Association of Thyroid Dysfunction With Cognitive Function: An Individual Participant Data Analysis - Archive ouverte HAL Accéder directement au contenu
Article Dans Une Revue JAMA Internal Medicine Année : 2021

Association of Thyroid Dysfunction With Cognitive Function: An Individual Participant Data Analysis

1 LUMC - Leiden University Medical Center
2 UWA - The University of Western Australia
3 NTNU - Norwegian University of Science and Technology [Trondheim]
4 Department of Psychiatry [St. Olav's hospital, Trondheim]
5 Inselspital - Bern University Hospital [Berne]
6 UNIBE - Universität Bern = University of Bern = Université de Berne
7 University of Michigan [Ann Arbor]
8 SNUBH - Seoul National University Bundang Hospital
9 CAM - University of Cambridge [UK]
10 UC San Francisco - University of California [San Francisco]
11 University of Pennsylvania
12 Azienda Ospedaliero-Universitaria di Parma = Maggiore Hospital in Parma
13 VU - Vrije Universiteit Amsterdam [Amsterdam]
14 BPH - Bordeaux population health
15 KU Leuven - Catholic University of Leuven = Katholieke Universiteit Leuven
16 University of Groningen [Groningen]
17 Amsterdam UMC - Amsterdam University Medical Center
18 Harbor Hospital
19 National Institute on Aging, Baltimore
20 VA Healthcare System
21 University of Minnesota [MN, USA]
22 University of Medicine Greifswald
23 DZNE - German Research Center for Neurodegenerative Diseases - Deutsches Zentrum für Neurodegenerative Erkrankungen
24 Erasmus MC - Erasmus University Medical Center [Rotterdam]
25 RERF - Radiation Effects Research Foundation [Hiroshima City, Japan]
26 ICIN - Netherlands Heart Institute
27 Seoul National University College of Natural Sciences
28 SNU - Seoul National University [Seoul]
29 PITT - University of Pittsburgh
30 University of Pittsburgh School of Medicine
31 DZHK - German Center for Cardiovascular Research
32 University of Birmingham [Birmingham]
33 OHSU - Oregon Health and Science University [Portland]
34 Max planck Institute for Biology of Ageing [Cologne]
35 UCPH - University of Copenhagen = Københavns Universitet
36 Fiona Stanley Hospital [Murdoch]
Carol Brayne
Ji Won Han

Résumé

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 114267 person-years (median, 1.7-11.3 years) of follow-up for cognitive function and 525222 person-years (median, 3.8-15.3 years) for dementia between 1989 and 2017. Analyses on cognitive function included 21 cohorts comprising 38144 participants. Analyses on dementia included eight cohorts with a total of 2033 cases with dementia and 44573 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 74565 total participants, 66567 (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; 42847 (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 74000 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.
Fichier principal
Vignette du fichier
BPH_JAMAIM_2021_Van Vliet.pdf (419.64 Ko) Télécharger le fichier
Origine Fichiers éditeurs autorisés sur une archive ouverte

Dates et versions

hal-03419544 , version 1 (08-11-2021)

Licence

Identifiants

Citer

Nicolien A. van Vliet, Diana van Heemst, Osvaldo P. Almeida, Bjorn O. Asvold, Carole E. Aubert, et al.. Association of Thyroid Dysfunction With Cognitive Function: An Individual Participant Data Analysis. JAMA Internal Medicine, 2021, ⟨10.1001/jamainternmed.2021.5078⟩. ⟨hal-03419544⟩

Collections

U1219
13 Consultations
89 Téléchargements

Altmetric

Partager

Gmail Mastodon Facebook X LinkedIn More