MRI data reveal that the use of steroid medications can result in structural changes of the brain.
Experts involved in compiling the new research suggest these findings were observed in patients using both systemic and/or inhaled glucocorticoid and could help explain the neuropsychiatric effects seen in many patients who are prescribed steroids long-term. Compared to a control group, patients with a history of steroid use displayed decreased white matter integrity in addition to changes in gray matter.
While prior studies have addressed both the anatomical and physiological side effects of steroid use, they were limited by small, disease-specific sample sizes. As such, the authors of this new study, published in BMJ Open, sought to expand upon previous research to understand whether steroid users, including those who use inhalers for respiratory conditions like asthma, are impacted on a more wide-ranging scale.
Their research consisted of analyzing thousands of MRI scans from the U.K. Biobank, including 222 exams on systemic steroid users, 557 of participants using inhaled steroids and 24,106 controls with no known history of use. Additionally, none of the participants were reported to have been diagnosed with neurological, psychiatric or hormonal disorders.
Compared to the non-users, those with a history of systemic and inhaled glucocorticoid use displayed reduced white matter integrity, though systemic users appeared to be more impacted. Systemic use was also linked with larger caudate GMV, while inhaled users had smaller amygdala GMV.
A secondary analysis compared the groups’ answers to questions relating to cognitive function and emotional symptoms. Again, the experts concluded that the systemic users appeared to be more affected than the inhaled glucocorticoid group and the controls. They reported more depressive symptoms, disinterest, tenseness/restlessness and tiredness/lethargy, while the inhaled glucocorticoid cohort reported tiredness and lethargy only.
The experts acknowledged several limitations in their study design, including limited assessments of mood and missing data regarding the type of systemic steroid use—tablets or infusions, etc—that could have impacted the data.
However, the researchers maintained that their findings hold relevance given the widespread use of prescribed steroids.
“While it remains unclear whether the observed effect sizes have clinical consequences for the population of glucocorticoid users as a whole, these findings are remarkable given the common neuropsychiatric side effects of synthetic glucocorticoids,” corresponding author Dr. Merel van der Meulen, of the Department of Medicine, Division of Endocrinology at Leiden University Medical Center in The Netherlands, and co-authors wrote. ““This study shows that both systemic and inhaled glucocorticoids are associated with an apparently widespread reduction in white matter integrity, which may in part underlie the neuropsychiatric side effects observed in patients using glucocorticoids.”
The detailed research can be viewed here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She joined Innovate Healthcare in 2021 and has since put her unique expertise to use in her editorial role with Health Imaging.