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The association between hypoparathyroidism and cognitive impairment: a systematic review

Abstract

Context and purpose

Hypocalcemia and low parathyroid hormone levels have been commonly suggested as factors able to induce central nervous system disturbances. However, evidences on the occurrence of cognitive impairment are limited or underestimated. The aim of this review is, therefore, to systematically summarize the available evidence concerning the occurrence of cognitive impairment among subjects suffering from idiopathic or secondary hypoparathyroidism.

Methods

A systematic selection of the available literature was performed by searching the online databases PubMed, Scopus and Web of Knowledge.

Results

The present systematic review included sixteen case report articles and one cross-sectional controlled study. Case reports were the most representative literature sources and involved ten women and seven men. The presence of cognitive impairment was mostly discussed in association with idiopathic hypoparathyroidism (HPT); five articles described the occurrence of cognitive impairment following postsurgical HPT. The case-controlled study reported a significant presence of peculiar cognitive deficits (e.g. reduced inhibitory control, impairment in visuo-spatial functioning among, and psychomotor retardation) among HPT subjects compared to healthy controls, with serum total calcium and its product with phosphorus as independent predictors of neuropsychological dysfunctions.

Conclusion

Even though mostly based on single case reports, the presence of neuropsychological dysfunctions in the context of HPT appears to be a consistent core finding.

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Fig. 1

Abbreviations

SCD:

Subjective cognitive decline

MCI:

Mild cognitive impairment

PTH:

Parathyroid hormone

BBB:

Blood brain barrier

HPT:

Hypoparathyroidism

MMSE:

Mini Mental State Examination

MoCA:

Montreal Cognitive Assessment

WAIS:

Wechsler Adult Intelligence Scale

PTH2R:

PTH 2 receptor

GPCRs:

G protein-coupled receptors

TIP39:

Tuber infundibular peptide of 39 residues

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AS: methodology, acquisition, screening and interpretation of data, drafting of the manuscript; AC: conceptualization, interpretation of data, drafting of the manuscript, final revision of the manuscript; FB, NM and GB: acquisition and screening of data; SM and FC: supervision.

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Correspondence to A. Catalano.

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Sardella, A., Bellone, F., Morabito, N. et al. The association between hypoparathyroidism and cognitive impairment: a systematic review. J Endocrinol Invest 44, 905–919 (2021). https://doi.org/10.1007/s40618-020-01423-1

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Keywords

  • Hypoparathyroidism
  • Parathyroid
  • Hypocalcaemia
  • Cognitive functions
  • Cognitive impairment