Title: Neuropsychological Features in Primary Hyperparathyroidism ...

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immunochemiluminometric assay (Scantibodies Laboratories, Inc.). Vitamin D metabolites were measured by radioimmunoassay (DiaSorin, Inc). Cognitive and Psychological Testing Testing, conducted by 3 individuals using identical procedures, lasted approximately 1.5 hours. Test administrators were not blinded to disease state or time of testing. Psychological tests refer to those measuring depression (BDI) and anxiety (STAI) while the remainder of the tests measured cognitive function. 1. Estimated Intellectual Quotient (IQ): The NAART provides an estimate of intellectual ability. Estimated full-scale IQ (FSIQ) scores are obtained: Estimated FSIQ=127.8 – (.78)(NAART errors) (31, 32). The mean normal value (±SD) is 100±15 (33). 2. Depression: The BDI (2 nd ed.) is a 21-item depression severity scale for adults. Higher scores indicate more symptoms: 0-13 indicates no or minimal depression, 14-19 mild depression, 20-28 moderate depression, 29-63 severe depression (34). 3. Anxiety: The STAI-Y (35) measures anxiety and consists of two 20-item scales, measuring trait anxiety (anxiety proneness), and state anxiety (a current emotional condition). Mean raw values (± SD) for working adults, ages 50-69, are 32.2±8.7 for state anxiety and 31.8±7.8 for trait anxiety. 4. Memory for Contextually Related Material: LM requires examinees to repeat two brief, orally-presented stories immediately and after a 30-min delay. Results indicate idea units recalled in the two stories (36). Immediate recall mean values (±SD) for individuals age 50-59 and 60-69 are 23.6±6.1 and 20.5±6.4 respectively. Delayed recall mean values (±SD) for individuals age 50-59 and 60-69 are 20.1±6.5 and 17.3±6.7 respectively (37). 5. Word List Memory: The SRT (38, 39) assesses recall and learning for a word list. Results indicate words correctly recalled over six trials (maximum=72) and after a 30-min delay (maximum=12). 6. Visual Memory: The RVDLT requires subjects to recall and draw visually-presented geometric designs. Results are scored as number of correctly reproduced designs during three learning trials (40). 6
7. Non-verbal Abstraction: This was assessed with the BCT, Victoria Revision (41), an 81-item version of the Halstead Category Test (HCT) (42), requiring examinees to infer the governing principle for sets of visual stimuli. Errors are summed and full HCT performance is predicted: 4.335 + [1.839 x (Victoria Revision errors)] (43), then converted to a T-score adjusting for age, education and gender (42). T-scores are interpreted as follows: ≥55 above average, 45-54 average, 40-44 below average, 35-39 mildly impaired, 30- 34 mildly to moderately impaired, 25-29 moderately impaired, 20-24 moderately to severely impaired, and ≤19 severely impaired. 8. Visual Concentration/Attention: The RTD examines sustained visual concentration and attention. Examinees find a target among similar items. Results indicate time to completion and errors. The mean normal value (±SD) for the symbol version of the test and errors are 35.7±8.4 and 3.8±2.8 respectively. The DSy (33) measures response speed and visual attention. Examinees fill in the blank squares with a nonsense symbol corresponding to a digit. Results are scored as symbols transcribed in 90 seconds. Raw scores are converted to scaled scores, which adjusts for age differences. The mean scaled score (±SD) is 10±3 (33). 9. Auditory Attention and Mental Manipulation: The DSpan tests immediate span of auditory attention and mental manipulation (mean scaled score (±SD) is 10±3) (33). Statistics Differences between PHPT and control test performance at baseline and after 6-months were evaluated for each outcome with linear mixed models for repeated measures with fixed effects for group, time and their interaction, random effect of subjects and an unstructured covariance structure. Model estimated means + SEM adjusted for covariates are reported. The method of simultaneous confidence limits was used to assess between-groups differences at baseline or 6-months when the effects of group or the group-by-time interaction attained statistical significance, and again for within-groups differences between times when the fixed effects of time or group-by-time interaction achieved statistical significance. Test scores were adjusted for age, education and sex as suggested by the test manual when methods of adjustment were available. Since not all tests had methods of correction, all scores were additionally adjusted statistically for age, education and estimated IQ. Scores were not adjusted for years since menopause due to 7
Page 1 and 2: J Clin Endocrin Metab. First publis
Page 3 and 4: Introduction Classical PHPT was a s
Page 5: malignancy other than non-melanoma
Page 9 and 10: PHPT, mean performance levels on th
Page 11 and 12: RCT results have been inconsistent
Page 13 and 14: address the issue of differing resp
Page 15 and 16: 14. Prager G, Kalaschek A, Kaczirek
Page 17 and 18: Figure legends Figure 1. A) Depress
Page 19 and 20: Table 2. Cognitive Testing Adjusted
Page 21 and 22: Figure 2 A. Wechsler Logical Memory
Page 23: Figure 4 Booklet Category Test T-sc

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