Cortisol and cognition in psychotic disorders: A systematic review and multi-level meta-analysis.

In 30 seconds

This systematic review and three-level meta-analysis examined associations between cortisol and cognition in people with psychotic disorders. Twelve studies involving 940 participants were reviewed; nine studies with 822 participants contributed to meta-analyses of basal cortisol and cognitive domains. There was no general association between basal cortisol and cognition. Sampling time moderated the association with executive functioning, with higher afternoon/evening cortisol associated with poorer executive functioning (r = -0.27, 95% CI [-0.42, -0.12], p = .01). A morning-cortisol association with attention, working memory and processing speed appeared only in a sensitivity analysis excluding an influential study.

Key findings

• Afternoon/evening cortisol was negatively associated with executive functioning (r = -0.27, 95% CI [-0.42, -0.12], p = .01).
• Cortisol sampling time moderated the relationship between cortisol and executive functioning (F = 10.98, p = .004).
• No other robust associations between basal cortisol and the assessed cognitive domains were observed.
• A negative association between morning cortisol and attention, working memory and processing speed emerged after excluding an influential study.

Why it matters

The findings caution against treating basal cortisol as a general marker of cognitive impairment in psychotic disorders. They suggest that any relationship may depend on both the cognitive domain assessed and the time cortisol is sampled. This distinction is relevant when interpreting studies of HPA-axis function and cognition, while the limited and inconsistent associations leave the clinical significance uncertain.

What to keep in mind

Only nine studies contributed to the meta-analyses, and the morning-cortisol finding depended on excluding an influential study. The authors call for more precise assessment of cortisol dynamics.