Abstract
Cortisol and psychosocial stress are known to affect learning and memory. Individuals with chronic adrenal insufficiency (CAI), who must substitute basal cortisol levels pharmacologically and do not exhibit a cortisol response to stress, provide a unique opportunity to explore the relationship between stress, cortisol, and memory performance. Twenty-eight patients with CAI learned one wordlist prior to exposure to the Trier Social Stress Test (TSST) and one wordlist following TSST exposure. Delayed recall of wordlist 1 occurred immediately after the TSST and delayed recall of wordlist 2 occurred 100 minutes post-TSST. Thirteen patients received an injection of hydrocortisone (HC) after the TSST to mimic a stress response and the other 15 received an injection of saline (NaCl). Among CAI patients treated with NaCl, exposure to the TSST did not impact learning (ps > .46). When recall occurred post-TSST and after the injections, the NaCl and HC treatment groups did not differ in delayed recall performance of the wordlist 1 (ps > .30). Patients treated with HC recalled fewer words from wordlist 2, which was learned following stress exposure and injection administration, than those treated with NaCl at both immediate and delayed recall (F = 4.60, p = .042). Both groups recalled more negative than neutral words. These findings may indicate that psychosocial stress and cortisol impact memory differently among patients with CAI as compared to healthy individuals. This also suggests that acute administration of HC is detrimental to memory in CAI patients. Future work should explore the potentially negative effect of cortisol replacement therapy on cognitive function.