Mental Health Care Line, Michael E. DeBakey Veteran's Affairs Medical Center, Houston, Texas 77230-1402, USA.
J Int Neuropsychol Soc. 2009 Nov;15(6):1002-11. doi: 10.1017/S1355617709990695. Epub 2009 Oct 7.
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.
认知和情感主诉在原发性甲状旁腺功能亢进症（PHPT）患者中很常见，但很少有研究使用心理计量测试来记录这些症状及其对甲状旁腺切除术的反应。本研究旨在阐明 PHPT 患者认知和情感障碍的性质以及手术后的变化。111 例 PHPT 患者在甲状旁腺切除术前接受神经心理学评估，其中 68 例在术后早期接受评估。使用经过练习效果校正的可靠变化指数评估认知变化。比较了改善和下降组的生化和麻醉变量。在患者亚组中，评估发现术前存在认知速度减慢、运动速度降低、记忆障碍和抑郁的显著模式。术后评估显示，计时测试和抑郁有改善趋势，但记忆下降。年龄较大的患者对手术干预的反应较差，术后生化状态变化较大的患者也是如此。甲状旁腺切除术后早期的认知变化以信息处理速度提高和言语记忆下降为特征，年轻患者在此急性阶段更有可能恢复。讨论了需要进行更长期的随访研究，并在该人群中增加神经心理学评估的应用。
