Aaron Wilson

It is health that is real wealth and not pieces of gold and silver. – Mahatma Gandhi

Diseases · 30.03.2023.

Unveiling the Effects of Oral and Inhaled Steroids on Brain Structure

Corticosteroids, commonly prescribed to treat a wide range of inflammatory diseases, have long been known for their potential side effects. However, new research has brought to light concerns regarding the impact of these medications on brain health.

In this article, we delve into the latest findings and explore the implications for both patients and healthcare providers.

The Study: Investigating the Relationship between Corticosteroids and Brain Structure

A recent study published in the Journal of Clinical Endocrinology & Metabolism set out to investigate the relationship between oral and inhaled corticosteroids and changes in brain structure. The research involved analyzing MRI scans of over 7,000 participants, allowing the researchers to examine the possible link between long-term corticosteroid use and changes in the brain.

The Participants

The study population consisted of 7,045 individuals, with an average age of 62 years. Among these participants, 1,141 reported using corticosteroids in the past, while 5,904 had no history of corticosteroid use. The corticosteroid users were further divided into two groups: those who took oral corticosteroids and those who used inhaled corticosteroids.

The Methods

To determine the relationship between corticosteroid use and brain structure, the researchers utilized advanced MRI techniques to assess brain volumes and white matter integrity. These factors were then compared between the corticosteroid users and non-users.

Additionally, the researchers examined the effects of corticosteroid use on cognitive performance. Participants underwent a series of neuropsychological tests to assess their memory, attention, and executive functioning.

The Findings: Corticosteroids and Brain Changes

The results of the study revealed several noteworthy findings:

Brain Volume Reduction

Participants who reported long-term use of oral corticosteroids had significantly lower brain volumes compared to those who had never used corticosteroids. More specifically, these individuals displayed reductions in gray matter and hippocampal volume, areas of the brain responsible for memory and cognitive function.

Interestingly, the researchers did not find a significant difference in brain volume between inhaled corticosteroid users and non-users.

White Matter Integrity

In addition to the changes in brain volume, the study also found that long-term oral corticosteroid users had reduced white matter integrity. This was evidenced by a higher incidence of white matter lesions, which have been linked to an increased risk of cognitive decline and stroke.

Similar to the findings on brain volume, inhaled corticosteroid users did not show significant differences in white matter integrity compared to non-users.

Cognitive Performance

When it came to cognitive performance, the researchers found that long-term oral corticosteroid users performed worse on tests of memory, attention, and executive functioning compared to non-users. However, there were no significant differences in cognitive performance between inhaled corticosteroid users and non-users.

Interpreting the Results: What Do These Findings Mean?

The results of this study suggest that long-term use of oral corticosteroids may have a negative impact on brain structure, including reductions in gray matter and hippocampal volume, as well as decreased white matter integrity. These changes are concerning because they have been linked to cognitive decline and an increased risk of stroke.

In contrast, the findings indicate that inhaled corticosteroids may have a more benign effect on brain health. The researchers did not find significant differences in brain volume, white matter integrity, or cognitive performance between inhaled corticosteroid users and non-users.

It is essential to note that this study was observational in nature, meaning that it cannot definitively establish causality between corticosteroid use and the observed brain changes. However, the findings do raise important questions about the potential long-term effects of corticosteroids on brain health and cognitive function.

Implications for Patients and Healthcare Providers

The findings of this study have several implications for both patients and healthcare providers:

Informed Decision Making

Patients and healthcare providers should be aware of the potential risks associated with long-term oral corticosteroid use. This information can help guide treatment decisions, with a focus on balancing the benefits of corticosteroid therapy against the potential risks to brain health.

Alternative Treatments

For patients who require long-term treatment with corticosteroids, healthcare providers may consider exploring alternative treatment options. This could include transitioning to inhaled corticosteroids, which appear to have a more benign impact on brain structure, or investigating non-steroidal anti-inflammatory drugs (NSAIDs) and other medications with fewer potential side effects.

Monitoring and Cognitive Assessment

Given the potential impact of oral corticosteroids on brain health, healthcare providers should closely monitor patients who require long-term corticosteroid therapy. This may include regular MRI scans to assess brain structure and neuropsychological testing to evaluate cognitive function.

Future Research Directions

While this study provides valuable insights into the relationship between corticosteroid use and brain structure, further research is needed to confirm these findings and explore the underlying mechanisms. Future studies should focus on:

  • Investigating the biological pathways through which corticosteroids may affect brain structure
  • Examining whether the observed brain changes are reversible upon discontinuation of corticosteroid therapy
  • Exploring potential interventions to mitigate the negative effects of corticosteroids on brain health


The results of this study highlight the potential long-term impact of oral corticosteroids on brain structure and cognitive function. While inhaled corticosteroids appear to have a more benign effect, the findings underscore the importance of carefully considering the risks and benefits of corticosteroid therapy. As our understanding of the relationship between corticosteroids and brain health continues to evolve, patients and healthcare providers must work together to make informed treatment decisions and ensure the best possible outcomes for those suffering from inflammatory diseases.