Tufts University Medical Center, Boston, MA, USA.
Neurology and Pathology, University of California, Irvine, CA, USA.
J Neuroendocrinol. 2021 Mar;33(3):e12948. doi: 10.1111/jne.12948.
Despite decades of research on the relation between thyroid diseases and cognition, the nature of this relationship remains elusive. An increasing prevalence of cognitive impairment and thyroid dysfunction has been consistently observed with ageing. Also, there appears to be an association between thyroid disorders and cognitive decline. Given the increasing global burden of dementia, elucidating the relationship between thyroid disorders as a potentially modifiable risk factor of cognitive impairment was the main goal of this review. We summarise the current literature examining the relationship between thyroid hormonal dysregulation and cognition or behaviour. We present the available imaging and pathological findings related to structural and functional brain changes related to thyroid hormonal dysregulation. We also propose potential mechanisms of interaction between thyroid hormones, autoantibodies and cognition/behaviour. Effects of gender, ethnicity and environmental factors are also briefly discussed. This review highlights the need for long-term prospective studies to capture the course of brain functional changes associated with the incidence and progression of thyroid dysregulations along with the confounding effects of non-modifiable risk factors such as gender and ethnicity. Moreover, double-blind controlled clinical trials are necessary to devise appropriate treatment plans to prevent cognitive consequences of over or undertreatment of thyroid disorders.
尽管几十年来一直在研究甲状腺疾病与认知之间的关系，但这种关系的本质仍然难以捉摸。随着年龄的增长，认知障碍和甲状腺功能障碍的患病率不断增加。此外，甲状腺疾病与认知能力下降之间似乎存在关联。鉴于痴呆症的全球负担不断增加，阐明甲状腺疾病作为认知障碍潜在可改变的危险因素之间的关系是本综述的主要目标。我们总结了目前研究甲状腺激素失调与认知或行为之间关系的文献。我们介绍了与甲状腺激素失调相关的结构和功能脑变化相关的现有影像学和病理学发现。我们还提出了甲状腺激素、自身抗体和认知/行为之间相互作用的潜在机制。性别、种族和环境因素的影响也进行了简要讨论。这篇综述强调了需要进行长期前瞻性研究，以捕捉与甲状腺功能紊乱的发生和进展相关的脑功能变化的过程，同时还需要考虑性别和种族等不可改变的危险因素的混杂影响。此外，还需要进行双盲对照临床试验，以制定适当的治疗计划，防止甲状腺疾病治疗过度或不足带来的认知后果。
