Title: Neuropsychological Features in Primary Hyperparathyroidism ...

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Abstract Context: Data regarding the presence, extent and reversibility of psychological and cognitive features of primary hyperparathyroidism (PHPT) are conflicting. Objective: This study evaluated psychological and cognitive function symptoms in PHPT. Design: This is a case-control study in which symptoms and their improvement 6 months after surgical cure of PHPT were assessed. Settings: University hospital metabolic bone disease unit and endocrine surgery practice. Participants: 39 postmenopausal women with PHPT and 89 postmenopausal controls without PHPT. Intervention: Parathyroidectomy Outcome Measures: Beck Depression Inventory (BDI); State-Trait Anxiety Inventory, Form Y (STAI-Y); North American Adult Reading Test (NAART); Wechsler Memory Scale Logical Memory Test, Russell revision (LM); Buschke Selective Reminding Test (SRT); Rey Visual Design Learning Test (RVDLT); Booklet Category Test, Victoria revision (BCT); Rosen Target Detection Test (RTD); Wechsler Adult Intelligence Scale-Revised Digit Symbol Subtest (DSy); Wechsler Adult Intelligence Scale Digit Span Subtest (DSpan). Results: At baseline, women with PHPT had significantly higher symptom scores for depression and anxiety than controls, and worse performance on tests of verbal memory (LM and SRT) and non-verbal abstraction (BCT). Depressive symptoms, non-verbal abstraction and some aspects of verbal memory (LM) improved after parathyroidectomy to the extent that scores in these domains were no longer different from controls. Baseline differences and postoperative improvement in cognitive measures were independent of anxiety and depressive symptoms, and were not linearly associated with serum levels of calcium or parathyroid hormone. Conclusions: Mild PHPT is associated with cognitive features affecting verbal memory and non-verbal abstraction that improve after parathyroidectomy. 2
Introduction Classical PHPT was a symptomatic disease with commonly recognized neurologic, cognitive and psychiatric manifestations (1, 2). Many patients with PHPT are now asymptomatic or report only non- specific symptoms, including weakness, easy fatigability, depression, intellectual weariness, loss of initiative, anxiety, irritability, and sleep disturbance (3). While these symptoms are concerning, they are difficult to quantify and there is debate about whether they are directly attributable to the underlying disease. At the Third International Workshop on Asymptomatic Primary Hyperparathyroidism (4), studies on the psychological and cognitive features of PHPT were reviewed and not considered to be an indication for parathyroidectomy (5). The workshop recognized inconsistencies in the abnormalities described, their association with the underlying disease, and the extent to which these features were reversible after parathyroidectomy. A number of studies have attempted to delineate the psychological and cognitive features of PHPT, and their resolution with surgical cure (6-24). Most have focused on psychological symptoms, such as depression, anxiety, or quality of life (QOL), rather than cognitive function such as logic, memory, abstraction, attention/concentration, and mental manipulation. Most have suggested that there are psychological features of the disease. A number of observational studies, some without control groups, report improved psychological symptoms or QOL with parathyroidectomy. Findings of the 3 randomized controlled trials (RCTs) of parathyroidectomy in mild PHPT were inconsistent; two found improved QOL after surgery (18, 25) while one did not (17). A smaller number of studies have examined cognitive function in PHPT (6, 9, 12, 14, 15, 26-28). Explanations for the conflicting results from these studies include: small sample sizes; investigation of only one or two aspects of cognition, making generalization difficult; lack of control groups or validated measures in some studies and failure to take into account demographic differences in others. Some studies monitored subjects shortly after parathyroidectomy, an experimental design which introduces biases due to non-specific benefits of surgery. Finally, no studies examining cognitive function have assessed the influence of 3
Page 1: J Clin Endocrin Metab. First publis
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Title: Neuropsychological Features in Primary Hyperparathyroidism ...

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