The association between hypoparathyroidism and cognitive impairment: a systematic review

Sardella, Alberto; Bellone, Federica; Morabito, Nunziata; Minisola, Salvatore; Basile, Giorgio; Corica, Francesco; Catalano, Antonino

doi:10.1007/s40618-020-01423-1

Cited by 12 publications

(9 citation statements)

References 47 publications

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“…In the present study, 8% of patients underwent the CT Scan of the Head/Brain at baseline evaluation, where basal ganglia calcification was revealed in more than in a half of cases. The risks of developing neuropsychiatric disorders are 2.01–2.45 times higher than in the general population ( 18 , 22 , 23 ). In our cohort, the common prevalence of neuropsychiatric disorders was 5.15%, although this is most likely due to the low referral to a psychiatrist.…”

Section: Discussionmentioning

confidence: 95%

The Russian Registry of Chronic Hypoparathyroidism

et al. 2022

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IntroductionChronic hypoparathyroidism is a relatively rare disease associated with multicomponent medical therapy and various complications. The analysis of large databases of patients with chronic hypoparathyroidism is a necessary tool to enhance quality of medical care, as well as to determine the optimal clinical and therapeutic approaches, and prognostic markers of the disease.The Aimof this study is to estimate the clinical and biochemical profile, long-term complications, medical therapy and disease control of the patients with chronic postsurgical and non-surgical hypoparathyroidism.Materials and Methodsthe cross-sectional, observational, continuous study was based on the Russian Registry of patients with hypoparathyroidism. 544 patients from 63 regions of the Russian Federation were included in this study.ResultsThe majority of cases had postsurgical etiology (88.4%). Postsurgical hypoparathyroidism prevailed in females (р<0.001). About a half of patients had blood calcium and phosphorus targets, 56 and 52% respectively. Nephrolithiasis was confirmed in 32.5%, nephrocalcinosis - in 12.3% of cases. The risk of nephrocalcinosis/nephrolithiasis increased by 1.85 times with disease duration more than 4.5 years. The cataract was found in 9.4%. The cut-off point for the development of cataracts was 9.5 years, with a 6.96-fold increased risk. The longer duration of hypoparathyroidism of any etiology was associated with more frequent cataract (p=0.0018).We found brain calcification in 4%, arrhythmias in 7.2% and neuropsychiatric symptoms in 5.15% of cases. Generally, the BMD in the studied group corresponded to age values, and there was no evidence for the phenomenon of high bone density. TBS was consistent with normal bone microarchitectonics. In our study, the majority of patients (83.5%) was treated with standard therapy of calcium and vitamin D supplements. 5 patients with severe disease course were treated with rhPTH (1–34).ConclusionsAnalysis of the presented database indicates insufficient diagnosis of the complications associated with chronic hypoparathyroidism. Overall, hypoparathyroidism is associated with higher risks of renal stone formation, decreased GFR, cataract especially in patients with longer duration of disease.

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Section: Discussionmentioning

confidence: 95%

The Russian Registry of Chronic Hypoparathyroidism

et al. 2022

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“…One limitation of that study was that it did not include postsurgical hypoparathyroid patients or adjust for demographic variables, including level of education. Nevertheless, that report and 16 case reports of cognitive impairment in hypoparathyroid patients were included in a recent systematic review [ 39 ], highlighting the need for clinical research in this area. Recently, disease-specific tools for hypoparathyroidism have been developed to assess symptoms of hypoparathyroidism from the patient perspective.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, disease-specific tools for hypoparathyroidism have been developed to assess symptoms of hypoparathyroidism from the patient perspective. An example is the Hypoparathyroidism Patient Experience Scale–Symptom, which assesses patient-reported physical and cognitive signs and symptoms, with cognitive symptoms including difficulty remembering, finding the right words, concentrating, understanding information, and thinking clearly [ 39 ]. This tool and others [ 40 , 41 ] will hopefully provide validated measures for assessing symptoms of hypoparathyroidism from the patient perspective.…”

Section: Discussionmentioning

confidence: 99%

A Pilot Study of Cognition Among Hypoparathyroid Adults

Rubin

Tabacco

Omeragic

et al. 2022

Journal of the Endocrine Society

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Purpose Hypoparathyroid patients describe cognitive deficits, yet data regarding objective assessment of cognitive function are limited. We assessed cognition in a pilot study of hypoparathyroid patients using the NIH Toolbox® Adult Cognitive Battery (NIHTB-CB). We also sought to determine whether cognition relates to emotion, quality of life (QoL) and hypoparathyroidism-related biochemistries. Methods Nineteen hypoparathyroid patients were studied. Objective cognition was assessed with NIHTB-CB. Impairment was defined as fully demographically adjusted T-score < 1.5 SD in at least 1 cognitive domain or < 1 SD in 2 or more domains. Results Of the 19 participants (17 women; median age 49; 18 postsurgical), impaired demographically adjusted NIHTB-CB cognition scores were observed in 13 subjects (68%). Cognition scores correlated with self-reported perception of general health. Processing speed was the most commonly impaired cognitive domain, with T-scores that were ≤ 2 SD in 6 subjects (32%). Processing speed correlated with serum calcium (r=0.53, p=0.023) and inversely with serum phosphate (r=-0.48, p=0.042) levels. Conclusions Impaired cognition using the NIHTB-CB was common in this small pilot cohort of hypoparathyroid patients. Slower processing speed was present and associated with lower serum calcium and higher serum phosphate levels. Larger controlled studies with additional neuropsychological testing are needed to investigate cognitive function in hypoparathyroidism.

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“…At the best of our knowledge, this is the first study evaluating, in a such rigorous methodological approach, some cognitive domains in the clinical model of chronic PS-HypoPT. In a very recent systematic review [ 24 ], mainly describing patients with idiopathic HypoPT, a relationship between HypoPT and cognitive impairment was demonstrated. The cross-sectional study by Aggarwal et al also showed a greater alteration of cognitive functioning in 62 patients with idiopathic HypoPT, younger than our patients (mean age 24.5 ± 4.1, females 43.5%) who were followed for 12.0 ± 8.7 years, and 70 controls.…”

Section: Discussionmentioning

confidence: 99%

“…They enable clinicians to gain insight into the structural and functional integrity of the brain, to assess the severity of cognitive dysfunction, and to help establish a diagnosis [ 23 ]. Unfortunately, very little data are available on HypoPT focusing on the specific cognitive impairment: a recent meta-analysis covered this aspect, but consistent data were available only for idiopathic HypoPT, while for PS-HypoPT only clinical cases were reported [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

Serum calcium levels are associated with cognitive function in hypoparathyroidism: a neuropsychological and biochemical study in an Italian cohort of patients with chronic post-surgical hypoparathyroidism

Saponaro

Alfì

Cetani

et al. 2022

J Endocrinol Invest

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Purpose Hypoparathyroidism (HypoPT) is a rare endocrine disease and conventional therapy is based on calcium and vitamin D analogues. Conventional therapy does not restore calcium homeostasis and patients complain with neuropsychological symptoms, which have been evaluated with nonspecific self-administered questionnaires. This study aims to evaluate cognitive functions of patients with chronic post-surgical (PS)-HypoPT compared to a control population, using a standardized neuropsychological approach and evaluating the relationship with serum calcium (Alb-Ca). Methods Observational, monocentric study on 33 patients with PS-HypoPT and 24 controls, in whom biochemical testing and a standardized neuropsychological assessment by a trained psychologist were performed. Results In patients with PS-HypoPT, low Alb-Ca correlated with a worse performance on semantic memory abilities and executive function, as suggested by a significant inverse correlation between Alb-Ca and Trail Making Test A (TMT-A) scores (r = − 0.423; p = 0.014) and by a positive correlation with Semantic Fluency Test scores (SF)(r = 0.510; p = 0.002). PS-HypoPT patients with Alb-Ca ≤ 8.9 mg/dl had a significantly lower test performance compared with PS-HypoPT patients with Alb-Ca > 8.9 mg/dl, both at the TMT-A test (mean score: 34.53–18.55; p < 0.0001) and at SF test (mean score: 41.94–48.68; p = 0.01) and also a significantly lower test performance compared with control patients’ group at TMT-A (mean score: 34.53–25.5; p = 0.0057). Conclusions Patients with chronic PS-HypoPT in conventional therapy do not show a severe cognitive impairment; however, cognitive functions namely visuo-spatial attention, executive function and semantic memory appear to be modulated by Alb-Ca and impaired by its low levels.

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The association between hypoparathyroidism and cognitive impairment: a systematic review

Cited by 12 publications

References 47 publications

The Russian Registry of Chronic Hypoparathyroidism

The Russian Registry of Chronic Hypoparathyroidism

A Pilot Study of Cognition Among Hypoparathyroid Adults

Serum calcium levels are associated with cognitive function in hypoparathyroidism: a neuropsychological and biochemical study in an Italian cohort of patients with chronic post-surgical hypoparathyroidism

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