Title: Neuropsychological Features in Primary Hyperparathyroidism ...

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its co-linearity with age. Education level was coded as number of years of schooling completed. Cognitive measures were also evaluated with adjustment for levels of anxiety and depression to minimize the influence of affective factors on cognition. Linear associations between biochemical measures and cognitive and psychological test scores were assessed with Pearson correlation coefficients. For all analyses, a two-tailed p≤0.05 was considered to indicate statistical significance. Statistical analysis was performed using SAS, Version 9.1.3 (Cary, NC). Results Clinical and Biochemical Results Cases had biochemical evidence of PHPT (serum calcium: 10.6±0.1 mg/dl; PTH: 77±4 pg/ml; Table 1). At baseline, PHPT patients were slightly older (61.3±1.0 vs. 55.6±0.4 years; p
PHPT, mean performance levels on these tests were not in a range suggestive of clinical depression or anxiety. Depressive symptoms improved - the pattern of change in depressive symptoms over time differed between the groups (group by time interaction; p=0.024) such that there was no difference between the control and postoperative groups (PHPT 5.2±1.0 versus control 3.7±0.8, p=0.28) after parathyroidectomy. Trait anxiety but not state anxiety decreased after parathyroidectomy in the PHPT group compared to baseline. However, there were no differences in change over time between the groups for either trait or state anxiety (p=0.152 and p=0.184, respectively). Cognitive Function Memory: Those with PHPT had worse scores for both immediate and delayed recall of contextually related material (immediate: 17.2±0.9 versus 20.6±0.8, p=0.01; delayed: 12±0.9 versus 16.0±0.7, p=0.002; Figure 2). Both tests improved to levels that were no longer different from control subjects after parathyroidectomy (immediate: 20.0±0.8 versus 20.0±0.7, p=0.97; delayed: 14.5±0.9 versus 15.7±0.8, p=0.36), and the change over time differed between normal and PHPT subjects (p=0.003 immediate and p=0.009 delayed recall). Immediate, but not delayed, word list recall (SRT) was also worse at baseline in the PHPT group (immediate: 49.2±1.3 versus 53±1.1, p=0.04; delayed: 6.8±0.4 versus 7.9±0.4, p=0.064). Neither immediate nor delayed recall changed with surgery (Figure 3). No differences were found between PHPT and controls in visual memory (Table 3). Both groups improved to similar extents over time, consistent with a learning effect. Other cognitive functions: Non-verbal abstraction was worse in the PHPT group (39.9±1.9 versus 45.6±1.6, p=0.041, Figure 4). While scores in both PHPT and control subjects improved over time, those with PHPT improved to a greater extent, so that they were indistinguishable from normal subjects (49.5±2.3 versus 50.5±1.9, p=0.74; group by time interaction: p=0.036). Visual concentration and attention as measured by the RTD or Digit Symbol test was similar in the PHPT and control groups (Table 3). While target detection did not change over time, the PHPT group improved compared to baseline on one test of visual concentration and attention (Digit Symbol test), while the control group did not (between groups change over time, 9
Page 1 and 2: J Clin Endocrin Metab. First publis
Page 3 and 4: Introduction Classical PHPT was a s
Page 5 and 6: malignancy other than non-melanoma
Page 7: 7. Non-verbal Abstraction: This was
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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