Characterizing neurocognitive symptoms in older adults with primary hyperparathyroidism

项目摘要 原发性甲状旁腺功能亢进（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、肾功能下降有关， 和心血管相关的发病率。然而，超过80%的PHPT患者缺乏经典症状 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悄悄发生。 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，可能是患者存在的唯一症状。研究利用 客观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，以及受损的结构和视觉空间记忆。 这些损伤导致老年人的显著功能下降和生活质量（QoL）下降- 非常重视认知能力的保护，将其作为一个重要的健康指标。 甲状旁腺切除术通常作为门诊手术进行，是PHPT的一线治疗， 有疗效的一些研究已经证明了认知功能的改善（甚至正常化）， 术后生活质量。尽管如此，PHPT作为一种诊断往往被忽视，高达70%的 老年人即使符合手术治疗的标准，对PHPT的治疗也不足。均不会及无须 迄今为止，已经进行了关于患有PHPT的老年人的NC症状的研究。因此， 老年人中PHPT相关NC症状的数据，包括可能与 他们的反应和他们的治疗。 在这项提案中，我们的目标是（a）前瞻性地描述NC症状和治疗反应模式， 老年人PHPT使用有效的主观调查工具和一组3个客观NC措施 以及（B）开发结合机器学习和自然语言的基于人工智能的策略 处理技术，以加快PHPT诊断。所有研究将在杜克大学进行 卫生系统。 该提案的目的是： 1：描述PHPT老年人的NC症状 2：描述与老年PHPT相关患者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，以加快老年人PHPT的诊断， 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