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.

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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

This article originally appeared on Endocrinology Advisor