Association of Thyroid Dysfunction With Cognitive Function: An Individual Participant Data Analysis
IMPORTANCE: In clinical guidelines, overt and subclinical thyroid dysfunction are mentioned as causal and treatable factors for cognitive decline. However, the scientific literature on these associations shows inconsistent findings. OBJECTIVE: To assess cross-sectional and longitudinal associations...
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| creator | van Vliet, Nicolien A van Heemst, Diana Almeida, Osvaldo P Åsvold, Bjørn O Aubert, Carole E Bae, Jong Bin Barnes, Linda E Bauer, Douglas C Blauw, Gerard J Brayne, Carol Cappola, Anne R Ceresini, Graziano Comijs, Hannie C Dartigues, Jean-Francois Degryse, Jean-Marie Dullaart, Robin P. F van Eersel, Marlise E. A den Elzen, Wendy P. J Ferrucci, Luigi Fink, Howard A Flicker, Leon Grabe, Hans J Han, Ji Won Helmer, Catherine Huisman, Martijn Ikram, M. Arfan Imaizumi, Misa de Jongh, Renate T Jukema, J. Wouter Kim, Ki Woong Kuller, Lewis H Lopez, Oscar L Mooijaart, Simon P Moon, Jae Hoon Moutzouri, Elisavet Nauck, Matthias Parle, Jim Peeters, Robin P Samuels, Mary H Schmidt, Carsten O Schminke, Ulf Slagboom, P. Eline Stordal, Eystein Vaes, Bert Völzke, Henry Westendorp, Rudi G. J Yamada, Michiko Yeap, Bu B Rodondi, Nicolas Gussekloo, Jacobijn Trompet, Stella |
| description | IMPORTANCE: In clinical guidelines, overt and subclinical thyroid dysfunction are mentioned as causal and treatable factors for cognitive decline. However, the scientific literature on these associations shows inconsistent findings. OBJECTIVE: To assess cross-sectional and longitudinal associations of baseline thyroid dysfunction with cognitive function and dementia. DESIGN, SETTING, AND PARTICIPANTS: This multicohort individual participant data analysis assessed 114 267 person-years (median, 1.7-11.3 years) of follow-up for cognitive function and 525 222 person-years (median, 3.8-15.3 years) for dementia between 1989 and 2017. Analyses on cognitive function included 21 cohorts comprising 38 144 participants. Analyses on dementia included eight cohorts with a total of 2033 cases with dementia and 44 573 controls. Data analysis was performed from December 2016 to January 2021. EXPOSURES: Thyroid function was classified as overt hyperthyroidism, subclinical hyperthyroidism, euthyroidism, subclinical hypothyroidism, and overt hypothyroidism based on uniform thyrotropin cutoff values and study-specific free thyroxine values. MAIN OUTCOMES AND MEASURES: The primary outcome was global cognitive function, mostly measured using the Mini-Mental State Examination. Executive function, memory, and dementia were secondary outcomes. Analyses were first performed at study level using multivariable linear regression and multivariable Cox regression, respectively. The studies were combined with restricted maximum likelihood meta-analysis. To overcome the use of different scales, results were transformed to standardized mean differences. For incident dementia, hazard ratios were calculated. RESULTS: Among 74 565 total participants, 66 567 (89.3%) participants had normal thyroid function, 577 (0.8%) had overt hyperthyroidism, 2557 (3.4%) had subclinical hyperthyroidism, 4167 (5.6%) had subclinical hypothyroidism, and 697 (0.9%) had overt hypothyroidism. The study-specific median age at baseline varied from 57 to 93 years; 42 847 (57.5%) participants were women. Thyroid dysfunction was not associated with global cognitive function; the largest differences were observed between overt hypothyroidism and euthyroidism—cross-sectionally (−0.06 standardized mean difference in score; 95% CI, –0.20 to 0.08; P = .40) and longitudinally (0.11 standardized mean difference higher decline per year; 95% CI, –0.01 to 0.23; P = .09). No consistent associations were observed between thyroid d |
| doi_str_mv | 10.1001/jamainternmed.2021.5078 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8424529</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><ama_id>2783799</ama_id><sourcerecordid>2597513439</sourcerecordid><originalsourceid>FETCH-LOGICAL-a395t-abe872d82f2cb2682c862920aa54e4c255aaf657b5df69573ac6d15f716743f03</originalsourceid><addsrcrecordid>eNpdkUtvEzEUhUcIRKvSP8ACLLGBRYKf4xkWSFH6lCLBooildeOxG0cTO9ieSPn3eJoQ0Xpj697vHF_7VNVHgqcEY_J1DRtwPpvoN6abUkzJVGDZvKrOKambSU0If3064_qsukxpjctqMOaMva3OGOctoXVzXulZSkE7yC54FCx6WO1jcB262ic7eP1U_u3yCs3Do3fZ7Qy6Oda_oZlH975zO9cN0KOfELPTbgs-oyvIUNrQ75NL76o3FvpkLo_7RfXr5vphfjdZ_Li9n88WE2CtyBNYmkbSrqGW6mUZjuqmpi3FAIIbrqkQALYWcik6W7dCMtB1R4SVpJacWcwuqu8H3-2wLD-jjc8RerWNbgNxrwI49bzj3Uo9hp1qOOWCtsXgy8Fg9UJ2N1uosYYZJ63gfEcK-_l4WQx_BpOy2rikTd-DN2FIigqJCW4EG20_vUDXYYjlc0aqlYIw_kTJA6VjSCkae5qAYDXmrp7lrsbc1Zh7UX74_90n3b-UC_D-ABSDU5cWpWxb9hfAZrXk</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2597513439</pqid></control><display><type>article</type><title>Association of Thyroid Dysfunction With Cognitive Function: An Individual Participant Data Analysis</title><source>MEDLINE</source><source>American Medical Association Journals</source><creator>van Vliet, Nicolien A ; van Heemst, Diana ; Almeida, Osvaldo P ; Åsvold, Bjørn O ; Aubert, Carole E ; Bae, Jong Bin ; Barnes, Linda E ; Bauer, Douglas C ; Blauw, Gerard J ; Brayne, Carol ; Cappola, Anne R ; Ceresini, Graziano ; Comijs, Hannie C ; Dartigues, Jean-Francois ; Degryse, Jean-Marie ; Dullaart, Robin P. F ; van Eersel, Marlise E. A ; den Elzen, Wendy P. J ; Ferrucci, Luigi ; Fink, Howard A ; Flicker, Leon ; Grabe, Hans J ; Han, Ji Won ; Helmer, Catherine ; Huisman, Martijn ; Ikram, M. Arfan ; Imaizumi, Misa ; de Jongh, Renate T ; Jukema, J. Wouter ; Kim, Ki Woong ; Kuller, Lewis H ; Lopez, Oscar L ; Mooijaart, Simon P ; Moon, Jae Hoon ; Moutzouri, Elisavet ; Nauck, Matthias ; Parle, Jim ; Peeters, Robin P ; Samuels, Mary H ; Schmidt, Carsten O ; Schminke, Ulf ; Slagboom, P. Eline ; Stordal, Eystein ; Vaes, Bert ; Völzke, Henry ; Westendorp, Rudi G. J ; Yamada, Michiko ; Yeap, Bu B ; Rodondi, Nicolas ; Gussekloo, Jacobijn ; Trompet, Stella</creator><creatorcontrib>van Vliet, Nicolien A ; van Heemst, Diana ; Almeida, Osvaldo P ; Åsvold, Bjørn O ; Aubert, Carole E ; Bae, Jong Bin ; Barnes, Linda E ; Bauer, Douglas C ; Blauw, Gerard J ; Brayne, Carol ; Cappola, Anne R ; Ceresini, Graziano ; Comijs, Hannie C ; Dartigues, Jean-Francois ; Degryse, Jean-Marie ; Dullaart, Robin P. F ; van Eersel, Marlise E. A ; den Elzen, Wendy P. J ; Ferrucci, Luigi ; Fink, Howard A ; Flicker, Leon ; Grabe, Hans J ; Han, Ji Won ; Helmer, Catherine ; Huisman, Martijn ; Ikram, M. Arfan ; Imaizumi, Misa ; de Jongh, Renate T ; Jukema, J. Wouter ; Kim, Ki Woong ; Kuller, Lewis H ; Lopez, Oscar L ; Mooijaart, Simon P ; Moon, Jae Hoon ; Moutzouri, Elisavet ; Nauck, Matthias ; Parle, Jim ; Peeters, Robin P ; Samuels, Mary H ; Schmidt, Carsten O ; Schminke, Ulf ; Slagboom, P. Eline ; Stordal, Eystein ; Vaes, Bert ; Völzke, Henry ; Westendorp, Rudi G. J ; Yamada, Michiko ; Yeap, Bu B ; Rodondi, Nicolas ; Gussekloo, Jacobijn ; Trompet, Stella ; Thyroid Studies Collaboration ; Thyroid Studies Collaboration</creatorcontrib><description>IMPORTANCE: In clinical guidelines, overt and subclinical thyroid dysfunction are mentioned as causal and treatable factors for cognitive decline. However, the scientific literature on these associations shows inconsistent findings. OBJECTIVE: To assess cross-sectional and longitudinal associations of baseline thyroid dysfunction with cognitive function and dementia. DESIGN, SETTING, AND PARTICIPANTS: This multicohort individual participant data analysis assessed 114 267 person-years (median, 1.7-11.3 years) of follow-up for cognitive function and 525 222 person-years (median, 3.8-15.3 years) for dementia between 1989 and 2017. Analyses on cognitive function included 21 cohorts comprising 38 144 participants. Analyses on dementia included eight cohorts with a total of 2033 cases with dementia and 44 573 controls. Data analysis was performed from December 2016 to January 2021. EXPOSURES: Thyroid function was classified as overt hyperthyroidism, subclinical hyperthyroidism, euthyroidism, subclinical hypothyroidism, and overt hypothyroidism based on uniform thyrotropin cutoff values and study-specific free thyroxine values. MAIN OUTCOMES AND MEASURES: The primary outcome was global cognitive function, mostly measured using the Mini-Mental State Examination. Executive function, memory, and dementia were secondary outcomes. Analyses were first performed at study level using multivariable linear regression and multivariable Cox regression, respectively. The studies were combined with restricted maximum likelihood meta-analysis. To overcome the use of different scales, results were transformed to standardized mean differences. For incident dementia, hazard ratios were calculated. RESULTS: Among 74 565 total participants, 66 567 (89.3%) participants had normal thyroid function, 577 (0.8%) had overt hyperthyroidism, 2557 (3.4%) had subclinical hyperthyroidism, 4167 (5.6%) had subclinical hypothyroidism, and 697 (0.9%) had overt hypothyroidism. The study-specific median age at baseline varied from 57 to 93 years; 42 847 (57.5%) participants were women. Thyroid dysfunction was not associated with global cognitive function; the largest differences were observed between overt hypothyroidism and euthyroidism—cross-sectionally (−0.06 standardized mean difference in score; 95% CI, –0.20 to 0.08; P = .40) and longitudinally (0.11 standardized mean difference higher decline per year; 95% CI, –0.01 to 0.23; P = .09). No consistent associations were observed between thyroid dysfunction and executive function, memory, or risk of dementia. CONCLUSIONS AND RELEVANCE: In this individual participant data analysis of more than 74 000 adults, subclinical hypothyroidism and hyperthyroidism were not associated with cognitive function, cognitive decline, or incident dementia. No rigorous conclusions can be drawn regarding the role of overt thyroid dysfunction in risk of dementia. These findings do not support the practice of screening for subclinical thyroid dysfunction in the context of cognitive decline in older adults as recommended in current guidelines.</description><identifier>ISSN: 2168-6106</identifier><identifier>EISSN: 2168-6114</identifier><identifier>DOI: 10.1001/jamainternmed.2021.5078</identifier><identifier>PMID: 34491268</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>Aged ; Cognition - physiology ; Cognitive ability ; Cognitive Dysfunction - diagnosis ; Cognitive Dysfunction - physiopathology ; Correlation of Data ; Data Analysis ; Dementia ; Female ; Humans ; Hyperthyroidism - blood ; Hyperthyroidism - diagnosis ; Hyperthyroidism - psychology ; Hypothyroidism - blood ; Hypothyroidism - diagnosis ; Hypothyroidism - psychology ; Life Sciences ; Male ; Mental Status and Dementia Tests - statistics & numerical data ; Online First ; Original Investigation ; Risk Assessment - methods ; Risk Assessment - statistics & numerical data ; Santé publique et épidémiologie ; Thyroid diseases ; Thyroid Function Tests - methods ; Thyroid Function Tests - statistics & numerical data ; Thyroid gland ; Thyroid Gland - physiopathology ; Thyrotropin - analysis ; Thyroxine - analysis</subject><ispartof>Archives of internal medicine (1960), 2021-11, Vol.181 (11), p.1440-1450</ispartof><rights>Copyright American Medical Association Nov 2021</rights><rights>Attribution</rights><rights>Copyright 2021 van Vliet NA et al. .</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-a395t-abe872d82f2cb2682c862920aa54e4c255aaf657b5df69573ac6d15f716743f03</cites><orcidid>0000-0001-5307-663X ; 0000-0003-2418-4257</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jamanetwork.com/journals/jamainternalmedicine/articlepdf/10.1001/jamainternmed.2021.5078$$EPDF$$P50$$Gama$$H</linktopdf><linktohtml>$$Uhttps://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2021.5078$$EHTML$$P50$$Gama$$H</linktohtml><link.rule.ids>64,230,314,780,784,885,3340,27924,27925,76489,76492</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34491268$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.science/hal-03419544$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>van Vliet, Nicolien A</creatorcontrib><creatorcontrib>van Heemst, Diana</creatorcontrib><creatorcontrib>Almeida, Osvaldo P</creatorcontrib><creatorcontrib>Åsvold, Bjørn O</creatorcontrib><creatorcontrib>Aubert, Carole E</creatorcontrib><creatorcontrib>Bae, Jong Bin</creatorcontrib><creatorcontrib>Barnes, Linda E</creatorcontrib><creatorcontrib>Bauer, Douglas C</creatorcontrib><creatorcontrib>Blauw, Gerard J</creatorcontrib><creatorcontrib>Brayne, Carol</creatorcontrib><creatorcontrib>Cappola, Anne R</creatorcontrib><creatorcontrib>Ceresini, Graziano</creatorcontrib><creatorcontrib>Comijs, Hannie C</creatorcontrib><creatorcontrib>Dartigues, Jean-Francois</creatorcontrib><creatorcontrib>Degryse, Jean-Marie</creatorcontrib><creatorcontrib>Dullaart, Robin P. F</creatorcontrib><creatorcontrib>van Eersel, Marlise E. A</creatorcontrib><creatorcontrib>den Elzen, Wendy P. J</creatorcontrib><creatorcontrib>Ferrucci, Luigi</creatorcontrib><creatorcontrib>Fink, Howard A</creatorcontrib><creatorcontrib>Flicker, Leon</creatorcontrib><creatorcontrib>Grabe, Hans J</creatorcontrib><creatorcontrib>Han, Ji Won</creatorcontrib><creatorcontrib>Helmer, Catherine</creatorcontrib><creatorcontrib>Huisman, Martijn</creatorcontrib><creatorcontrib>Ikram, M. Arfan</creatorcontrib><creatorcontrib>Imaizumi, Misa</creatorcontrib><creatorcontrib>de Jongh, Renate T</creatorcontrib><creatorcontrib>Jukema, J. Wouter</creatorcontrib><creatorcontrib>Kim, Ki Woong</creatorcontrib><creatorcontrib>Kuller, Lewis H</creatorcontrib><creatorcontrib>Lopez, Oscar L</creatorcontrib><creatorcontrib>Mooijaart, Simon P</creatorcontrib><creatorcontrib>Moon, Jae Hoon</creatorcontrib><creatorcontrib>Moutzouri, Elisavet</creatorcontrib><creatorcontrib>Nauck, Matthias</creatorcontrib><creatorcontrib>Parle, Jim</creatorcontrib><creatorcontrib>Peeters, Robin P</creatorcontrib><creatorcontrib>Samuels, Mary H</creatorcontrib><creatorcontrib>Schmidt, Carsten O</creatorcontrib><creatorcontrib>Schminke, Ulf</creatorcontrib><creatorcontrib>Slagboom, P. Eline</creatorcontrib><creatorcontrib>Stordal, Eystein</creatorcontrib><creatorcontrib>Vaes, Bert</creatorcontrib><creatorcontrib>Völzke, Henry</creatorcontrib><creatorcontrib>Westendorp, Rudi G. J</creatorcontrib><creatorcontrib>Yamada, Michiko</creatorcontrib><creatorcontrib>Yeap, Bu B</creatorcontrib><creatorcontrib>Rodondi, Nicolas</creatorcontrib><creatorcontrib>Gussekloo, Jacobijn</creatorcontrib><creatorcontrib>Trompet, Stella</creatorcontrib><creatorcontrib>Thyroid Studies Collaboration</creatorcontrib><creatorcontrib>Thyroid Studies Collaboration</creatorcontrib><title>Association of Thyroid Dysfunction With Cognitive Function: An Individual Participant Data Analysis</title><title>Archives of internal medicine (1960)</title><addtitle>JAMA Intern Med</addtitle><description>IMPORTANCE: In clinical guidelines, overt and subclinical thyroid dysfunction are mentioned as causal and treatable factors for cognitive decline. However, the scientific literature on these associations shows inconsistent findings. OBJECTIVE: To assess cross-sectional and longitudinal associations of baseline thyroid dysfunction with cognitive function and dementia. DESIGN, SETTING, AND PARTICIPANTS: This multicohort individual participant data analysis assessed 114 267 person-years (median, 1.7-11.3 years) of follow-up for cognitive function and 525 222 person-years (median, 3.8-15.3 years) for dementia between 1989 and 2017. Analyses on cognitive function included 21 cohorts comprising 38 144 participants. Analyses on dementia included eight cohorts with a total of 2033 cases with dementia and 44 573 controls. Data analysis was performed from December 2016 to January 2021. EXPOSURES: Thyroid function was classified as overt hyperthyroidism, subclinical hyperthyroidism, euthyroidism, subclinical hypothyroidism, and overt hypothyroidism based on uniform thyrotropin cutoff values and study-specific free thyroxine values. MAIN OUTCOMES AND MEASURES: The primary outcome was global cognitive function, mostly measured using the Mini-Mental State Examination. Executive function, memory, and dementia were secondary outcomes. Analyses were first performed at study level using multivariable linear regression and multivariable Cox regression, respectively. The studies were combined with restricted maximum likelihood meta-analysis. To overcome the use of different scales, results were transformed to standardized mean differences. For incident dementia, hazard ratios were calculated. RESULTS: Among 74 565 total participants, 66 567 (89.3%) participants had normal thyroid function, 577 (0.8%) had overt hyperthyroidism, 2557 (3.4%) had subclinical hyperthyroidism, 4167 (5.6%) had subclinical hypothyroidism, and 697 (0.9%) had overt hypothyroidism. The study-specific median age at baseline varied from 57 to 93 years; 42 847 (57.5%) participants were women. Thyroid dysfunction was not associated with global cognitive function; the largest differences were observed between overt hypothyroidism and euthyroidism—cross-sectionally (−0.06 standardized mean difference in score; 95% CI, –0.20 to 0.08; P = .40) and longitudinally (0.11 standardized mean difference higher decline per year; 95% CI, –0.01 to 0.23; P = .09). No consistent associations were observed between thyroid dysfunction and executive function, memory, or risk of dementia. CONCLUSIONS AND RELEVANCE: In this individual participant data analysis of more than 74 000 adults, subclinical hypothyroidism and hyperthyroidism were not associated with cognitive function, cognitive decline, or incident dementia. No rigorous conclusions can be drawn regarding the role of overt thyroid dysfunction in risk of dementia. These findings do not support the practice of screening for subclinical thyroid dysfunction in the context of cognitive decline in older adults as recommended in current guidelines.</description><subject>Aged</subject><subject>Cognition - physiology</subject><subject>Cognitive ability</subject><subject>Cognitive Dysfunction - diagnosis</subject><subject>Cognitive Dysfunction - physiopathology</subject><subject>Correlation of Data</subject><subject>Data Analysis</subject><subject>Dementia</subject><subject>Female</subject><subject>Humans</subject><subject>Hyperthyroidism - blood</subject><subject>Hyperthyroidism - diagnosis</subject><subject>Hyperthyroidism - psychology</subject><subject>Hypothyroidism - blood</subject><subject>Hypothyroidism - diagnosis</subject><subject>Hypothyroidism - psychology</subject><subject>Life Sciences</subject><subject>Male</subject><subject>Mental Status and Dementia Tests - statistics & numerical data</subject><subject>Online First</subject><subject>Original Investigation</subject><subject>Risk Assessment - methods</subject><subject>Risk Assessment - statistics & numerical data</subject><subject>Santé publique et épidémiologie</subject><subject>Thyroid diseases</subject><subject>Thyroid Function Tests - methods</subject><subject>Thyroid Function Tests - statistics & numerical data</subject><subject>Thyroid gland</subject><subject>Thyroid Gland - physiopathology</subject><subject>Thyrotropin - analysis</subject><subject>Thyroxine - analysis</subject><issn>2168-6106</issn><issn>2168-6114</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkUtvEzEUhUcIRKvSP8ACLLGBRYKf4xkWSFH6lCLBooildeOxG0cTO9ieSPn3eJoQ0Xpj697vHF_7VNVHgqcEY_J1DRtwPpvoN6abUkzJVGDZvKrOKambSU0If3064_qsukxpjctqMOaMva3OGOctoXVzXulZSkE7yC54FCx6WO1jcB262ic7eP1U_u3yCs3Do3fZ7Qy6Oda_oZlH975zO9cN0KOfELPTbgs-oyvIUNrQ75NL76o3FvpkLo_7RfXr5vphfjdZ_Li9n88WE2CtyBNYmkbSrqGW6mUZjuqmpi3FAIIbrqkQALYWcik6W7dCMtB1R4SVpJacWcwuqu8H3-2wLD-jjc8RerWNbgNxrwI49bzj3Uo9hp1qOOWCtsXgy8Fg9UJ2N1uosYYZJ63gfEcK-_l4WQx_BpOy2rikTd-DN2FIigqJCW4EG20_vUDXYYjlc0aqlYIw_kTJA6VjSCkae5qAYDXmrp7lrsbc1Zh7UX74_90n3b-UC_D-ABSDU5cWpWxb9hfAZrXk</recordid><startdate>20211101</startdate><enddate>20211101</enddate><creator>van Vliet, Nicolien A</creator><creator>van Heemst, Diana</creator><creator>Almeida, Osvaldo P</creator><creator>Åsvold, Bjørn O</creator><creator>Aubert, Carole E</creator><creator>Bae, Jong Bin</creator><creator>Barnes, Linda E</creator><creator>Bauer, Douglas C</creator><creator>Blauw, Gerard J</creator><creator>Brayne, Carol</creator><creator>Cappola, Anne R</creator><creator>Ceresini, Graziano</creator><creator>Comijs, Hannie C</creator><creator>Dartigues, Jean-Francois</creator><creator>Degryse, Jean-Marie</creator><creator>Dullaart, Robin P. 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J</creator><creator>Yamada, Michiko</creator><creator>Yeap, Bu B</creator><creator>Rodondi, Nicolas</creator><creator>Gussekloo, Jacobijn</creator><creator>Trompet, Stella</creator><general>American Medical Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>1XC</scope><scope>VOOES</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-5307-663X</orcidid><orcidid>https://orcid.org/0000-0003-2418-4257</orcidid></search><sort><creationdate>20211101</creationdate><title>Association of Thyroid Dysfunction With Cognitive Function: An Individual Participant Data Analysis</title><author>van Vliet, Nicolien A ; van Heemst, Diana ; Almeida, Osvaldo P ; Åsvold, Bjørn O ; Aubert, Carole E ; Bae, Jong Bin ; Barnes, Linda E ; Bauer, Douglas C ; Blauw, Gerard J ; Brayne, Carol ; Cappola, Anne R ; Ceresini, Graziano ; Comijs, Hannie C ; Dartigues, Jean-Francois ; Degryse, Jean-Marie ; Dullaart, Robin P. F ; van Eersel, Marlise E. A ; den Elzen, Wendy P. J ; Ferrucci, Luigi ; Fink, Howard A ; Flicker, Leon ; Grabe, Hans J ; Han, Ji Won ; Helmer, Catherine ; Huisman, Martijn ; Ikram, M. Arfan ; Imaizumi, Misa ; de Jongh, Renate T ; Jukema, J. Wouter ; Kim, Ki Woong ; Kuller, Lewis H ; Lopez, Oscar L ; Mooijaart, Simon P ; Moon, Jae Hoon ; Moutzouri, Elisavet ; Nauck, Matthias ; Parle, Jim ; Peeters, Robin P ; Samuels, Mary H ; Schmidt, Carsten O ; Schminke, Ulf ; Slagboom, P. Eline ; Stordal, Eystein ; Vaes, Bert ; Völzke, Henry ; Westendorp, Rudi G. J ; Yamada, Michiko ; Yeap, Bu B ; Rodondi, Nicolas ; Gussekloo, Jacobijn ; Trompet, Stella</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a395t-abe872d82f2cb2682c862920aa54e4c255aaf657b5df69573ac6d15f716743f03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Aged</topic><topic>Cognition - physiology</topic><topic>Cognitive ability</topic><topic>Cognitive Dysfunction - diagnosis</topic><topic>Cognitive Dysfunction - physiopathology</topic><topic>Correlation of Data</topic><topic>Data Analysis</topic><topic>Dementia</topic><topic>Female</topic><topic>Humans</topic><topic>Hyperthyroidism - blood</topic><topic>Hyperthyroidism - diagnosis</topic><topic>Hyperthyroidism - psychology</topic><topic>Hypothyroidism - blood</topic><topic>Hypothyroidism - diagnosis</topic><topic>Hypothyroidism - psychology</topic><topic>Life Sciences</topic><topic>Male</topic><topic>Mental Status and Dementia Tests - statistics & numerical data</topic><topic>Online First</topic><topic>Original Investigation</topic><topic>Risk Assessment - methods</topic><topic>Risk Assessment - statistics & numerical data</topic><topic>Santé publique et épidémiologie</topic><topic>Thyroid diseases</topic><topic>Thyroid Function Tests - methods</topic><topic>Thyroid Function Tests - statistics & numerical data</topic><topic>Thyroid gland</topic><topic>Thyroid Gland - physiopathology</topic><topic>Thyrotropin - analysis</topic><topic>Thyroxine - analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>van Vliet, Nicolien A</creatorcontrib><creatorcontrib>van Heemst, Diana</creatorcontrib><creatorcontrib>Almeida, Osvaldo P</creatorcontrib><creatorcontrib>Åsvold, Bjørn O</creatorcontrib><creatorcontrib>Aubert, Carole E</creatorcontrib><creatorcontrib>Bae, Jong Bin</creatorcontrib><creatorcontrib>Barnes, Linda E</creatorcontrib><creatorcontrib>Bauer, Douglas C</creatorcontrib><creatorcontrib>Blauw, Gerard J</creatorcontrib><creatorcontrib>Brayne, Carol</creatorcontrib><creatorcontrib>Cappola, Anne R</creatorcontrib><creatorcontrib>Ceresini, Graziano</creatorcontrib><creatorcontrib>Comijs, Hannie C</creatorcontrib><creatorcontrib>Dartigues, Jean-Francois</creatorcontrib><creatorcontrib>Degryse, Jean-Marie</creatorcontrib><creatorcontrib>Dullaart, Robin P. F</creatorcontrib><creatorcontrib>van Eersel, Marlise E. A</creatorcontrib><creatorcontrib>den Elzen, Wendy P. J</creatorcontrib><creatorcontrib>Ferrucci, Luigi</creatorcontrib><creatorcontrib>Fink, Howard A</creatorcontrib><creatorcontrib>Flicker, Leon</creatorcontrib><creatorcontrib>Grabe, Hans J</creatorcontrib><creatorcontrib>Han, Ji Won</creatorcontrib><creatorcontrib>Helmer, Catherine</creatorcontrib><creatorcontrib>Huisman, Martijn</creatorcontrib><creatorcontrib>Ikram, M. Arfan</creatorcontrib><creatorcontrib>Imaizumi, Misa</creatorcontrib><creatorcontrib>de Jongh, Renate T</creatorcontrib><creatorcontrib>Jukema, J. Wouter</creatorcontrib><creatorcontrib>Kim, Ki Woong</creatorcontrib><creatorcontrib>Kuller, Lewis H</creatorcontrib><creatorcontrib>Lopez, Oscar L</creatorcontrib><creatorcontrib>Mooijaart, Simon P</creatorcontrib><creatorcontrib>Moon, Jae Hoon</creatorcontrib><creatorcontrib>Moutzouri, Elisavet</creatorcontrib><creatorcontrib>Nauck, Matthias</creatorcontrib><creatorcontrib>Parle, Jim</creatorcontrib><creatorcontrib>Peeters, Robin P</creatorcontrib><creatorcontrib>Samuels, Mary H</creatorcontrib><creatorcontrib>Schmidt, Carsten O</creatorcontrib><creatorcontrib>Schminke, Ulf</creatorcontrib><creatorcontrib>Slagboom, P. Eline</creatorcontrib><creatorcontrib>Stordal, Eystein</creatorcontrib><creatorcontrib>Vaes, Bert</creatorcontrib><creatorcontrib>Völzke, Henry</creatorcontrib><creatorcontrib>Westendorp, Rudi G. J</creatorcontrib><creatorcontrib>Yamada, Michiko</creatorcontrib><creatorcontrib>Yeap, Bu B</creatorcontrib><creatorcontrib>Rodondi, Nicolas</creatorcontrib><creatorcontrib>Gussekloo, Jacobijn</creatorcontrib><creatorcontrib>Trompet, Stella</creatorcontrib><creatorcontrib>Thyroid Studies Collaboration</creatorcontrib><creatorcontrib>Thyroid Studies Collaboration</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><collection>Hyper Article en Ligne (HAL) (Open Access)</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Archives of internal medicine (1960)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>van Vliet, Nicolien A</au><au>van Heemst, Diana</au><au>Almeida, Osvaldo P</au><au>Åsvold, Bjørn O</au><au>Aubert, Carole E</au><au>Bae, Jong Bin</au><au>Barnes, Linda E</au><au>Bauer, Douglas C</au><au>Blauw, Gerard J</au><au>Brayne, Carol</au><au>Cappola, Anne R</au><au>Ceresini, Graziano</au><au>Comijs, Hannie C</au><au>Dartigues, Jean-Francois</au><au>Degryse, Jean-Marie</au><au>Dullaart, Robin P. F</au><au>van Eersel, Marlise E. A</au><au>den Elzen, Wendy P. J</au><au>Ferrucci, Luigi</au><au>Fink, Howard A</au><au>Flicker, Leon</au><au>Grabe, Hans J</au><au>Han, Ji Won</au><au>Helmer, Catherine</au><au>Huisman, Martijn</au><au>Ikram, M. Arfan</au><au>Imaizumi, Misa</au><au>de Jongh, Renate T</au><au>Jukema, J. Wouter</au><au>Kim, Ki Woong</au><au>Kuller, Lewis H</au><au>Lopez, Oscar L</au><au>Mooijaart, Simon P</au><au>Moon, Jae Hoon</au><au>Moutzouri, Elisavet</au><au>Nauck, Matthias</au><au>Parle, Jim</au><au>Peeters, Robin P</au><au>Samuels, Mary H</au><au>Schmidt, Carsten O</au><au>Schminke, Ulf</au><au>Slagboom, P. Eline</au><au>Stordal, Eystein</au><au>Vaes, Bert</au><au>Völzke, Henry</au><au>Westendorp, Rudi G. J</au><au>Yamada, Michiko</au><au>Yeap, Bu B</au><au>Rodondi, Nicolas</au><au>Gussekloo, Jacobijn</au><au>Trompet, Stella</au><aucorp>Thyroid Studies Collaboration</aucorp><aucorp>Thyroid Studies Collaboration</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association of Thyroid Dysfunction With Cognitive Function: An Individual Participant Data Analysis</atitle><jtitle>Archives of internal medicine (1960)</jtitle><addtitle>JAMA Intern Med</addtitle><date>2021-11-01</date><risdate>2021</risdate><volume>181</volume><issue>11</issue><spage>1440</spage><epage>1450</epage><pages>1440-1450</pages><issn>2168-6106</issn><eissn>2168-6114</eissn><abstract>IMPORTANCE: In clinical guidelines, overt and subclinical thyroid dysfunction are mentioned as causal and treatable factors for cognitive decline. However, the scientific literature on these associations shows inconsistent findings. OBJECTIVE: To assess cross-sectional and longitudinal associations of baseline thyroid dysfunction with cognitive function and dementia. DESIGN, SETTING, AND PARTICIPANTS: This multicohort individual participant data analysis assessed 114 267 person-years (median, 1.7-11.3 years) of follow-up for cognitive function and 525 222 person-years (median, 3.8-15.3 years) for dementia between 1989 and 2017. Analyses on cognitive function included 21 cohorts comprising 38 144 participants. Analyses on dementia included eight cohorts with a total of 2033 cases with dementia and 44 573 controls. Data analysis was performed from December 2016 to January 2021. EXPOSURES: Thyroid function was classified as overt hyperthyroidism, subclinical hyperthyroidism, euthyroidism, subclinical hypothyroidism, and overt hypothyroidism based on uniform thyrotropin cutoff values and study-specific free thyroxine values. MAIN OUTCOMES AND MEASURES: The primary outcome was global cognitive function, mostly measured using the Mini-Mental State Examination. Executive function, memory, and dementia were secondary outcomes. Analyses were first performed at study level using multivariable linear regression and multivariable Cox regression, respectively. The studies were combined with restricted maximum likelihood meta-analysis. To overcome the use of different scales, results were transformed to standardized mean differences. For incident dementia, hazard ratios were calculated. RESULTS: Among 74 565 total participants, 66 567 (89.3%) participants had normal thyroid function, 577 (0.8%) had overt hyperthyroidism, 2557 (3.4%) had subclinical hyperthyroidism, 4167 (5.6%) had subclinical hypothyroidism, and 697 (0.9%) had overt hypothyroidism. The study-specific median age at baseline varied from 57 to 93 years; 42 847 (57.5%) participants were women. Thyroid dysfunction was not associated with global cognitive function; the largest differences were observed between overt hypothyroidism and euthyroidism—cross-sectionally (−0.06 standardized mean difference in score; 95% CI, –0.20 to 0.08; P = .40) and longitudinally (0.11 standardized mean difference higher decline per year; 95% CI, –0.01 to 0.23; P = .09). No consistent associations were observed between thyroid dysfunction and executive function, memory, or risk of dementia. CONCLUSIONS AND RELEVANCE: In this individual participant data analysis of more than 74 000 adults, subclinical hypothyroidism and hyperthyroidism were not associated with cognitive function, cognitive decline, or incident dementia. No rigorous conclusions can be drawn regarding the role of overt thyroid dysfunction in risk of dementia. These findings do not support the practice of screening for subclinical thyroid dysfunction in the context of cognitive decline in older adults as recommended in current guidelines.</abstract><cop>United States</cop><pub>American Medical Association</pub><pmid>34491268</pmid><doi>10.1001/jamainternmed.2021.5078</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0001-5307-663X</orcidid><orcidid>https://orcid.org/0000-0003-2418-4257</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 2168-6106 |
| ispartof | Archives of internal medicine (1960), 2021-11, Vol.181 (11), p.1440-1450 |
| issn | 2168-6106 2168-6114 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8424529 |
| source | MEDLINE; American Medical Association Journals |
| subjects | Aged Cognition - physiology Cognitive ability Cognitive Dysfunction - diagnosis Cognitive Dysfunction - physiopathology Correlation of Data Data Analysis Dementia Female Humans Hyperthyroidism - blood Hyperthyroidism - diagnosis Hyperthyroidism - psychology Hypothyroidism - blood Hypothyroidism - diagnosis Hypothyroidism - psychology Life Sciences Male Mental Status and Dementia Tests - statistics & numerical data Online First Original Investigation Risk Assessment - methods Risk Assessment - statistics & numerical data Santé publique et épidémiologie Thyroid diseases Thyroid Function Tests - methods Thyroid Function Tests - statistics & numerical data Thyroid gland Thyroid Gland - physiopathology Thyrotropin - analysis Thyroxine - analysis |
| title | Association of Thyroid Dysfunction With Cognitive Function: An Individual Participant Data Analysis |
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