Author ORCID Identifier

Date of Award


Degree Type

Closed Dissertation

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Erin B. Tone

Second Advisor

Vonetta Dotson

Third Advisor

Sierra Carter

Fourth Advisor

Suzanne Penna


Individuals with active Cushing’s Syndrome (CS) often experience psychiatric conditions, including depression (80-90%), anxiety (66%), and mania (30%). They also commonly exhibit impairments in memory, attention, and executive functioning. Furthermore, these symptoms and impairments often persist, despite long-term biochemical remission. No research to date, however, has used standardized, objective measures to investigate cognitive and psychiatric functioning in parallel among CS patients in remission. Comparison of cognitive and psychological functioning between CS patients in remission and patients with non-functioning adenomas (NFAs) would also help isolate outcomes that are directly associated with chronic hypercortisolemia. Finally, researchers have yet to clarify whether and how psychiatric symptoms relate to cognitive dysfunction in people with remitted CS.

The present study examined 1) the neuropsychological functioning of CS patients in remission (n = 20), relative to that of individuals with NFAs (n = 20), and 2) the potential mediating role of psychiatric dysfunction in the relationship between CS/NFA and cognitive functioning. We hypothesized that remitted CS patients would demonstrate worse neuropsychological outcomes than NFA patients and that the relationship between cortisol and cognitive functioning would be partially mediated by psychiatric functioning. Finally, we aimed to assess associations between various protective and risk factors (e.g., age at diagnosis, remission duration, radiation therapy) and neuropsychological outcomes in remitted CS patients.

Results showed no evidence of significant differences in neuropsychological outcomes between groups; however, modest proportions of both groups demonstrated mild impairments in attention, processing speed, executive functioning, and visual memory. Results of our mediation models were also not significant. Finally, length of remission was significantly and negatively associated with processing speed, such that more time in remission was associated with slower processing speed. Results indicate the need for longitudinally-followed NFA and CS patients, as well as treatments targeting cognitive and psychiatric dysfunction in both patient groups. The present study also highlights the accessibility and feasibility of using digital neuropsychology, particularly with low-base rate patient populations.


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