Allostatic load and cognitive outcome after 12 weeks of alprazolam treatment in patients with anxiety disorders.

SORIA CA, REMEDI C, D' ALESSIO L, ROLDÁN EJA.

París

Congreso; European Congress of Neuropsychopharmacology; 2017

ECNP

Purpose To provide a promising assessment of the cumulative influence of stress on health, Seeman and Crimmins developed Allostatic Load (AL) index [1][2]. AL index proposes indicators for the functioning of main potentially stress-affected systems, and is considered a marker of cumulative biological risk [1][2]. Anxiety disorders are frequently associated with chronic stress and high AL, with clinical and cognitive consequences [3]. Chronic stress has been demonstrated to induce functionally-relevant effects on hippocampus and prefrontal cortex neuroplasticity, traduced on impairments in cognition [4]. Additionally, benzodiazepines are effective in reducing anxiety scores but may have controversial effects on cognition [5]. The aim of this study was to determine the AL impact on cognitive performance in patients with anxiety disorders and to estimate the influence of alprazolam (a positive allosteric modulator of GABA A receptor) on clinical and cognitive variables after 12 week of treatment, in an observational clinical trial.Methods: Patients with GAD (general anxiety disorders, DSM IV), >6 in Hamilton scale (HAM-A), AL (≥3 Crimmins and Seeman AL modified criteria), neuroticism > 18 (NEO-FFI), and normal Mini-Mental Examination, were included. All patients completed psychiatric, AL index and cognitive assessment before (- 1 week) and after (12 week) of treatment with alprazolam (0.25-1mg/t.i.d). Cognitive assessment included Five Point Test (FPT), Verbal Fluency Test (VFT), Continuous Performance Test (CPT) and Digit Spam Test (DST). AL parameters were: systolic and diastolic blood pressure, body mass index and waist-hip ratio (indexes of adipose tissue deposition), serum lipid profile and total cholesterol/HDL ratio, salivary cortisol, salivary methoxyhydroxyphenylglycol (MHPG) (noradrenaline metabolite) and serum noradrenaline (indexes of HPA hyperactivity), serum dehydroepiandrosterone sulphate (DHEA-S) (a functional HPA axis antagonist), inflammatory parameters (serum fibrinogen, C reactive protein and low albumin), and serum creatinine levels and glycosylated hemoglobin (as markers of organ-system dysfunction). Student´s t-test (related variables), and Pearson?s correlations were determined. Results: Forty-four patients, 18 males (44.3± 13.2 years) and 26 females (50.3± 11.7 years), completed 12 weeks of treatment and were included in this study. Clinical variables including anxiety scores and neuroticism were significantly reduced at 12 week (p