C. Bell1, M. Warrick1, N. Baregamian1 1Vanderbilt University Medical Center,Department Of Surgery,Nashville, TN, USA
Introduction:
Neurocognitive factors are integral to the diagnosis of primary hyperparathyroidism (PHPT), and parathyroidectomy has been shown to improve health-related quality of life, functional and physical capacity, visual-spatial working memory, and reduction of depression and anxiety. Our pilot study performs computerized analysis of neurocognitive executive functions such as memory, attention, speed of processing, and problem-solving in a reliable, measurable way. It examines the Neurocognitive Performance Profile (NCPP) pre- and post-parathyroidectomy by using an online battery of brief, repeatable, modular, well-known neuropsychological assessments (Neurocognitive Performance Testing, NCPT) developed by Lumosity (LumosLabs, Inc).
Methods:
Thirty-three patients with biochemically confirmed PHPT and indication for parathyroidectomy were enrolled and asked to complete online computerized NCPTs at 3 time points (preoperative, early post-operative, and 6-month post-operative) to calculate their overall NCCP and individual test scores by quantifying levels of performance on defined categories of cognition. These scores were normalized to their age-matched controls from the Lumosity database. All patients underwent parathyroidectomy, 24 patients completed pre- and early post-operative NCPTs only, and 10 patients completed all 3 visits. Nine patients were excluded from analysis for incomplete testing.
Results:
Significant difference was observed in overall NCPP scores over three visits using one-way ANOVA (n=10, p=0.043) and post-hoc Tukey’s multiple comparison analysis of pre- vs 6-month post-op performance (n=10, p=0.012). There was significant improvement in visual-spatial memory (Object Recognition, n=10, p=0.015) post-operatively. No significant difference in overall NCPP score was observed in paired comparison of 24 subjects completing only pre- and early post-operative testing, however, significant improvement in speed of processing and memory (Digit Symbol Coding, n=24, p=0.017) in early post-operative period was observed. Biochemical cure was achieved post-parathyroidectomy in all patients (n=24, both serum calcium and parathyroid hormone levels, p<0.0001). Patients reporting neurocognitive symptoms preoperatively (95.8%) and at early postoperative time points (58.3%) expressed significant relief of symptoms (n=24, p=0.001). This effect persisted at 6 months (n=10, p=0.004).
Conclusion:
This pilot study has begun to characterize the types of neurocognitive deficits and post-operative improvements in the overall neurocognitive performance in PHPT patient population in a measurable way. NCPT is a novel method that can provide a long-term metric for objective assessment of neurocognitive changes post-parathyroidectomy and biochemical normalization. NCPT can be a valuable diagnostic and prognostic testing tool for all patients with PHPT, and a large multi-center prospective randomized trial may further elucidate the importance of NCPT.