Characterizing neurocognitive symptoms in older adults with primary hyperparathyroidism

项目总结 原发性甲状旁腺功能亢进症(PHPT)是一种常见的内分泌疾病，影响约100万老年人(年龄≥，65岁) 美国人。未经治疗的PHPT与骨质疏松症、骨折、肾结石、肾功能下降、 和心血管相关的发病率。然而，80%以上的PHPT患者缺乏典型症状 例如肾结石；它们通常是“无症状”的，即使骨丢失和肾功能衰退无声地发生。 神经认知(NC)症状，包括记忆障碍和认知功能障碍(“脑雾”)， 常见的主观主诉，可能是患者出现的唯一症状。研究利用 目的神经认知测试发现PHPT患者的注意力明显降低 水平，非语言学习过程中的障碍，以及结构和视觉空间记忆的损害。 这些损伤导致老年人功能显著下降和生活质量(QOL)下降-- 非常重视认知的保存作为一个关键的健康指标的人群。 甲状旁腺切除术通常作为门诊手术进行，是PHPT的一线治疗方法，通常 治愈了。一些研究表明，认知功能有所改善，甚至正常化 手术后的生活质量。尽管如此，PHPT作为一种诊断往往被忽视，高达70%的 老年人即使达到了手术治疗的标准，也没有得到充分的PHPT治疗。更进一步说，不 到目前为止，关于患有PHPT的老年人的NC症状的研究已经进行。因此，这里缺乏 老年人中与PHPT相关的NC症状的数据，包括可能是 在他们中普遍存在，以及他们对治疗的反应。 在这项建议中，我们的目标是(A)前瞻性地描述NC的症状和治疗-反应模式 使用经过验证的主观调查工具和一组3项客观NC测量对患有PHPT的老年人进行评估 和(B)制定一项以人工智能为基础的战略，将机器学习和自然语言结合起来 处理技术，以加快PHPT的诊断。所有研究将在杜克大学内进行 卫生系统。 这项建议的目的是： 1：老年人PHPT的NC症状特征 2：描述与PHPT相关的老年患者的治疗反应模式相关的因素 NC症状 3：开发一种基于人工智能的算法，以加快诊断患有PHPT的老年人 或无NC症状

PROJECT SUMMARY Primary hyperparathyroidism (PHPT) is a common endocrine disorder affecting ~1 million older (age ≥ 65 years) Americans. Untreated PHPT is associated with osteoporosis, fractures, kidney stones, renal function decline, and cardiovascular-related morbidity. However, more than 80% of patients with PHPT lack classic symptoms such as kidney stones; they are often “asymptomatic” even as bone loss and renal decline silently occur. Neurocognitive (NC) symptoms, including memory impairment and cognitive dysfunction (“brain fog”), are common subjective complaints and may be the only symptoms with which patients present. Studies utilizing objective neurocognitive testing have found that PHPT patients have significantly diminished concentration levels, impairments in nonverbal learning processes, and compromised constructional and visuospatial memory. These impairments result in significant functional decline and decreased quality of life (QoL) in older adults – the very subpopulation that prizes the preservation of cognition as a critical health metric. Parathyroidectomy, commonly done as an outpatient procedure, is the first-line treatment for PHPT and is often curative. Several studies have demonstrated improvements (and even normalization) in cognitive function and quality of life following surgery. Nonetheless, PHPT is too often overlooked as a diagnosis, and up to 70% of older adults are undertreated for PHPT even when they meet the criteria for surgical treatment. Further, no studies on NC symptoms in older adults with PHPT have been conducted to date. Thus, there is a paucity of data on PHPT-associated NC symptoms among older adults, including specific cognitive deficits that may be prevalent among them and their response to treatment. In this proposal, we aim to (a) prospectively characterize NC symptoms and treatment-response patterns for older adults with PHPT using a validated subjective survey instrument and a battery of 3 objective NC measures and (b) develop an artificial intelligence-based strategy incorporating machine learning and natural language processing techniques, to expedite PHPT diagnosis. All studies will be conducted within the Duke University Health System. The aims of the proposal are: 1: Characterize NC symptoms of older adults with PHPT 2: Delineate factors associated with treatment-response patterns among older patients with PHPT-associated NC symptoms 3: Develop an artificial intelligence-based algorithm to expedite the diagnosis of PHPT among older adults with or without NC symptoms