Thyroid

Cognitive disorders and link with hypoparathyroidism

Hypo- and Hyperthyroidism

According to a study published in the Journal of the Endocrine Society.

Columbia University researchers analyzed the relationships between cognitive deficits and several variables in a small study group of 19 people with hypoparathyroidism. They used the National Institutes of Health toolkit® Adult Cognition Battery (NIHTB-CB), the National Institutes of Health Toolkit® Emotion Battery (NIHTB-EB) and the Short Form Health Survey (SF-36) to assess cognitive function, emotional function, and quality of life. Serum calcium, serum phosphate, parathyroid and thyroid-stimulating hormones were measured, as well as 25-hydroxyvitamin D, estimated glomerular filtration rate (eGFR), and 24-hour urinary calcium excretion.

About 13 of the 19 people in the study group (68%) had cognitive impairment based on NIHTB-CB global scores. Notable deficits occurred in processing speed, with more subtle impairments in episodic and working memory. Of the patients on medication, 3 were on therapies known to impair cognitive function, but none of them had reduced processing speed.


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Eight members of the study group reported decreased social satisfaction, 6 reported increased negative affect, and 4 reported decreased psychological well-being on the NIHTB-EB assessment. Compared to normative baseline data, patients in this study had lower SF-36 scores, particularly in areas related to vitality, social functioning, general perceptions of health, and role limitations due to physical health problems.

General perceptions of health in the SF-36 domain were positively correlated with adjusted NIHTB-CB scores measuring processing speed, attention, and executive function. The investigators observed no other correlation between the NIHTB-CB, NIHTB-EB and SF-36 scores.

Slower processing speed correlated with hypocalcemia (r = 0.53, P =.023), hyperphosphatemia (r =−.48, P = 0.042) and decreased 24-hour urinary calcium excretion (r = 0.58, P =.029); however, when comparing individuals with impaired (n = 6) and unimpaired (n = 13) processing speed, only hypocalcemia and hyperphosphatemia reached statistical significance (P =.009 and P =0.049, respectively) while the 24-hour calcium excretion did not (P =.36).

Study results were limited by small sample size, study homogeneity, inclusion of perimenopausal women, a group the researchers said were at risk for cognitive dysfunction, and patients taking medications known to affect cognition. The lack of a control group as well as standardized neuropsychological test batteries may also have affected the study results.

“Slowed processing speed may have adverse clinical effects,” the study authors concluded. Daily activities take longer to complete, reducing [quality of life] and potentially affecting safety,” the authors said. “Identifying a possible impairment could aid in the implementation of targeted cognitive interventions to reduce symptom burden in this rare but debilitating condition.”

Disclosure: One study author declared an affiliation with a pharmaceutical company. Please see the original citation for a full list of author disclosures.

Reference

Rubin MR, Tabacco G, Omeragic B, Majeed R, Hale C, Brickman AM. A pilot study of cognition in adults with hypoparathyroidism. J Endocr Soc. Published online January 30, 2022.doi:10.1210/jendso/bvac002