Title: Neuropsychological Features in Primary Hyperparathyroidism ...

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,
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