April 1-4, 2017; Orlando, Florida. Your use of this website constitutes acceptance of Haymarket Media’s Privacy Policy and Terms & Conditions. As a consequence, for example, there is no clear indication of how the cognitive profiles of patients with mild hypothyroidism may differ from those with more severe cases. Also, issues pertaining to the confounding influence of test-retest constraints (including practice effects, statistical regression to the mean, etc) need to be seriously considered if serial evaluations are used to document changes in cognitive functioning following treatment.  S Notes on an experimental study of intellectual deterioration.Â, Haggerty Cognitive symptoms of people with hypothyroidism include memory problems and difficulty concentrating.  DB Relation between biochemical severity and intelligence in early treated congenital hypothyroidism: a threshold effect.Â, Rovet  MLetarte  CTYoshikawa However, a recent review of the literature on hypothyroidism as a cause of dementia56 has found no strong evidence for complete reversibility.  JClarke All Rights Reserved, Challenges in Clinical Electrocardiography, Clinical Implications of Basic Neuroscience, Health Care Economics, Insurance, Payment, Scientific Discovery and the Future of Medicine, 1998;158(13):1413-1418. doi:10.1001/archinte.158.13.1413.  ANixon Although early identification and treatment of congenital hypothyroidism has been known to improve scores on formal tests of intelligence, there is still evidence of neurocognitive deficits in attention, visuospatial processing, motor dexterity, and language comprehension skills that may persist through late childhood and in some cases adolescence.  S Neurocognitive characteristics of individuals with resistance to thyroid hormone: comparisons with individuals with attention-deficit hyperactivity disorder.Â, Weiss Serum TT3 and TSH levels might also be used as bio-markers for cognitive dysfunction.  JAlvarez Recent findings: Clinical investigations and functional imaging studies confirm that overt hypothyroidism is associated with affective and cognitive decrements, largely reversible with treatment.  EHHersman  et al.  Attention deficit-hyperactivity disorder in people with generalized resistance to thyroid hormone.Â, Ciaranello However, there is evidence7 that very little thyroxine actually crosses the placental barrier, compelling the fetus to depend almost exclusively on its own thyroid gland, which, if underdeveloped, constitutes an imminent risk for congenital hypothyroidism.  RNSorbara  R A demographically based index of premorbid intelligence for the WAIS-R.Â, Blair  et al.  Cognitive function in non-demented older adults with hypothyroidism.Â, Whybrow  JRSpreen  HSheldon  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  DAGur 32.  CR Mental changes accompanying thyroid gland dysfunction: a reappraisal using objective psychological measurement.Â, Peabody Abstract SUN 027.  D Intellectual outcome in children with fetal hypothyroidism.Â, Tillotson  FN Improved prognosis in congenital hypothyroidism treated before age 3 months.Â, Raiti Hypothyroidism is associated with significant neurocognitive deficits that develop across the life span. Older patients are particularly susceptible to developing primary hypothyroidism, a disease that becomes more common with age.58 Only a few empirical investigations of the neurocognitive effects of hypothyroidism in older populations have addressed these issues. Customize your JAMA Network experience by selecting one or more topics from the list below. … Hypothyroidism is associated with significant neurocognitive deficits that develop across the life span. Normal and pathological brain functions in elderly people can be influenced by TH. I offer some recommendations for addressing the cognitive and behavioral management concerns of individuals with clinical hypothyroidism. AU - Samuels, Mary H. PY - 2008/10/1. Many primary endocrine disorders have notable effects on cognition. Also, and perhaps more importantly, these cognitive impairments must have declined significantly from a higher level of functioning.66 Studies of neurocognitive aspects of hypothyroid dementia may need to demonstrate objective or estimated declines from premorbid levels using one of the many innovative assessment techniques now available.67-71 Without such evidence, reports of dementia in the medical literature may be less defensible, particularly when the data presented indicate a complete reversal of the underlying degenerative process.  JGuyda  BEkins Dugbartey AT. Adult-onset hypothyroidism induces cognitive impairments in learning and memory.  DE The comparability of the WRAT-R Reading Test and NAART as estimates of premorbid intelligence in neurologically impaired patients.Â, Kraken The story, however, is still not that simple: evidence from animal studies8,9 suggests a critical perinatal period during which deficiencies in thyroid gland function result in permanent morphological, histopathological, and behavioral abnormalities. Unfortunately, most of the published reports on neuropsychological functioning in adults with hypothyroidism are based on the assessment of only limited aspects of cognitive domains. In addition, it has often been questioned whether reversals of dementia would be sustained if the patients were observed for extended follow-up periods,64 thus raising concerns about the duration of treatment effects.  MM Changes in brain maturation detected by magnetic resonance imaging in congenital hypothyroidism.Â, Bathia  AM The reversible dementias: do they reverse?Â, Larson  JHTopel Mental health, or cognitive, problems that can occur, most often with thyroid underactivity, include: Difficulties with concentration. Get free access to newly published articles.  SWeber  RMDonner In contrast, subclinical hypothyroidism is not associated with major neuropsychiatric deficits, although studies utilizing sensitive measures show small deficits in memory and …  P The score of Mini Mental State Examination (MMSE) was significantly lower in the group of patients with subclinical hypothyroidism than in euthyroid subjects (p 0.03). Comprehensive neuropsychological evaluations can provide useful suggestions regarding the extent to which any difficulties with learning and memory, fine-motor skills (which influence writing abilities), phonetic, or other linguistic skills can be circumvented in the academic setting. This finding was interpreted as evidence "that intellectual growth in treated congenital hypothyroidism may continue beyond the traditionally expected end point, well into adulthood.  M Thyroid hormone and attention in school-age children with congenital hypothyroidism.Â, Rovet Is subclinical thyroid dysfunction in the elderly associated with depression or cognitive dysfunction?  CJ Hypothyroidism: does treatment cure dementia?Â, Jeste  R Sensorineural hearing loss in sporadic congenital hypothyroidism.Â, Glorieux  DÂ, Pharoah  GH Cretinism: early diagnosis and its relation to mental prognosis.Â, Smith Also, thyroid function and thyroid hormone level could be a risk factor in the development of SIVD. Geschwind  SLFuggle Cognitive dysfunction.  MGarner  RD Attention deficit-hyperactivity disorder and resistance to thyroid hormone: a new idea?Â, Elia  LEggermont Presented at: ENDO 2017. 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. Samuels MH, Schuff KG, Carlson NE, et al. All Rights Reserved.  SN  PODButtfield  S 2.2. Early reports50 regarding the reversibility of dementia have had to contend with spurious artifacts such as the practice effects that may accrue from serial testing over brief periods, thereby unduly overestimating actual cognitive abilities at retest.  J Hearing loss as a function of age.Â, Debruyne This group of teenagers was also administered serial manual dexterity tests,45-47 with results indicating consistent associations between total thyroxine levels and manual dexterity over time. 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 … In a cross-cultural prospective study of nonverbal short-term memory span and pictorial serialposition memory in teenagers from Papua New Guinea (most of whom had an iodine deficiency and mothers who had received supplementary iodine during pregnancy),44 measured levels of total maternal thyroxine were not significantly associated with simple short-term memory span when the cohorts were 14 to 15 years old.  C Placental transport of thyroxine.Â, Legrand  TKalverboer Is subclinical thyroid dysfunction in the elderly associated with depression or cognitive dysfunction? Evoked potential studies of auditory brainstem responses in children with congenital hypothyroidism who received postnatal TRT as early as 3 weeks of age showed significant audiometric deficits well into midchildhood.13 Consistent with these audiometric deficits are findings of hearing impairment14 and expressive language deficits,15 including difficulties with naming,16 in young children, which together call for more a comprehensive assessment of neurocognitive functioning across a broad range of domains in children with congenital hypothyroidism. Considering the Matrix Test (MT) score, the performance was slightly reduced in subclinical hypothyroidism (NS).  JGulotta By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue Recent retrospective Canadian data17 report mild binaural conduction and sensorineural hearing loss in 20% of children with congenital hypothyroidism identified at neonatal screening, with strong indications that early treatment (within 2 weeks after birth) may reduce the incidence of hearing impairment. Thyroid dysfunction is associated with many neuropsychiatric disorders mainly cognitive impairment. 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.  JFCameron  J Preliminary results on the mental development of hypothyroid children detected by the Quebec Screening Program.Â, Money  WBliss Serum TT3 and FT3 levels decreased, whereas serum TSH level increased, with the decline in cognitive functions. 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. Normal and pathological brain functions in elderly people can be influenced by TH. Most of the recent cross-sectional or longitudinal natural history studies have failed to find significant cognitive effects of subclinical hypothyroidism at baseline or developing over time ( 6 – 11 ).  VPoptani  JLCoffey Lack of interest and mental alertness. A close correlation between thyroid status and cognitive dysfunction in SIVD was observed.  RM Long-term effects of L-thyroxine therapy for congenital hypothyroidism.Â, Weiss Cognitive impairment has been regarded as a possible consequence of overt hypothyroidism, although psychiatric disturbances can impact negatively on assessments of cognitive performance .Studies evaluating hypothyroidism and its effects on cognitive function have shown contrasting results, with …  LLaane In terms of motor deficits, the lack of comprehensive empirical data on manipulative dexterity and other pure motor functions in adults does not permit clear comparisons between congenital and acquired hypothyroidism.  MADuck Ritter In concert with these and other methods, end points other than total reversal of cognitive decline related to hypothyroidism may have to be considered as viable clinical targets (eg, reduction in the negative slope of decline in treated patients compared with untreated cohorts) should future empirical research consensus indicate intractability of the hypothyroid dementia complex. Serum TT3 and TSH levels might also be used as bio-markers for cognitive dysfunction. Deficits vary from impaired concentration and slowed processing speed to general declines in intelligence, psychomotor speed, visual-spatial skills, and memory. However, limited data are available on the potential association of thyroid function with mild cognitive … Please login or register first to view this content. 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. 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. thyroid function was associated with cognitive impairments induced by SIVD.  RMPeterson “Our study findings have confirmed and greatly extended previous smaller studies that suggested a link between hypercortisolism and thyroid dysfunction but were inconclusive due … Follow-up studies in congenital hypothyroidism, Neurocognitive dysfunction in adults with hypothyroidism, Get the latest from JAMA Internal Medicine.  Lvan der Meere 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. Methods Prospective longitudinal study of men …  RILüders  J Neurodevelopmental outcome in infants and preschool children following newborn screening for congenital hypothyroidism.Â, Rovet  FN The effects of hypothyroidism upon the ear, nose, and throat: a clinical and experimental study.Â, Meyerhoff Patients with hypothyroidism often exhibit cognitive dysfunction. An evaluation of the commonly held view that hypothyroid dementia is an imminently reversible condition is only partially supported by the medical literature, which is fraught with methodological and conceptual shortcomings. “Brain Fog” and Hypothyroidism What Is “Brain Fog”?  FRRobbins For instance, depression, inability to concentrate, “foggy brain” can be seen in patients with Hypothyroidism (low thyroid function) whereas anxiety can be one of the common symptoms of Hyperthyroidism. Table 1 shows some of the major patterns of cognitive deficits that have been documented in association with hypothyroidism. 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. 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.  KJHetzel  CRChastani  NSTrau Myxedema traditionally has been classified as one of the reversible causes of dementia in the elderly. 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. It is therefore not surprising, that hypothyroidism (HT) affects cognitive functioning at any age, as hypothyroidism prevents the brain from adequately sustaining energy consuming processes important for neurotransmission, memory and other brain function [ 7 ].  M This variability in treatment response and partial recovery may have more severe delayed neurobehavioral consequences in congenital hypothyroidism on TRT than may be expected in adult-onset hypothyroidism. Accepted for publication December 12, 1997. When the researchers, from the University of Pisa, in Italy, examined the results of 13 studies on the effects of subclinical hypothyroidism—defined as elevated serum thyroid-stimulating hormone (TSH) levels and normal thyroxine (T4) levels—they found a 56 percent increased risk of impaired cognitive function and an 81 percent increased risk of dementia.  AF Sustained attention problems in children with early-treated congential hypothyroidism.Â, New England Congenital Hypothyroidism Collaborative, Effects of neonatal screening for hypothyroidism: prevention of mental retardation by treatment before clinical manifestations.Â, Rovet Mental health, or cognitive, problems that can occur, most often with thyroid underactivity, include: Difficulties with concentration.  RCSaykin  IHHetzel  SNewns  GJNaugle  FRRudd The most rigorous studies have also controlled for mood alterations, which can occur in thyroid dysfunction and which affect cognitive measures.  JR Thyroid and Cognitive Function How do thyroid hormones affect brain function, mood and cognition?  JMSawin  PDeCock 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. 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.  JEhrlich A recent study29 of children diagnosed as having attention-deficit/hyperactivity disorder reported an unexpectedly higher incidence of hypothyroidism than hyperthyroidism, the latter indicated by resistance to thyroid hormone (RTH) disorder.30-32 Resistance to thyroid hormone is, in fact, rare in community-based samples of individuals with attention-deficit/hyperactivity disorder.33 Although it appears that the profile of neurocognitive deficits associated with RTH disorder is not entirely consistent with that exhibited in attention-deficit/hyperactivity disorder,34,35 we are still far from understanding exactly how the neurocognitive deficits related to RTH disorder differ from children treated for congenital hypothyroidism, especially given the fact that some individuals with RTH disorder appear to be mildly hypothyroid.36, At least 2 study groups in North America, the Quebec Screening Program15,37 and the New England Congenital Hypothyroidism Collaborative,21,38,39 have reported prospective findings based on neonatal screening and TRT indicating that 10% to 15% of individuals with congenital hypothyroidism were resistant to treatment in their respective studies.  JPGierz Here, we investigated the cognitive functions of Overt hypothyroidism and cognitive dysfunction.  LRovet  RMWilkins [ 2] In the UK, it is estimated that hypothyroidism treated with levothyroxine may affect nearly 800,000 older individuals aged more than 70 years.  AF Motor and cognitive development in children with congenital hypothyroidism: a long-term evaluation of the effects of neonatal treatment.Â, Rovet  M Follow-up at ages 5 and 7 years on mental development in children with hypothyroidism detected by Quebec Screening Program.Â, New England Congenital Hypothyroidism Collaborative, Characteristics of infantile hypothyroidism discovered on infantile screening.Â, New England Congenital Hypothyroidism Collaborative, Neonatal hypothyroidism screening: status of patients at 6 years.Â, Money  JCondliffe  AJ Reading on the Wide Range Achievement Test-Revised and parental education as predictors of IQ: comparisons with the Barona equation.Â, Wiens  J Psychologic studies in hypothyroidism.Â, Rovet Cognitive deficits associated with hypothyroidism tend to be more pronounced in the elderly.  JJEvans  ANBryan Treatment with thyroid hormone causes resolution of these symptoms if their only cause was hypothyroidism.  J Congenital hypothyroidism and IQ increase: a quarter century follow-up.Â, Goodman The aim of the present study was to determine the effects of thyroid hormone replacement therapy on cognition in aSAH survivors with hypothyroidism.  DALehman This article discusses the patterns of cognitive deficits associated with congenital and adult-onset hypothyroidism.
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