Dementia Improvement after Primary Hyperparathyroidism Surgery

Abstract

This is the case of a 76-year-old man admitted to hospital in a delirium state, previously diagnosed with a major depressive disorder at an age of 50 years, treated for years for chronic tension headache. The computed tomography of the head resulted negative. Inpatient laboratory tests revealed a mild hypercalcemia. Due to the progression of the disease (delirium state, dementia, tension headache, and depression), he was again admitted to hospital. The patient showed dysarthria, postural tremors, mirror movements and palmar hyperhidrosis, mild ataxia when walking, and rigidity. Sleep disturbances were also observed. He underwent several clinical diagnostic tests, which resulted negative. After more than 2 years, the ultrasound of the neck identified enlarged parathyroid glands. The patient was surgically treated, and three parathyroid glands were removed. Parathyroidectomy and lithium treatment resulted in improvement of cognitive functions. In elderly patients, concomitant presence of cognitive dysfunction may mask the underlying primary hyperparathyroidism.

Primary Hyperparathyroidism in Older Adults: A Narrative Review of the Most Recent Literature on Epidemiology, Diagnosis and Management

“…Interestingly, short-term normalization of hypercalcemia via calcimimetic treatment and subsequent improvement in depression and anxiety symptoms (according to the Hospital Anxiety and Depression Scale) are good predictors of long-term outcomes after 6 months of parathyroidectomy, especially at the level of the cognitive response (according to the Montreal Cognitive Assessment) and therefore aid in an appropriate patient selection for surgery [46]. It is worth noting that improvement in neurological and psychiatric symptoms following parathyroidectomy was also supported by some case reports [28,[30][31][32]. Despite the evidence-based positive outcomes, parathyroidectomy is still underused for symptomatic PHPT in older adults [47].…”

“…A total of 29 articles met the inclusion criteria (Table 1). The studies break down as follows: 5 studies emphasized the epidemiology [7,[23][24][25][26], 8 studies were available with regard to the clinical manifestations [25,[27][28][29][30][31][32][33], 25 studies addressed the treatments [7,15,[23][24][25][27][28][29][30][31][32][34][35][36][37][38][39][40][41][42][43][44][45][46][47], and 7 considered the post-operative complications [7,25,26,37,44,48,49]. The Joanna Briggs Institute (JBI) critical appraisal tool was used to assess the methodological quality of the included studies and the data are presented in Appendix A (Tables A1-A4).…”

“…Patients can also exhibit cognitive, affective, and behavioral manifestations as well as movement disorders [25,[28][29][30][31][32] with even mild hypercalcemia [33]. Neuropsychiatric symptoms include memory loss, disorders of consciousness, sleep disturbance, fatigue, anxiety, and depression, as well as manic, psychotic, and obsessive-compulsive symptoms, among others.…”