred to rehabilitation units addressing such deficits in Norway. This study will explore the need for cognitive rehabilitation in patients with Cushing’s syndrome in long term remission.

Participants and method: The study is an ongoing serial case study. Each patient gave their written consent of participation. The patients are referred from the Department of Endocrinology, Morbid Obesity and Preventive medicine Oslo University Hospital to an interdisciplinary assessment at Sunnaas Rehabilitation Hospital. So far, five patients are included: 2 males and 3 females, treated for Cushing’s syndrome where 4 had pituitary adenoma and 1 had cortisol producing adrenal adenoma. Time since surgery varied from 3-45 years. The assessment included a medical examination, cognitive tests, fatigue screening (FSS and MFS), self-reported memory difficulties in everyday life (EMQ-R), and a semi-structured interview about impairment in daily life functioning (COPM). The patients received a multidisciplinary feedback after the assessment including advices on managing cognitive difficulties and fatigue, and recommendations for treatment alternatives. 

Results:  The preliminary data shows that the patients report high levels of fatigue, and moderate memory and attention difficulties in their everyday life. The neuropsychological data showed variance between the patients, with indications of mild impairments in attention, verbal and visual memory. All subjects were partly or fully unemployed. They reported difficulties with activity performance in their everyday life, where results from the COPM suggest that fatigue and attention difficulties had the greatest impact. 
Conclusions: Patients with Cushing’s syndrome in remission experience high level of fatigue in their everyday life, that is considered to have an impact on their attention capacity and activities in daily life and work. The study shows a variance between the patients, especially in their verbal and visual memory, indicating that some might have an underlying memory deficit.  With regard to rehabilitation needs, these cases do not show significant cognitive impairment at a level that would suggest the need for structured cognitive rehabilitation for all patients with Cushing’s syndrome in remission. A neuropsychological examination, guidance in compensatory strategies and psychoeducation might suffice. More patients will be included in the project before final conclusions are made

COGNITIVE IMPAIRMENTS IN PATIENTS WITH CUSHING’S SYNDROME IN REMISSION – CASE REPORTS