title: Preliminary report: functional MRI of the brain may be the ideal tool for evaluating neuropsychologic and sleep complaints of patients with primary hyperparathyroidism.
abstract: BACKGROUND
  The incidence, pattern, and severity of sleep disturbance and cognitive dysfunction has not been well characterized for patients with primary hyperparathyroidism (PHPT). There is no agreement on the mechanism of the development or resolution of such symptoms, and in no previous study has cerebral activity been functionally assessed and change documented following surgical cure of patients with PHPT.
  
  
  METHODS
  We undertook a prospective analysis to obtain pilot data on 6 patients with PHPT. Functional magnetic resonance imaging (fMRI), formal neuropsychologic (NP) tests, and health-related quality of life (HRQL) measures that included sleep assessments were performed on patients before and after parathyroidectomy. Changes in cortical activation under both conflict and neutral conditions (distracting tasks) were recorded.
  
  
  RESULTS
  Functional MRI demonstrated postoperative changes in medial prefrontal cortex activity during cognitive processing of conflict and nonconflict tasks. Further postoperative changes were noted in the dorsolateral prefrontal cortex and parietal cortex with shifts in activations. In addition to the fMRI findings, the patients demonstrated improvements in sleep and social behavior. They tended to experience less fatigue and their processing speed on cognitive tests improved.
  
  
  CONCLUSIONS
  These data support the feasibility and willingness of patients with PHPT to undergo fMRI assessment. Preliminary findings reflected a generalized improvement in processing efficiency postoperatively compared with a patient's preoperative state, and the HRQL measures showed improved sleep. These findings mirror those expected with sleep dysfunction. Longitudinal assessment with advanced brain imaging technology, neuropsychological (NP), and sleep evaluations is warranted to further explore cognitive, sleep, and HRQL improvement after parathyroidectomy.
authors.affiliation: Department of Surgical Oncology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030-4009, USA. nperrier@mdanderson.org
authors.forename: Nancy D
authors.initials: ND
authors.lastname: Perrier
authors.forename: Laura H
authors.initials: LH
authors.lastname: Coker
authors.forename: Kashemi D
authors.initials: KD
authors.lastname: Rorie
authors.forename: Nicole S
authors.initials: NS
authors.lastname: Burbank
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Kirkland
authors.forename: Leah V
authors.initials: LV
authors.lastname: Passmore
authors.forename: Terry
authors.initials: T
authors.lastname: Tembreull
authors.forename: David A
authors.initials: DA
authors.lastname: Stump
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Laurienti
mesh_terms: D000328:Adult; D001921:Brain; D001927:Brain Diseases / Q000175:diagnosis* / Q000209:etiology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000150:complications* / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000209:etiology; D008875:Middle Aged; D009483:Neuropsychological Tests; D016105:Parathyroidectomy; D010865:Pilot Projects; D011446:Prospective Studies; D011788:Quality of Life; D012893:Sleep Wake Disorders / Q000175:diagnosis* / Q000209:etiology