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Cognitive and affective sequelae of primary hyperparathyroidism and early response to parathyroidectomy

Published online by Cambridge University Press:  01 November 2009

JARED F. BENGE ,
NANCY D. PERRIER ,
PAUL J. MASSMAN ,
CHRISTINA A. MEYERS ,
ANNE E. KAYL  and
JEFFREY S. WEFEL
JARED F. BENGE
Affiliation:
Mental Health Care Line, Michael E. DeBakey Veteran’s Affairs Medical Center, Houston, Texas The Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
NANCY D. PERRIER
Affiliation:
Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
PAUL J. MASSMAN
Affiliation:
Department of Psychology, University of Houston, Houston, Texas
CHRISTINA A. MEYERS
Affiliation:
Department of Neuro-Oncology, Section of Neuropsychology, University of Texas MD Anderson Cancer Center, Houston, Texas
ANNE E. KAYL
Affiliation:
Department of Neuro-Oncology, Section of Neuropsychology, University of Texas MD Anderson Cancer Center, Houston, Texas
JEFFREY S. WEFEL*
Affiliation:
Department of Neuro-Oncology, Section of Neuropsychology, University of Texas MD Anderson Cancer Center, Houston, Texas
*
*Correspondence and reprint requests to: Jeffrey S. Wefel, Department of Neuro-Oncology, Unit 431, University of Texas M. D. Anderson Cancer Center, P.O. Box 301402, Houston, Texas 77230-1402. E-mail: jwefel@mdanderson.org
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Abstract

Cognitive and affective complaints are common in patients with primary hyperparathyroidism (PHPT), but few studies have used psychometric testing to document these symptoms and their response to parathyroidectomy. The current study sought to clarify the nature of cognitive and affective impairments in PHPT and changes postparathyroidectomy. One hundred eleven patients with PHPT underwent neuropsychological evaluation prior to parathyroidectomy with 68 returning for an early postsurgical evaluation. Changes in cognition were assessed using practice effect corrected reliable change indices. Biochemical and anesthesia variables were compared between groups who improved and declined. In a subset of patients, assessment revealed a significant pattern of cognitive slowing, reductions in psychomotor speed, memory impairment, and depression prior to parathyroidectomy. Postsurgical evaluations revealed a trend for improvements on timed tests and depression but a decline in memory. Older patients responded less well to surgical intervention, as did patients who experienced more dramatic changes in biochemical status following surgery. Cognitive changes early postparathyroidectomy are characterized by improved information processing speed and decline in verbal memory, with younger patients more likely to recover during this acute phase. The need for longer-term follow-up studies and increasing utilization of neuropsychological assessments in this population are discussed. (JINS, 2009, 15, 1002–1011.)

Keywords

HyperparathyroidismParathyroidectomyCognitionDepressionNeuropsychologySurgery
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 15 , Issue 6 , November 2009 , pp. 1002 - 1011
Copyright
Copyright © The International Neuropsychological Society 2009

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References

REFERENCES

Akerström, G., & Hellman, P. (2004). Primary hyperparathyroidism. Current Opinion in Oncology, 16, 1–7.CrossRefGoogle ScholarPubMed
Beck, A.T., & Steer, R.A. (1987). BDI: Beck Depression Inventory Manual. San Antonio, TX: The Psychological Corporation, Harcourt Brace Jovanovich.Google Scholar
Beglinger, L.J., Gaydos, B., Tangphao-Daniles, O., Duff, K., Kareken, D.A., Crawford, J., et al. . (2005). Practice effects and the use of alternate forms in serial neuropsychological testing. Archives of Clinical Neuropsychology, 20, 517–529.CrossRefGoogle ScholarPubMed
Benedict, R.H., Schretlen, D., Groninger, L., & Brandt, J. (1998). Hopkins Verbal Learning Test-Revised: Normative data and analysis of inter-form and test-retest reliability. Clinical Neuropsychologist, 12, 43–55.CrossRefGoogle Scholar
Benton, A.L., & Hamsher, K.D. (1989). Multilingual Aphasia Examination. Iowa City, IA: AJA.Google Scholar
Bilezikian, J.P. (2000). Primary hyperparathyroidism: When to observe and when to operate. Endocrinology and Metabolism Clinics of North America, 29, 465–478.CrossRefGoogle ScholarPubMed
Bilezikian, J.P., Potts, J.T., Fuleihan, G., Kleerekoper, M., Neer, R., Peacock, M., et al. . (2002). Summary statement from a workshop on asymptomatic primary hyperparathyroidism: A perspective for the 21st century. The Journal of Clinical Endocrinology and Metabolism, 87, 5353–5361.CrossRefGoogle Scholar
Brandt, J. (1996). The Hopkins Verbal Learning Test: Development of a new verbal memory test with six equivalent forms. The Clinical Neuropsychologist, 5, 125–142.CrossRefGoogle Scholar
Chelnue, G.J., Naugle, R.I., Uders, H., Sedlak, J., & Awad, I. (1993). Individual change after epilepsy surgery: Practice effects and base-rate information. Neuropsychology, 7, 41–52.CrossRefGoogle Scholar
Chiang, C.Y., Andrewes, D.G., Anderson, D., Devere, M., Schweitzer, I., & Zajac, J.D. (2005). A controlled, prospective study of neuropsychological outcomes post parathyroidectomy in primary hyperparathyroid patients. Clinical Endocrinology, 62, 99–104.CrossRefGoogle ScholarPubMed
Clementi, G., Drago, F., Prato, A., Cavaliere, S., Di Benedetto, A., Leone, F., et al. . (1984). Effects of calcitonin, parathyroid hormone and its related fragments on acquisition of active avoidance behavior. Physiology & Behavior, 33, 913–916.CrossRefGoogle ScholarPubMed
Cogan, M.G., Covey, C.M., Arieff, A.I., Wisniewski, A., Clark, O.H., Lazarowitz, V., et al. . (1978). Central nervous system manifestations of hyperparathyroidism. The American Journal of Medicine 65, 963–970.CrossRefGoogle ScholarPubMed
Coker, L.H., Rorie, K., Cantley, L., Kirkland, K., Stump, D., Burbank, N., et al. . (2005). Primary hyperparathyroidism, cognition, and health-related quality of life. Annals of Surgery, 242, 642–650.CrossRefGoogle ScholarPubMed
Dikmen, S., Heaton, R.K., Grant, I., & Temkin, N.R. (1999). Test-retest reliability and practice effect of Expanded Halstead-Reitan Neuropsychological Test Battery. Journal of the International Neuropsychological Society, 5, 346–356.CrossRefGoogle ScholarPubMed
Dotzenrath, C.M., Kaetsch, A.K., Pfingsten, H., Cupisti, K., Weyerbrock, N., Vossough, A., et al. . (2006). Neuropsychiatric and cognitive changes after surgery for primary hyperparathyroidism. World Journal of Surgery, 30, 680–685.CrossRefGoogle ScholarPubMed
Eigelberger, M.S., Cheah, W.K., Ituarte, P.H., Streja, L., Duh, Q.Y., & Clark, O.H. (2004). The NIH criteria for parathyroidectomy in asymptomatic primary hyperparathyroidism: Are they too limited? Annals of Surgery, 239, 528–535.CrossRefGoogle ScholarPubMed
Evaldsson, U., Ertekin, C., Ingvar, D.H., & Waldenström, J.G. (1969). Encephalopathia hypercalcemica. A clinical and electroencephalographic study in myeloma and other disorders. Journal of Chronic Diseases, 22, 431–449.CrossRefGoogle ScholarPubMed
Golden, C.J. (1976). Identification of brain disorders by the Stroop Color and Word Test. Journal of Clinical Psychology, 32, 654–658.3.0.CO;2-Z>CrossRefGoogle ScholarPubMed
Golden, C.J., & Freshwater, S.M. (2002) Stroop Color and Word Test. A Manual for Clinical and Experimental Uses. Wood Dale, IL: Skoelting.Google Scholar
Grey, A., Lucas, J., Horne, A., Gamble, G., Davidson, J.S., & Reid, I.R. (2005). Vitamin D repletion in patients with primary hyperparathyroidism and coexistent vitamin D insufficiency. Journal of Clinical Endocrinology & Metabolism, 90, 2122–2126.CrossRefGoogle ScholarPubMed
Gronwall, D.M.A. (1977). Paced Auditory Serial Addition Task: A measure of recovery from concussion. Perceptual and Motor Skills, 44, 367–373.CrossRefGoogle ScholarPubMed
Heath, H., Hodgson, S.F., & Kennedy, M.A. (1980). Primary hyperparathyroidism: Incidence, morbidity, and potential economic impact in a community. The New England Journal of Medicine, 302, 189–193.CrossRefGoogle ScholarPubMed
Heaton, R.K., Temkin, N., Dikmen, S., Avitable, N., Taylor, M.J., Marcotte, T.D., et al. . (2001). Detecting change: A comparison of three neuropsychological methods, using normal and clinical samples. Archives of Clinical Neuropsychology, 16, 75–91.CrossRefGoogle Scholar
Horst, W.D., & Burke, M.J. (2008). Intracellular and intercellular principles of pharmacotherapy for neuropsychiatric disorders. In Yudofsky, S.C. & Hales, R.E. (Eds.), The American Psychiatric Publishing Textbook of Neuropsychiatry and Behavioral Neurosciences (5th ed., pp. 1117–1148). Arlingon, VA: American Psychiatric Publishing.Google Scholar
Ingraham, L.J., & Aiken, C.B. (1996). An empirical approach to determining criteria for abnormality in test batteries with multiple measures. Neuropsychology, 10, 120–124.CrossRefGoogle Scholar
Joborn, C., Hetta, J., Niklasson, F., Rastad, J., Wide, L., Agren, H., et al. . (1991). Cerebrospinal fluid calcium, parathyroid hormone, and monoamine and purine metabolites and the blood-brain barrier function in primary hyperparathyroidism. Psychoneuroendocrinology, 16, 311–322.CrossRefGoogle ScholarPubMed
Jorde, R., Waterloo, K., Saleh, F., Haug, E., & Svartberg, J. (2006). Neuropsychological function in relation to serum parathyroid hormone and serum 25-hydroxyvitamin D levels: The Tromsø study. Journal of Neurology, 253, 464–470.CrossRefGoogle Scholar
LaBuda, C.J., & Usdin, T.B. (2004). Tuberoinfundibular peptide of 39 residues decreases pain-related affective behavior. Neuroreport, 15, 1779–1782.CrossRefGoogle ScholarPubMed
Mittendorf, E.A., Wefel, J.S., Meyers, C.A., Doherty, D., Shapiro, S.E., Lee, J.E., et al. . (2007). Improvement of sleep disturbance and neurocognitive function after parathyroidectomy in patients with primary hyperparathyroidism. Endocrinology Practice, 4, 338–344.CrossRefGoogle Scholar
Mjåland, O., Normann, E., Halvorsen, E., Rynning, S., & Egeland, T. (2003). Regional cerebral blood flow in patients with primary hyperparathyroidism before and after successful parathyroidectomy. The British Journal of Surgery, 90, 732–737.CrossRefGoogle ScholarPubMed
Newman, S., Stygall, J., Hirani, S., Shaefi, S., & Maze, M. (2007). Postoperative cognitive dysfunction after noncardiac surgery: A systematic review. Anesthesiology, 106, 572–590.CrossRefGoogle ScholarPubMed
Nilsson, I.L., Aberg, J., Rastad, J., & Lind, L. (1999). Endothelial vasodilatory dysfunction in primary hyperparathyroidism is reversed after parathyroidectomy. Surgery, 6, 1049–1055.CrossRefGoogle Scholar
Numann, P.J., Tora, A.J., & Blumetti, A.E. (1984). Neuropsychologic deficits associated with primary hyperparathyroidism. Surgery, 96, 1119–1123.Google ScholarPubMed
Orff, H.J., Drummond, S.P., Nowakowski, S., & Perlis, M.L. (2007). Discrepancy between subjective symptomatology and objective neuropsychological performance in insomnia. Sleep, 30, 1205–1211.CrossRefGoogle ScholarPubMed
Pasieka, J.L., Parsons, L.L., Demeure, M.J., Wilson, S., Malycha, P., Jones, J., et al. . (2002). Patient-based surgical outcome tool demonstrating alleviation of symptoms following parathyroidectomy in patients with primary hyperparathyroidism. World Journal of Surgery, 26, 942–949.CrossRefGoogle ScholarPubMed
Perrier, N.D., Coker, L.H., Rorie, K.D., Burbank, N.S., Kirkland, K.A., Passmore, L.V., et al. . (2006). Preliminary report: Functional MRI of the brain may be the ideal tool for evaluating neuropsychologic and sleep complaints of patients with primary hyperparathyroidism. World Journal of Surgery, 30, 686–696.CrossRefGoogle ScholarPubMed
Prager, G., Kalaschek, A., Kaczirek, K., Passler, C., Scheuba, C., Sonneck, G., et al. . (2002). Parathyroidectomy improves concentration and retentiveness in patients with primary hyperparathyroidism. Surgery, 132, 930–935.CrossRefGoogle ScholarPubMed
Prete, C., Foiani, L., Trasciatti, S., Senesi, B., Veneziano, M., Barone, A., et al. . (2005). Primary hyperparathyroidism and neuropsychiatric alterations in a nonagenarian woman. Aging Clinical and Experimental Research, 17, 67–70.CrossRefGoogle Scholar
Przbelski, R.J., & Binkley, N.C. (2007). Is vitamin D important for preserving cognition? A positive correlation of serum 25-hydroxyvitamin D concentration with cognitive function. Archives of Biochemistry and Biophysics, 460, 202–205.CrossRefGoogle Scholar
Rao, S.M., Leo, G.J., Haughton, V.M., St Aubin-Faubert, P., & Bernardin, L. (1989). Correlation of magnetic resonance imaging with neuropsychological testing in multiple sclerosis. Neurology, 39, 161–166.CrossRefGoogle ScholarPubMed
Reitan, R.M. (1958). Validity of the Trail Making Test as an indicator of organic brain damage. Perceptual and Motor Skills, 8, 271–276.CrossRefGoogle Scholar
Roman, S.A., Sosa, J.A., Mayes, L., Desmond, E., Boudourakis, L., Lin, R., et al. . (2005). Parathyroidectomy improves neurocognitive deficits in patients with primary hyperparathyroidism. Surgery, 138, 1121–1128.CrossRefGoogle ScholarPubMed
Seggar, L.B., Lambert, M.J., & Hansen, N.B. (2002). Assessing clinical significance: Application to the Beck Depression Inventory. Behavior Therapy, 33, 253–269.CrossRefGoogle Scholar
Spielberger, C.D. (1983). Manual for the State-Trait Anxiety Inventory (Form Y)(Self-Evaluation Questionnaire). Palo Alto, CA: Consulting Psychologists Press.Google Scholar
Tilvis, R.S., Kähönen-Väre, M.H., Jolkkonen, J., Valvanne, J., Pitkala, K.H., & Strandberg, T.E. (2004). Predictors of cognitive decline and mortality of aged people over a 10-year period. The Journals of Gerontology Series A, Biological Sciences and Medical Sciences, 59, 268–274.CrossRefGoogle ScholarPubMed
Tombaugh, T. (2004). Normative data stratified by age and education. Archives of Clinical Neuropsychology, 19, 203–214.CrossRefGoogle ScholarPubMed
Tombaugh, T., Kozak, J., & Rees, L. (1999). Normative data stratified by age and education on two measures of verbal fluency: FAS and animal naming. Archives of Clinical Neuropsychology, 14, 167–177.Google ScholarPubMed
Trites, R. (1977). Neuropsychological Test Manual. Ottawa, Ontario: Royal Ottawa Hospital (available from Lafayette Instrument Company).Google Scholar
Weaver, D.R., Deeds, J.D., Lee, K., & Segre, G.V. (1995). Localization of parathyroid hormone-related peptide (PTHrP) and PTH/PTHrP receptor mRNAs in rat brain. Brain Research: Molecular Brain Research, 28, 296–310.Google ScholarPubMed
Wechsler, D. (1997). Wechsler Adult Intelligence Scale- III. San Antonio, TX: The Psychological Corporation.Google Scholar
Woods, S.P., Childers, M., Ellis, R., Guaman, S., Grant, I., & Heaton, R.K. (2006). A battery approach for measuring neuropsychological change. Archives of Clinical Neuropsychology, 21, 83–89.CrossRefGoogle ScholarPubMed