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Antiglucocorticoid therapy for older adults with anxiety and co-occurring cognitive dysfunction: results from a pilot study with mifepristone.
- Source :
-
International journal of geriatric psychiatry [Int J Geriatr Psychiatry] 2014 Sep; Vol. 29 (9), pp. 962-9. Date of Electronic Publication: 2014 Mar 14. - Publication Year :
- 2014
-
Abstract
- Objectives: In older adults with anxiety disorders, chronically elevated cortisol may contribute to cognitive impairment and elevated anxiety. We conducted a pilot study with mifepristone, a glucocorticoid receptor antagonist, as a potential treatment for late-life anxiety disorders and co-occurring cognitive dysfunction.<br />Methods: Fifteen individuals 60 years and older with an anxiety disorder plus cognitive dysfunction participated in the 12-week study. In the first week, participants were randomly assigned to mifepristone 300 mg daily or placebo. In the subsequent 3 weeks, all participants received mifepristone 300 mg. Mifepristone was then discontinued, and the participants were reassessed 8 weeks later. We examined the following: (1) cognitive changes; (2) worry symptom severity; (3) safety and tolerability; and (4) salivary cortisol before, during, and after mifepristone exposure.<br />Results: Overall safety, tolerability, and high retention supported the feasibility of this research. Participants with higher baseline cortisol levels (peak cortisol >6.0 ng/ml, n = 5) showed improvements in memory, executive function, and worry severity after 3-4 weeks of mifepristone with persistent memory and worry improvements 8 weeks after mifepristone discontinuation. Individuals with low-to-normal baseline cortisol (n = 8) showed little to no improvement. As expected, cortisol levels rose during mifepristone exposure and returned to pretreatment levels 8 weeks after mifepristone discontinuation. In the first week of treatment, there were no differences between placebo-treated and mifepristone-treated participants.<br />Conclusion: The results of this pilot study warrant further testing of antiglucocorticoid agents in late-life anxiety disorders with co-occurring cognitive dysfunction. Mifepristone is hypothesized to have benefits in patients with evidence of glucocorticoid excess. Directions for further study are discussed.<br /> (Copyright © 2014 John Wiley & Sons, Ltd.)
- Subjects :
- Aged
Aged, 80 and over
Anxiety Disorders psychology
Biomarkers analysis
Cognition physiology
Executive Function physiology
Female
Humans
Hydrocortisone analysis
Male
Memory physiology
Pilot Projects
Receptors, Glucocorticoid antagonists & inhibitors
Saliva chemistry
Anxiety Disorders drug therapy
Hormone Antagonists therapeutic use
Mifepristone therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1099-1166
- Volume :
- 29
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- International journal of geriatric psychiatry
- Publication Type :
- Academic Journal
- Accession number :
- 24633761
- Full Text :
- https://doi.org/10.1002/gps.4085