Original Communication| Volume 143, ISSUE 4, P526-532, April 2008

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Cognitive changes after parathyroidectomy in patients with secondary hyperparathyroidism

Published:January 31, 2008DOI:


      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.


      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.


      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.


      Parathyroidectomy for symptomatic secondary hyperparathyroidism can improve cognition.


      iPTH (intact parathyroid hormone), Alk-ptase (alkaline phosphatase), MMSE (mini-mental state examination), CDR (clinical dementia rating)
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        • Kurella M.
        • Chertow G.M.
        • Luan J.
        • Yaffe K.
        Cognitive impairment in chronic kidney disease.
        J Am Geriatr Soc. 2004; 52: 1863-1869
        • Kurella M.
        • Chertow G.M.
        • Fried L.F.
        • et al.
        Chronic kidney disease and cognitive impairment in the elderly: the health, aging, and body composition study.
        J Am Soc Nephrol. 2005; 16: 2127-2133
        • Kurella M.
        • Yaffe K.
        • Shlipak M.G.
        • Wenger N.K.
        • Chertow G.M.
        Chronic kidney disease and cognitive impairment in menopausal women.
        Am J Kidney Dis. 2005; 45: 66-76
        • Pereira A.A.
        • Weiner D.E.
        • Scott T.
        • Sanaj M.J.
        Cognitive function in dialysis patients.
        Am J Kidney Dis. 2005; 45: 448-462
        • Brickman A.M.
        • Riba A.
        • Bell K.
        • et al.
        Longitudinal assessment of patient dependence in Alzheimer disease.
        Arch Neurol. 2002; 59: 1304-1308
        • Romans
        • Sosa J.A.
        Psychiatric and cognitive aspect of primary hyperparathyroidism.
        Curr Opin Oncol. 2007; 19: 1-5
        • Prager G.
        • Kalashek A.
        • Kaczirek K.
        • et al.
        Parathyroidectomy improved concentration and retentiveness in patients with primary hyperparathyroidism.
        Surgery. 2002; 132: 930-936
        • Chou F.F.
        • Chan H.M.
        • Huang T.J.
        • Lee C.H.
        • Hsu K.T.
        Autotransplantation of parathyroid glands into subcutaneous forearm tissue for renal parathyroidism.
        Surgery. 1998; 124: 1-5
        • Morris J.C.
        The clinical dementia rating (CDR): current version and scoring rules.
        Neurology. 1993; 43: 2412-2414
        • Sehgal A.R.
        • Grey S.F.
        • DeOreo P.B.
        • Whitehouse P.J.
        Prevalence, recognition, and implications of mental impairment among hemodialysis patients.
        Am J Kidney Dis. 1997; 30: 41-49
        • Fazekas G.
        • Fazekas F.
        • Schmidt R.
        • et al.
        Brain MRI finding and cognitive impairment in patients undergoing chronic hemodialysis treatment.
        J Neurol Sci. 1995; 134: 83-84
        • Schmidt R.
        • Schmidt H.
        • Curb J.D.
        • Masaki K.
        • White L.R.
        • Launer L.J.
        Early inflammation and dementia: a 25-year follow-up of the Honolulu Asia aging study.
        Ann Neurol. 2002; 52: 168-174
        • Iso H.
        • Moriyama Y.
        • Sato S.
        • et al.
        Serum total homocysteine concentrations and risk of stoke and its subtypes in Japanese.
        Circulation. 2004; 109: 2766-2772
        • Iuliano L.
        The oxidant stress hypothesis of atherogenesis.
        Lipids. 2001; 36: S41-S44
        • Lindsberg P.J.
        • Grau A.J.
        Inflammation and infections as risk factors for ischemic stroke.
        Stroke. 2003; 34: 2518-2532
        • Pratico D.
        • Clark C.
        • Liun F.
        • Rokach J.
        • Lee V.Y.
        • Trojanowski J.Q.
        Increase of brain oxidative stress in mild cognitive impairment: a possible predictor of Alzheimer disease.
        Arch Neurol. 2002; 59: 972-976
        • DeCarli C.
        The role of cerebral vascular disease in dementia.
        Neurologist. 2003; 9: 123-136
        • Stewart R.
        Vascular dementia: a diagnosis running out of time.
        Br J Psychiatry. 2002; 180: 152-156
        • Moroney J.T.
        • Tang M.X.
        • Berglund L.
        • et al.
        Low-density lipoprotein cholesterol and the risk of dementia with stroke.
        JAMA. 1999; 282: 254-260
        • Johnson W.J.
        • McCarthy J.T.
        • Yanagihara T.
        • et al.
        Effects of recombinant human erythropoietin on cerebral and cutaneous blood flow and on blood coagulability.
        Kidney Int. 1990; 38: 919-924
        • Jumbe N.L.
        Erythropoietic agents as neurotherapeutic agents: what barriers exist?.
        Oncology. (Williston Park). 2002; 16: 91-107
        • Sun Y.
        • Zhou C.
        • Polk P.
        • Nanda A.
        • Zhang J.H.
        Mechanism of erythropoletin-induced brain protection in neonatal hypoxia-ischemia rat model.
        J Cereb Blood Flow Metab. 2004; 24: 259-270
        • Cerami A.
        • Brines M.
        • Ghezzi P.
        • Ceramic C.
        • Itri L.M.
        Neuroprotective properties of epoetin alfa.
        Nephrol Dial Transplant. 2002; 17: 8-12
        • Fraser C.L.
        • Arieff A.I.
        Nervous system complications in uremia.
        Ann Intern Med. 1988; 109: 143-153
        • Nissenson A.
        • Marsh J.
        • Brown W.S.
        • Wolcott D.
        Central nervous system function in dialysis patients: a practical approach.
        Semin Dial. 1991; 4: 115-123
        • Altmann P.
        • Al-Salihi F.
        • Butter K.
        • et al.
        Serum aluminum levels and erythrocyte dihydropteridine reductase activity in patients on hemodialysis.
        N Eng J Med. 1987; 371: 80-84
        • Altmann P.
        • Dhanesha U.
        • Hamon C.
        • Cunningham J.
        • Blair J.
        • Marsh F.
        Disturbance of cerebral function of aluminum in hemodialysis patients with overt aluminum toxicity.
        Lancet. 1989; 2: 7-12
        • Pliskin N.H.
        • Yurk H.M.
        • Ho L.T.
        • Umans J.G.
        Neurocognitive function in chronic hemodialysis patients.
        Kidney Int. 1996; 49: 1435-1440
        • Hickie I.
        • Scott E.
        • Mitchell P.
        • Wilhelm K.
        • Austin M.P.
        • Bennett B.
        Subcortical hyperintensity on magnetic resonance imaging: clinical correlates and prognostic significance in patients with severe depression.
        Biol Psychiatry. 1995; 37: 151-160
        • Simpson S.
        • Talbot P.R.
        • Snowden J.S.
        • Near D.
        Subcortical vascular disease in elderly patients with treatment resistant depression.
        J Neurol Neurosurg Psychiatry. 1997; 62: 196-197
        • Hickie I.
        • Scott E.
        • Wilhelm K.
        • Brodaty H.
        Subcortical hyperintensities on magnetic resonance imaging in patients with severe depression—a longitudinal evaluation.
        Biol Psychiatry. 1997; 42: 367-374
        • Manley H.J.
        • McClaran M.L.
        • Overbay D.K.
        • et al.
        Factors associated with medication-related problems in ambulatory hemodialysis patients.
        Am J Kidney Dis. 2003; 41: 386-393
        • Kaplan B.
        • Mason N.A.
        • Shimp L.A.
        • Ascione F.J.
        Chronic hemodialysis patients. Part I: characterization and drug-related problems.
        Ann Pharmacother. 1994; 28: 316-319
        • Bugge J.F.
        Influence of renal replacement therapy on pharmacokinetics in critically ill patients.
        Best Pract Res Clin Anesthesiol. 2004; 18: 175-187
        • Lee H.J.
        • Kim L.
        • Suh K.Y.
        Cognitive deterioration and changes of P300 during total sleep deprivation.
        Psychiatry Clin Neurosci. 2003; 57: 490-496
        • Roth T.
        • Costa e Silva J.A.
        • Chase M.H.
        Sleep and cognitive (memory) function: research and clinical perspectives.
        Sleep Med. 2001; 2: 379-387
        • Grigoletto F.
        • Zappala G.
        • Anderson D.W.
        • Lebowitz B.D.
        Norms for the mini-mental state examination in a health population.
        Neurology. 1999; 53: 315-320
        • Cagney K.A.
        • Lauderdale D.S.
        Education, wealth, and cognitive function in later life.
        J Gerontol B Psychol Sci Soc Sci. 2002; 57: 163-172
        • Mallocy P.F.
        • Cummings J.L.
        • Coffey C.E.
        • et al.
        Cognitive screening instruments in neuropsychiatry: a report of the committee on research of the American Neuropsychiatric Association.
        J Neuropsychiatry Clin Neurosci. 1999; 9: 189-197
        • Morris J.C.
        The Clinical Dementia Rating (CDR): current version and scoring rules.
        Neurology. 1993; 43: 2412-2414
        • Salinsky M.C.
        • Storzbach D.
        • Dodrill C.B.D.
        • Binder L.M.
        Test-retest bias, reliability, and regression equations for neuropsychological measures repeated over a 12-16-week period.
        J Int Neuropsychol Soc. 2001; 7: 597-605
        • Zgaljardic D.J.
        • Benedict R.H.
        Evaluation of practice effects in language and spatial processing test performance.
        Appl Neuropsychol. 2001; 8: 218-223
        • Jassal S.V.
        • Devins G.M.
        • Chan C.T.
        • Bozanovic R.
        • Rourke S.
        Improvements in cognition patients converting from thrice weekly hemodialysis to nocturnal hemodialysis: a longitudinal pilot study.
        Kidney Int. 2006; 70: 956-962
        • Kramer L.
        • Madl C.
        • Stockenhuber F.
        • et al.
        Beneficial effect of renal transplantation on cognitive brain function.
        Kidney Int. 1996; 49: 833-838
        • Chou F.F.
        • Lee C.H.
        • Chen J.B.
        • Huang S.C.
        • Lee C.T.
        Sleep disturbances before and after parathyroidectomy for secondary hyperparathyroidism.
        Surgery. 2005; 137: 426-430
        • Chou F.F.
        • Lee C.H.
        • Chen J.B.
        General weakness as an indication for parathyroid surgery in patients with secondary hyperparathyroidism.
        Arch Surg. 1999; 134: 1108-1111
        • Chou F.F.
        • Ho J.C.
        • Huang S.C.
        • Sheen-Chen S.M.
        A study on pruritus after parathyroidectomy for secondary hyperparathyroidism.
        J Am Coll Surg. 2000; 190: 65-70