Cognitive Impairments and the Link to Hypoparathyroidism

Hypo- and Hyperthyroidism
Hypo- and Hyperthyroidism
Cognitive issues are often reported by people with hypoparathyroidism, but there has been limited study data to link the two. Researchers analyzed the potential association.

Cognitive impairments and slower processing speeds correlated with lower serum calcium and higher serum phosphate levels in adults with hypoparathyroidism, according to a study published in the Journal of the Endocrine Society.

Researchers at Columbia University analyzed relationships between cognitive deficits and several variables in a small study group of 19 people with hypoparathyroidism. They used the National Institutes of Health Toolbox® Adult Cognition Battery (NIHTB-CB), the National Institutes of Health Toolbox® Emotion Battery (NIHTB-EB), and the Short Form Health Survey (SF-36) to assess cognitive function, emotional function, and quality of life. Serum calcium, serum phosphate, parathyroid and thyroid-stimulating hormones were measured, as were25-hydroxyvitamin D, estimated glomerular filtration rate (eGFR) and 24-hour urinary calcium excretion.

Approximately 13 of the 19 people in the study group (68%) exhibited cognitive impairments based upon global NIHTB-CB scores. Notable deficits occurred in processing speed, with more subtle impairments in episodic and working memory. Among patients on medication, 3 were on therapies known to impair cognitive function but none of them had impaired processing speed.

Eight study group members reported decreased social satisfaction, 6 reported increased negative affect, and 4 reported decreased psychological well-being on the NIHTB-EB assessment. Compared with normative reference data, patients in this study demonstrated lower SF-36 scores, particularly in areas related to vitality, social functioning, general health perceptions, and role limitations due to physical health problems.

General health perceptions in the SF-36 domain positively correlated with adjusted NIHTB-CB scores measuring processing speed, attention, and executive function. The investigators did not observe any other correlations between NIHTB-CB, NIHTB-EB, and SF-36 scores.

Slower processing speed correlated with hypocalcemia (r =.53, P =.023), hyperphosphatemia (r =−.48, P =.042), and decreased 24-hour urinary excretion of calcium (r =.58, P =.029); however, when comparing individuals with impaired (n=6) versus unimpaired (n=13) processing speeds, only hypocalcemia and hyperphosphatemia reached statistical significance (P =.009 and P =.049, respectively) while 24-hour calcium excretion did not (P =.36). 

The study findings were limited by the small sample size, study homogeneity, inclusion of perimenopausal women, a group researchers said are at risk for cognitive dysfunction, and patients on medications known to affect cognition. A lack of a control group as well as standardized neuropsychological test batteries may have also affected the study results.

“Slowed processing speed can have adverse clinical effects, =the study authors concluded. Increased time is required to perform everyday activities, leading to reduced [quality of life] and potentially affecting safety,” the authors said. “Identification of possible impairment could help with institution of targeted cognitive interventions to reduce symptom burden in this rare but debilitating disease.”  

Disclosure: One study author declared an affiliation with a pharmaceutical company. Please see the original reference for a full list of authors’ disclosures.


Rubin MR, Tabacco G, Omeragic B, Majeed R, Hale C, Brickman AM. A pilot study of cognition among hypoparathyroid adults. J Endocr Soc. Published online January 30, 2022.doi:10.1210/jendso/bvac002