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Secondary outcomes included cognitive functioning (six tests) and emotional symptoms (four questions).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Both systemic and inhaled glucocorticoid use were associated with reduced white matter integrity (lower fractional anisotropy (FA) and higher mean diffusivity (MD)) compared with controls, with larger effect sizes in systemic users (FA: adjusted mean difference (AMD)=\u22123.7e-3, 95% CI=\u22126.4e-3 to 1.0e-3; MD: AMD=7.2e-6, 95% CI=3.2e-6 to 1.1e-5) than inhaled users (FA: AMD=\u22122.3e-3, 95% CI=\u22124.0e-3 to \u22125.7e-4; MD: AMD=2.7e-6, 95% CI=1.7e-7 to 5.2e-6). Systemic use was also associated with larger caudate GMV (AMD=178.7\u2009mm\n                      <jats:sup>3<\/jats:sup>\n                      , 95% CI=82.2\u2009to 275.0), while inhaled users had smaller amygdala GMV (AMD=\u221223.9\u2009mm\n                      <jats:sup>3<\/jats:sup>\n                      , 95% CI=\u221241.5\u2009to \u22126.2) than controls. As for secondary outcomes, systemic users performed worse on the symbol digit substitution task (AMD=\u22120.17\u2009SD, 95% CI=\u22120.34\u2009to \u22120.01), and reported more depressive symptoms (OR=1.76, 95% CI=1.25 to 2.43), disinterest (OR=1.84, 95% CI=1.29 to 2.56), tenseness\/restlessness (OR=1.78, 95% CI=1.29 to 2.41), and tiredness\/lethargy (OR=1.90, 95% CI=1.45 to 2.50) compared with controls. Inhaled users only reported more tiredness\/lethargy (OR=1.35, 95% CI=1.14 to 1.60).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Both systemic and inhaled glucocorticoid use are associated with decreased white matter integrity and limited changes in GMV. This association may contribute to the neuropsychiatric side effects of glucocorticoid medication, especially with chronic use.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-062446","type":"journal-article","created":{"date-parts":[[2022,8,30]],"date-time":"2022-08-30T20:00:16Z","timestamp":1661889616000},"page":"e062446","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":41,"title":["Association between use of systemic and inhaled glucocorticoids and changes in brain volume and white matter microstructure: a cross-sectional study using data from the UK Biobank"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0001-4408","authenticated-orcid":false,"given":"Merel","family":"van der Meulen","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The 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