Systemic and Local Corticosteroid Use Is Associated with Reduced Executive Cognition, and Mood and Anxiety Disorders

Abstract

Background: Use of local corticosteroids, especially the inhaled types, has increasingly been associated with systemic uptake and consequent adverse effects. In this study, we assessed the associations between the use of different corticosteroid types with cognitive and neuropsychiatric adverse effects related to high glucocorticoid exposure.

Methods: In 83,592 adults (mean age 44 years, 59% women) of the general population (Lifelines Cohort Study), we analyzed the relationship between corticosteroid use with executive cognitive functioning (Ruff Figural Fluency Test), and presence of mood and anxiety disorders (Mini-International Neuropsychiatric Interview survey). We performed additional exploration for effects of physical quality of life (QoL; RAND-36), and inflammation (high-sensitive C-reactive protein [CRP]).

Results: Cognitive scores were lower among corticosteroid users, in particular of systemic and inhaled types, when compared to nonusers. Users of inhaled types showed lower cognitive scores irrespective of physical QoL, psychiatric disorders, and high-sensitive CRP. Overall corticosteroid use was also associated with higher likelihood for mood and anxiety disorders. Users of inhaled corticosteroids were more likely to have mood disorders (OR 1.40 [95% CI 1.19-1.65], p < 0.001) and anxiety disorders (OR 1.19 [95% CI 1.06-1.33], p = 0.002). These findings were independent of physical QoL. A higher likelihood for mood disorders was also found for systemic users whereas nasal and dermal corticosteroid users were more likely to have anxiety disorders.

Conclusions: Commonly used local corticosteroids, in particular inhaled types, and systemic corticosteroids are associated with reduced executive cognitive functioning and a higher likelihood of mood and anxiety disorders in the general adult population.

Keywords: Anxiety disorders; Brain; Cognition; Corticosteroids; Glucocorticoids; Mood disorders.

Fig. 1

Distribution of corticosteroid use in the study sample. Superimposed pie chart illustrating for each corticosteroid type the total number of users and the proportion of single-type use. The former is presented as the size of each slice and is also written in text beside. The radial length marks the percentage of users within each type who were not using any other corticosteroid types. These groups of single-type users were used to assess the associations for the specific administration forms. Single-type use was most prevalent in dermal corticosteroid users (77.6%) while nasal corticosteroids were relatively most often combined with other types of corticosteroids.

Fig. 2

Executive cognitive functioning in corticosteroid users in comparison to nonusers. Adjusted mean differences (95% CI) in unique design score between the single-type corticosteroid users, and nonusers as reference (a). The same analyses stratified for subjects with either low or high physical component summary score as proxy for physical QoL (b), and for presence or absence of mood and/or anxiety disorders (c). Analyses are adjusted for age, sex, educational attainment, BMI, smoking, alcohol use, physical activity, cardiovascular diseases, and use of psychotropic drugs.