Comprehensive Summary
This study by Xiong et al. evaluated the cortisol awakening response (CAR) that occurs 30-45 minutes after awakening, which depicts brain readiness rather than a byproduct of stress. Psycho-NeuroEndocrine-Developmental (PNED) Preparedness model integrated findings from neuroimaging and behavioral studies to demonstrate the role of CAR in the optimization of cognitive/emotional functioning. CAR uses mineralocorticoid and glucorticoid receptors (MR/GR) signaling, mobilizing energy resources and modulating neuronal excitability across networks, such as the hippocampus and amygdala. Evidence showed that individuals with a more robust CAR exhibited greater neural efficiency, as seen by the reduced prefrontal and hippocampal activation and more adaptive functional connectivity. In contrast, blunted CAR led to the over-recruitment of the limbic structures and impaired emotional discrimination, showing a reduced cognitive-affective efficiency. Early environmental adversity and socioeconomic disadvantage were associated with a reduced CAR and atypical amygdala-prefrontal coupling in children, indicating that gene-environment interactions shape the neuroendocrine architecture of CAR. The PNED model shows CAR as a circadian-behavioral tool to anticipate daily demands by coordinating neurobiological preparedness over endocrine aspects.
Outcomes and Implications
CAR demonstrated promising biomarkers of stress integrity and neural readiness related to depression, anxiety, PTSD, and cognitive dysfunction. Interventions designed to normalize/enhance CAR, such as sleep-wake schedules can help to improve cognitive control. Wearable biosensors for cortisol monitoring could enable approaches to optimize brain health outcomes.