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Acute Cognitive and Behavioral Effects of Systemic Corticosteroids in Children Treated for Inflammatory Bowel Disease

Published online by Cambridge University Press:  19 November 2012

Christine Mrakotsky ,
Peter W. Forbes ,
Jane Holmes Bernstein ,
Richard J. Grand ,
Athos Bousvaros ,
Eva Szigethy  and
Deborah P. Waber
Christine Mrakotsky*
Affiliation:
Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
Peter W. Forbes
Affiliation:
Clinical Research Program, Boston Children's Hospital, Boston, Massachusetts
Jane Holmes Bernstein
Affiliation:
Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
Richard J. Grand
Affiliation:
Division of Gastroenterology and Nutrition, Boston Children's Hospital, Boston, Massachusetts Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
Athos Bousvaros
Affiliation:
Division of Gastroenterology and Nutrition, Boston Children's Hospital, Boston, Massachusetts Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
Eva Szigethy
Affiliation:
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Deborah P. Waber
Affiliation:
Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
*
Correspondence and reprint requests to: Christine Mrakotsky, Department of Psychiatry, Boston Children's Hospital, 300 Longwood Avenue, Boston, Massachusetts 02115. E-mail: christine.mrakotsky@childrens.harvard.edu.
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Abstract

Systemic corticosteroids are a mainstay of treatment for many pediatric medical conditions. Although their impact on the central nervous system has been well-studied in animal models and adults, less is known about such effects in pediatric populations. The current study investigated acute effects of corticosteroids on memory, executive functions, emotion, and behavior in children and adolescents with inflammatory bowel disease (IBD). Patients 8–17 years with IBD (Crohn's disease, CD; ulcerative colitis, UC) on high-dose prednisone (n = 33) and IBD patients in remission off steroids (n = 33) completed standardized neuropsychological tests and behavior rating scales. In the IBD sample as a whole, few steroid effects were found for laboratory cognitive measures, but steroid-treated patients were rated as exhibiting more problems with emotional, and to a lesser extent with cognitive function in daily life. Steroid effects, assessed by laboratory measures and questionnaires, were more prevalent in CD than UC patients; UC patients on steroids sometimes performed better than controls. Sleep disruption also predicted some outcomes, diminishing somewhat the magnitude of the steroid effects. Corticosteroid therapy can have acute effects on cognition, emotion, and behavior in chronically ill children; the clinical and long-term significance of these effects require further investigation. (JINS, 2012, 19, 1–14)

Keywords

MemoryExecutive functionGlucocorticoidCorticosteroid therapyInflammatory bowel diseaseNeuropsychological assessment
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 19 , Issue 1 , January 2013 , pp. 96 - 109
Copyright
Copyright © The International Neuropsychological Society 2012

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