Background
Cognitive impairment was frequently reported in uremic patients with dialysis, but
improvements of cognition after parathyroidectomy for symptomatic secondary hyperparathyroidism
have never been reported before.
Methods
Thirty-nine patients, who were successfully operated on with total parathyroidectomy
plus autotransplantation were enrolled. Twenty-three dialysis patients, age >50 years,
who had a serum level of intact parathyroid hormone (iPTH) greater than 650 pg/ml,
and who did not undergo parathyroidectomy were selected as the control group. The
mini-mental state examination (MMSE) and the clinical dementia rating (CDR) test were
administered to all patients. Before the operation, educational level, symptoms of
bone pain, skin itching, general weakness and insomnia were recorded and serum levels
of calcium, phosphorus, alkaline phosphatase (Alk-ptase), iPTH, aluminum, and hemoglobin
were measured in the study and control groups. At 12-week postoperatively, serum levels
of calcium, phosphorus, Alk-ptase, iPTH, and aluminum were measured again and at 16-week
postoperatively, the MMSE and the CDR test were administered again. In the control
group, both MMSE and CDR test were administered again after the period or 16-week.
Results
Serum calcium level was only significant difference (p = 0.002), whereas clinical
symptoms, gender, etiologies of secondary hyperparathyroidism, duration of dialysis,
educational level, age, and serum levels of phosphorus, Alk-ptase, iPTH, aluminum,
and hemoglobin were not significantly different between the two groups. The educational
level was the only factor affecting MMSE scores (p = 0.003). In the study group, at
12-week postoperatively, symptoms improved significantly, serum levels of calcium,
phosphorus, Alk-ptase, iPTH, and aluminum decreased significantly, and at 16-week
postoperatively, MMSE scores increased from 25 ± 5 (mean ± SD) to 26 ± 5 (p < 0.001)
and CDR scales decreased significantly (p < 0.001). Neither MMSE scores nor CDR scales
of the control group changed significantly after the 16-week period.
Conclusion
Parathyroidectomy for symptomatic secondary hyperparathyroidism can improve cognition.
Abbreviation:
iPTH (intact parathyroid hormone), Alk-ptase (alkaline phosphatase), MMSE (mini-mental state examination), CDR (clinical dementia rating)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 31, 2008
Accepted:
November 14,
2007
Footnotes
Supported by Chang Gung Memorial Hospital Kaohsiung Medical Center, CMRP G840501.
Identification
Copyright
© 2008 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
