© 2021 American Medical Association. Thyroid dysfunction is a common condition that affects between 3 and 21% of the population with prevalence being more common in women and in older individuals. Deficits vary from impaired concentration and slowed processing speed to general declines in intelligence, psychomotor speed, visual-spatial skills, and memory. Connolly Customize your JAMA Network experience by selecting one or more topics from the list below.  RB MRI of the brain in sporadic congenital hypothyroidism (SCH) and endemic iodine deficiency cretinism.Â, Siragusa In sum, the current empirical studies that claim that hypothyroidism is a fully reversible dementia are constrained by significant conceptual and methodological difficulties, and in many cases do not report consistent improvements to normal or premorbid levels of cognitive functioning following treatment. Presented at: ENDO 2017.  J Hearing loss as a function of age.Â, Debruyne  J Congenital hypothyroidism and IQ increase: a quarter century follow-up.Â, Goodman For example, a Belgian study19 found notable deficits in the attention spans and cognitive information processing skills of children whose average IQ was a normal 100.1 (range, 87.6-113.8).  RM Long-term effects of L-thyroxine therapy for congenital hypothyroidism.Â, Weiss  E Long-term neurodevelopmental correlates of treatment adequacy in screened hypothyroid children.Â, Rovet  GJNaugle  ANBryan Deterioration in cognitive function (memory, attention, planning and productivity) and emotional lability are also recognised manifestations of hyperthyroidism.2 One of the reasons why this is easily missed is the clinical context: the symptoms may not be revealed in favour of a more obviously “neurological” symptom such as tremor, and even then they are not … Subclinical thyroid dysfunction and cognitive decline in old age. While there is conflicting evidence in the literature on adult and congenital hypothyroidism regarding the extent and duration of recovery of cognitive functions following treatment with TRT, such recovery may not always be complete and does not seem to follow a consistent pattern in all cases.  GH Cretinism: early diagnosis and its relation to mental prognosis.Â, Smith Clearly, more data are needed to determine the extent to which hypothyroid dementia can be treated and the level of disease severity for which pharmacological intervention would be most effective. Previous studies have demonstrated the ill effects of overt hypothyroidism on cognition in children, but the impact of subclinical hypothyroidism is not known. While children with congenital hypothyroidism have demonstrated notable neurocognitive impairments based on objective cognitive tests designed to assess attention span20 (rather than on the basis of observer ratings of distractibility and inattention), it appears that numerous other factors, including overall treatment efficacy,21 disease onset,22 severity,23 and duration,24 as well as levels of thyroxine and thyrotropin,25-28 contribute to the clinical manifestation of the attention deficits. Another important observation in the current empirical literature that must be considered is the lack of adequate classification criteria by which different degrees of thyroid gland hypofunction may be associated with their respective neurocognitive sequelae.  IHHetzel At first glance, congenital and adult-onset hypothyroidism may appear to be associated with similar patterns of neurocognitive deficits, especially with regard to short-term memory, visuospatial perception, and general intelligence.  SM Clinical features that predict potentially reversible progressive intellectual deterioration.Â, Cummings Health status, mood, and cognition in experimentally induced subclinical hypothyroidism. 1998;158(13):1413–1418.  BEkins AU - Samuels, Mary H. PY - 2008/10/1. A review of the extant literature shows that the successful treatment of clinically evident thyroid gland hypofunction, resulting in a return to euthyroidism in both infants and adults, may be associated with only partial and typically inconsistent patterns of recovery of overall neurocognitive function. In addition, with the exception of studies45-47 that found a consistent association between total thyroxine levels and motor dexterity over time, improvements in neurocognitive abilities do not generally appear to follow a predictable course, even with continued return to euthyroidism.  JFEhrlich For instance, there is a paucity of extant research on sustained and selective visual attention, speed of visual information processing, abstract concept formation and complex problem-solving abilities, academic achievement skills, tactile perception, and praxis/motor functions in patients with thyroid gland hypofunction. Here, we investigated the cognitive functions of  MGHarris  HLackey The onset of primary clinical hypothyroidism in adults has a variety of adverse effects on adaptive neurocognitive functioning. In addition to demonstrating different patterns of cognitive impairments, patients with congenital and acquired adult-onset hypothyroidism have variable responses to thyroid replacement therapy, which increases the risk of higher neurocognitive morbidity associated with congenital hypothyroidism. Adult-onset hypothyroidism induces cognitive impairments in learning and memory.  CDKapila  MS Dementia in the elderly: a search for treatable illness.Â, Freemon  JR Estimating WAIS-R FSIQ from National Adult Reading Test-Revised in normal subjects.Â, Wolff Hypothyroidism is associated with significant neurocognitive deficits that develop across the life span. Table 1 shows some of the major patterns of cognitive deficits that have been documented in association with hypothyroidism.  EVanasse Central hypothyroidism is prevalent in about 1 in 2 adults with Cushing’s syndrome, and thyroid function can be restored after curative surgery for most patients, according to study findings.  et al.  Low intelligence but not attention deficit hyperactivity disorder is associated with resistance to thyroid hormone caused by mutation R316H in the thyroid hormone receptor β gene.Â, Maenpaa This, however, does not imply that the progressive and relentless neurocognitive decline usually seen in patients with untreated hypothyroidism cannot be averted or at least slowed with prompt and appropriate pharmacological management. While both overt hyper- and hypothyroidism are known to lead to cognitive impairment and clinical guidelines recommend screening for thyroid dysfunction among patients with cognitive disorders (8), data on the association between subclinical thyroid dysfunction (SCTD) and cognitive function remain conflicting.  SLFuggle You’ve read {{metering-count}} of {{metering-total}} articles this month. To view unlimited content, log in or register for free. Short-term memory lapses.  KJEkins  SKenney The most rigorous studies have also controlled for mood alterations, which can occur in thyroid dysfunction and which affect cognitive measures.  J Psychologic studies in hypothyroidism.Â, Rovet One has to do with the extent and ability of the brain to recover lost function. Clinical and subclinical hypothyroidism as well as hyperthyroidism in middle-aged and elderly adults are both associated with decreased cognitive functioning, especially memory, visuospatial organization, attention, and reaction time. Get free access to newly published articles.  JEhrlich “Our study findings have confirmed and greatly extended previous smaller studies that suggested a link between hypercortisolism and thyroid dysfunction but were inconclusive due … We found a close correlation between thyroid status and cognitive dysfunction.  JR Progressive dementia associated with thyroid disease.Â, Clarnette Want to view more content from Neurology Advisor?  BCallahan Serum TT3 and TSH levels might also be used as bio-markers for cognitive dysfunction.  DFLoVerma One of the biological mechanisms underlying the relationship between thyroid dysfunction and dementia is suggested to be associated with cardiac vascular disease, which can contribute to cognitive impairment in later life (Wijsman et al. It has often been argued that more emphasis should be placed on the appropriate social management of patients with cognitive decline related to hypothyroidism,72 and that classification of reversible and irreversible forms of dementia65 be avoided. Please login or register first to view this content.  O Predicting premorbid IQ: a revision of the national adult reading test.Â, Johnstone Although the current empirical literature on the neurocognitive effects of clinical hypothyroidism is quite rudimentary, it is obvious that every individual diagnosed as having this disorder should be referred for comprehensive neuropsychological evaluation in view of the strong risk for cognitive morbidity.  FRRudd  RT Neuroendocrine testing in electroconvulsive therapy.Â, Nemeroff Recent innovative and promising techniques used to determine the reliability of data indicating neurocognitive change following intervention79 are currently being explored in clinical neuropsychological research80 and may be useful in assessing the reversibility of hypothyroid dementia. Reprints: Anthony T. Dugbartey, PhD, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Box 356560, Seattle, WA 98195-6560. In the elderly, there are multiple causes for cognitive problems other than hypothyroidism.  JR Deficits vary from impaired concentration and slowed processing speed to general declines in intelligence, psychomotor speed, visual-spatial skills, and memory. Thyroid dysfunction in children may adversely affect cognitive skills — specifically processing speed — according to the results of a study presented at the 2017 annual meeting of the Endocrine Society, April 1-4, 2017 in Orlando, Florida. A number of researchers59-63 have reported that between 10% and 30% of patients diagnosed as having syndromes that cause dementia have reversible or potentially treatable dementia. This article discusses the patterns of cognitive deficits associated with congenital and adult-onset hypothyroidism. I offer some recommendations for addressing the cognitive and behavioral management concerns of individuals with clinical hypothyroidism. Untreated hypothyroidism can contribute to hypertension, dyslipidemia, infertility, cognitive … Cognitive impairment is common in hypothyroidism and can range from mild to severe. 2013).  R Maternal thyroid function and motor competence in the child.Â, Pharoah  G Thyroid imbalance very commonly manifests as emotional and/or behavioral change.  SMChelune  G Severe hypothyroidism and the maturation of the rat cerebral cortex.Â, Klein Close more info about Cognitive Skills Adversely Affected by Thyroid Dysfunction, Treating Pain in Depression May Help Improve Cognition, Dysglycemia Impacts Brain Structure, Cognition, Evolocumab Does Not Affect Cognition When Combined With Statin Therapy. Primary disease was defined as low free thyroxine (T4)/total T4 and high thyroid stimulating hormone (TSH), subclinical disease was defined as normal free T4/total T4 and TSH above normal but <15 mIU/L, and normal function was defined as normal free T4/total T4 and normal TSH. 2013;8(3):e59199.  OTupper  KM Memory, mood and measurement in hypothyroidism.Â, Osterweil  AJTreadway  RD Attention deficit-hyperactivity disorder and resistance to thyroid hormone: a new idea?Â, Elia which your thyroid gland doesn't produce enough of certain crucial hormones. While this window of opportunity has not been clearly delineated in humans, there are reports of normal intellectual function in patients with hypothyroidism who underwent thyroid replacement therapy (TRT) prior to 3 or even 7 months of age.10-12 Despite these findings, the lack of a comprehensive evaluation of a wide variety of cognitive domains other than general intelligence (eg, attention, language, learning and memory skills) necessitates restraint in inferring that early intervention with TRT results in normal neurocognitive functioning.  JJKalverboer Y1 - 2008/10/1.  JLCoffey Cognitive deficits associated with hypothyroidism tend to be more pronounced in the elderly. The relationship between alterations in thyroid function and cognitive deficits has been investigated in several previous studies.  AF Motor and cognitive development in children with congenital hypothyroidism: a long-term evaluation of the effects of neonatal treatment.Â, Rovet  MGarner These results indicated that transgenic mice with the C57BL/6j genetic background are more suitable for revealing the mechanism underlying hypothyroidism-induced cognitive dysfunction, and that the cholinergic basal forebrain may be the appropriate target for treating cognitive dysfunction in adult-onset hypothyroidism.  VBoffelli  JDussault The thyroid hormone is important to the functional development and maturation of the central nervous system; the association between the absence of thyroid hormones and congenital hypothyroidism and profound mental retardation has been recognized for more than a century.  R Sensorineural hearing loss in sporadic congenital hypothyroidism.Â, Glorieux In 2018, a clinical review found that clinical and subclinical hypothyroidism as well as overt hyperthyroidism in middle-aged and elderly adults are both associated with decreased cognitive functioning. Interestingly, the few studies that have used the Mini-Mental State Examination or variations of this general-purpose cognitive screening test (Table 1) have reported clinically significant and relentless impairments that seem to be refractory to treatment in patients with hypothyroidism. thyroid function was associated with cognitive impairments induced by SIVD.  JLiewendahl  J Morphogenetic action of thyroid hormones.Â, Ruis-Marcos Considering the Matrix Test (MT) score, the performance was slightly reduced in subclinical hypothyroidism (NS).  WBliss  J The meaning of IQ constancy in young retarded children.Â, Spreen What is patently clear in both age groups, however, is the inexorable global decline in cognition when TRT is either delayed or absent. Patients with hypothyroidism often exhibit cognitive dysfunction.  JJVulsma  P Clinical significance: a statistical approach to defining meaningful change in psychotherapy research.Â, Sawrie  LLaane  JWalker  PFCummings Unfortunately, one cannot always be sure that these neuropsychological findings are exclusively due to the effects of hypothyroidism, because the likelihood of comorbidity with neurodegenerative disorders or other factors influencing cognitive status57 may be quite high.  CR Mental changes accompanying thyroid gland dysfunction: a reappraisal using objective psychological measurement.Â, Peabody Such errors of omission would be minimized if clinicians became more knowledgeable about the patterns of cognitive deficits that accompany hypothyroidism.  JF Medical diagnosis and intelligence levels in young mentally retarded children.Â, Goodman  MField Hence, the age at which hearing loss may have occurred in association with hypothyroidism is bound to have a differential impact on the nature and severity of subsequent language disorders exhibited on neurocognitive assessment in various age groups.  DR Dementia in elderly outpatients: a prospective study.Â, Barona  LEggermont Early assessment of cognition in adults can provide objective evidence for changes in their neuropsychological status over time, with ramifications for the establishment of long-term care planning and management.  RILüders No correlation was found between FT4 and FT3 and MMSE, PMT and MT score. Furthermore, TSH was negatively correlated with MMSE (p<0.04), PMT (p<0.05) and MT score (NS). Kooistra  FDooms  HO Empirical methods for assessing meaningful neuropsychological change following epilepsy surgery.Â.  et al.  Brain magnetic resonance imaging in congenital hypothyroid infants at diagnosis.Â, Fisher

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