Cognitive deficits in primary hyperparathyroidism – what we know and what we do not know: A narrative review

Chandran, Manju; Yeh, Lydia Tan Li; Jong, Mechteld C. de; Bilezikian, John P.; Parameswaran, Rajeev

doi:10.1007/s11154-022-09750-9

Cited by 10 publications

(9 citation statements)

References 77 publications

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“…The modi cation of PTH secretion by serum calcium is changed in patients with PHPT. In accordance with previous studies 13,17 , we found no link between calcium levels and neurocognitive function. By self-report neurocognitive symptoms (presenting di cult concentration and memory problems), Daniel…”

Section: Discussionsupporting

confidence: 93%

“…[40][41][42] According to a current systematic review, cognitive impairment in PHPT is more likely to be associated with elevated PTH levels rather than hypercalcemia. 13 However, the mechanism for inducing the impairment of cognition remains to be studied. The details of these relationships between cognitive impairment and serum biomarkers, such as PTH and serum calcium, merit further investigation.…”

Section: Discussionmentioning

confidence: 99%

“…An increasing number of PHPT patients present primarily with neuropsychological symptoms, such as cognitive de cits, anxiety, and poor concentration, rather than skeletal and renal complications like osteoporosis and nephrolithiasis resulting from long-term hypercalcemia, highlighting the value of assessing neuropsychological manifestations. 12,13 Moreover, recent studies has demonstrated that patients with non-central nervous system tumors frequently suffer cognitive impairment even prior to undergoing treatments associated with toxicity, including chemotherapy, immunotherapies and radiation. 14,15 However, due to the rarity of the disease, only a few studies have evaluated cognitive impairment in PHPT by examining a limited number of cognitive domains.…”

Section: Introductionmentioning

confidence: 99%

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Machine Learning-Based Prediction Models for Parathyroid Carcinoma Using Pre- Surgery Cognitive Function and Clinical Features

Wang

Wei

Zhao

et al. 2023

Preprint

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Background Patients with parathyroid carcinoma (PC) are often diagnosed postoperatively, due to incomplete resection during the initial surgery, resulting in poor outcomes. The aim of our study was to investigate the pre-surgery indicators of PC and try to develop a predictive model for PC utilizing machine learning. Methods Evaluation of pre-surgery neuropsychological function and confirmation of pathology were carried out in 133 patients with primary hyperparathyroidism (PHPT) in Beijing Chaoyang Hospital from December 2019 to January 2023. Patients were randomly divided into a training cohort (n = 93) and a validating cohort (n = 40). Analysis of the clinical dataset, two machine learning including the extreme gradient boosting (XGBoost) and the least absolute shrinkage and selection operator (LASSO) regression were utilized to develop the prediction model for PC. Logistic regression analysis was also conducted for comparison. Results Significant differences in elevated parathyroid hormone and decreased serum phosphorus in PC compared to (BP). The lower score of MMSE and MOCA was observed in PC and a cutoff of MMSE < 24 was the optimal threshold to stratify PC from BP (area under the curve AUC 0.699 vs 0.625). The predicted probability of PC by machine learning was similar to the observed probability in the test set, whereas the logistic model tended to overpredict the possibility of PC. The XGBoost model attained a higher AUC than the logistic algorithms and LASSO models. (0.835 vs 0.683 vs 0.607) Conclusions Preoperative cognitive function may be a probable predictor for PC. The cognitive function-based prediction model based on the XGBoost algorithm outperformed LASSO and logistic regression, providing valuable preoperative assistance to surgeons in clinical decision-making for patients suspected PC.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Machine Learning-Based Prediction Models for Parathyroid Carcinoma Using Pre- Surgery Cognitive Function and Clinical Features

Wang

Wei

Zhao

et al. 2023

Preprint

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“…Several studies ( 32 , 36 , 38 , 53 , 54 ) examined dysfunction in specific cerebral zones using functional resonance magnetic imaging, alteration in vertebral vascular flow using transcranial doppler ( 36 ) or single photon emission computed tomography ( 55 ), or perioperative changes in cortical excitability with transcranial magnetic stimulation ( 56 ) in patients with PHPT. However, these studies have not yet reach a systematic and homogeneous conclusion ( 16 ).…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, since the incidence of PHPT peaks during the sixth decade, it is often hard to isolate its effect on neurocognitive function, as some changes may be attributed to aging or comorbidities ( 15 ). Finally, the mechanisms leading to impaired neurocognitive functions are still unclear, and may be related to either hypercalcemia, decreased 25 hydroxy vitamin D (25OHD) or elevated PTH levels; all may impact brain activity ( 16 ).…”

Section: Introductionmentioning

confidence: 99%

Successful parathyroidectomy improves cognition in patients with primary hyperparathyroidism: A prospective study in a tertiary medical center and comprehensive review of the literature

et al. 2022

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ContextThe recent American and European guidelines on management of patients with primary hyperparathyroidism (PHPT) did not endorse neurocognitive evaluation as part of standard work-up and did not consider it as a surgery criterion.The neurocognitive deleterious effects of hyperparathyroidism and impact of parathyroidectomy on PHPT patients is yet to be elucidated.ObjectiveTo evaluate specific neurocognitive functions in PHPT patients prior to parathyroidectomy and describe the changes during follow-up with serial evaluations.DesignA prospective case-control study including parathyroidectomy candidates evaluated at a tertiary teaching university hospital. Thorough neurocognitive evaluation was conducted before and 1- & 6-months following parathyroidectomy: Rey Auditory Verbal Learning Test (RAVLT), Rey-Osterrieth Complex Figure Test (ROCF), Trail Making Test A, Trail Making Test B, Addenbrooke’s Cognitive Examination-III (ACE), Frontal Assessment Battery (FAB), Beck Depression Inventory (BDI).Results18 consecutive patients underwent successful parathyroidectomy. Various neurocognitive functions improved significantly after successful parathyroidectomy: long term auditory memory (RAVLT, p=0.008), short- and long-term visual memory (ROCF, p=0.006 and p=0.002 respectively), visual attention and complex concentration skills (trail making A, p<0.001) and executive abilities (trail making B, p=0.005). No change was identified in frontal-lobe abilities. Depression symptoms were absent or minimal prior to surgery and no significant change was observed after surgery.ConclusionsPHPT is associated with significant various neurocognitive dysfunctions when mindfully evaluated before surgery. Successful parathyroidectomy results in several neurocognitive aspect improvements. The data suggest that neurocognitive deterioration may be considered an added parathyroidectomy criterion when surgical decision is not straightforward.

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PTH levels, sleep quality, and cognitive function in primary hyperparathyroidism

Wang,

Xin,

Zhao

et al. 2023

Endocrine

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BackgroundCognitive function in patients with primary hyperparathyroidism (PHPT) may be affected and be identi ed to have been linked to the level of parathyroid hormone (PTH). Previous studies have suggested that patients with PHPT present poor sleep quality, which might interact with cognitive decline. The purpose of this study was to determine whether sleep quality mediates the association between PTH level and cognitive function and investigate whether surgery improves sleep quality and cognition in PHPT patients. MethodsBetween June 2019 and August 2022, we recruited 146 patients diagnosed with PHPT (n = 146). We collected clinical data from medical records and evaluated sleep quality and cognition preoperatively and 2 months postoperatively by using the Pittsburgh Sleep Quality Index and Min-Mental State Examination. We examined the mediation effects of sleep disturbance and latency on correlations between PTH level and cognitive impairment by using the Bootstrap method. ResultsThe sleep quality and cognitive function were correlated with PTH level before surgery. Sleep latency or sleep disturbance exhibited a partial mediating effect on the association between PTH level and MMSE scores in PHPT patients. (p < 0.05) In PHPT patients, there was a signi cant decline in PTH levels and an improvement in cognitive function post-surgery compared to pre-surgery, but no signi cant differences in sleep quality. ConclusionSleep disturbance and sleep latency may mediate the association between PTH level and cognitive impairment in PHPT before surgery.The surgery could reduce PTH levels and improve cognition, but might not improve sleep quality in PHPT patients.

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Cognitive deficits in primary hyperparathyroidism – what we know and what we do not know: A narrative review

Cited by 10 publications

References 77 publications

Machine Learning-Based Prediction Models for Parathyroid Carcinoma Using Pre- Surgery Cognitive Function and Clinical Features

Machine Learning-Based Prediction Models for Parathyroid Carcinoma Using Pre- Surgery Cognitive Function and Clinical Features

Successful parathyroidectomy improves cognition in patients with primary hyperparathyroidism: A prospective study in a tertiary medical center and comprehensive review of the literature

PTH levels, sleep quality, and cognitive function in primary hyperparathyroidism

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