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

doi:10.1001/jamainternmed.2021.5078

. 2021 Nov 1;181(11):1440-1450.

doi: 10.1001/jamainternmed.2021.5078.

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

Nicolien A van Vliet¹, Diana van Heemst¹, Osvaldo P Almeida^{2

3}, Bjørn O Åsvold^{4

5

6}, Carole E Aubert^{7

8

9

10}, Jong Bin Bae¹¹, Linda E Barnes¹², Douglas C Bauer¹³, Gerard J Blauw¹, Carol Brayne¹², Anne R Cappola¹⁴, Graziano Ceresini¹⁵, Hannie C Comijs^{16

17}, Jean-Francois Dartigues¹⁸, Jean-Marie Degryse^{19

20}, Robin P F Dullaart²¹, Marlise E A van Eersel²², Wendy P J den Elzen^{23

24

25}, Luigi Ferrucci^{26

27}, Howard A Fink^{28

29}, Leon Flicker^{2

3}, Hans J Grabe^{30

31}, Ji Won Han¹¹, Catherine Helmer¹⁸, Martijn Huisman^{32

33}, M Arfan Ikram³⁴, Misa Imaizumi³⁵, Renate T de Jongh³⁶, J Wouter Jukema^{37

38}, Ki Woong Kim^{11

39

40}, Lewis H Kuller⁴¹, Oscar L Lopez⁴², Simon P Mooijaart¹, Jae Hoon Moon⁴³, Elisavet Moutzouri^{7

8}, Matthias Nauck^{44

45}, Jim Parle⁴⁶, Robin P Peeters^{47

48}, Mary H Samuels⁴⁹, Carsten O Schmidt⁵⁰, Ulf Schminke⁵¹, P Eline Slagboom^{52

53}, Eystein Stordal^{54

55}, Bert Vaes¹⁹, Henry Völzke⁵⁶, Rudi G J Westendorp^{1

57}, Michiko Yamada³⁵, Bu B Yeap^{2

58}, Nicolas Rodondi^{7

8}, Jacobijn Gussekloo^{1

59}, Stella Trompet¹; Thyroid Studies Collaboration

Affiliations

¹ Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands.
² Medical School, University of Western Australia, Perth, Western Australia, Australia.
³ Western Australian Centre for Health and Ageing, University of Western Australia, Perth, Western Australia, Australia.
⁴ K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
⁵ Department of Endocrinology, Clinic of Medicine, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.
⁶ HUNT Research Center, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Levanger, Norway.
⁷ Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
⁸ Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
⁹ Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
¹⁰ Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.
¹¹ Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea.
¹² Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge, Cambridge, United Kingdom.
¹³ Division of General Internal Medicine, School of Medicine, University of California, San Francisco.
¹⁴ Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
¹⁵ Department of Medicine and Surgery, University of Parma, Unit of Internal Medicine and Oncological Endocrinology, University Hospital of Parma, Parma, Italy.
¹⁶ Department of Psychiatry, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
¹⁷ GGZ inGeest Specialized Mental Health Care, Research and Innovation, Amsterdam, the Netherlands.
¹⁸ UMR 1219, Bordeaux Population Health Research Center, Inserm, University of Bordeaux, Bordeaux, France.
¹⁹ Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium.
²⁰ Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium.
²¹ Division of Endocrinology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
²² University Center for Geriatric Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
²³ Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, the Netherlands.
²⁴ Atalmedial Diagnostics Centre, Amsterdam, the Netherlands.
²⁵ Department of Clinical Chemistry, Amsterdam UMC, Amsterdam, the Netherlands.
²⁶ Longitudinal Studies Section, Translational Gerontology Branch, Harbor Hospital, Baltimore, Maryland.
²⁷ National Institute on Aging NIA-ASTRA Unit, Baltimore, Maryland.
²⁸ Geriatric Research Education and Clinical Center, VA Healthcare System, Minneapolis, Minnesota.
²⁹ Department of Medicine, University of Minnesota, Minneapolis.
³⁰ Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany.
³¹ German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany.
³² Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
³³ Department of Sociology, VU University Amsterdam, Amsterdam, the Netherlands.
³⁴ Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands.
³⁵ Department of Clinical Studies, Radiation Effects Research Foundation, Hiroshima and Nagasaki, Japan.
³⁶ Department of Internal Medicine and Endocrinology, Amsterdam UMC, Amsterdam, the Netherlands.
³⁷ Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
³⁸ Netherlands Heart Institute, Utrecht, the Netherlands.
³⁹ Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, South Korea.
⁴⁰ Department of Psychiatry, Seoul National University, College of Medicine, Seoul, South Korea.
⁴¹ Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
⁴² Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
⁴³ Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
⁴⁴ Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany.
⁴⁵ DZHK (German Centre for Cardiovascular Research), partner site, Greifswald, Germany.
⁴⁶ Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom.
⁴⁷ Department of Internal Medicine, Erasmus MC, Rotterdam, the Netherlands.
⁴⁸ Academic Center for Thyroid Diseases, Erasmus MC, Rotterdam, the Netherlands.
⁴⁹ Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine, Oregon Health & Science University, Portland.
⁵⁰ Department of Radiology, University Medicine Greifswald, Greifswald, Germany.
⁵¹ Department of Neurology, University Medicine Greifswald, Greifswald, Germany.
⁵² Department of Biomedical Data Sciences, Section of Molecular Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
⁵³ Max Planck Institute for Biology of Ageing, Cologne, Germany.
⁵⁴ Namsos Hospital, Nord-Trøndelag Hospital Trust, Namsos, Norway.
⁵⁵ Department of Mental Health, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
⁵⁶ Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.
⁵⁷ Department of Public Health, Section of Epidemiology, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark.
⁵⁸ Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Western Australia, Australia.
⁵⁹ Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.

PMID: 34491268
PMCID: PMC8424529
DOI: 10.1001/jamainternmed.2021.5078

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

Nicolien A van Vliet et al. JAMA Intern Med. 2021.

. 2021 Nov 1;181(11):1440-1450.

doi: 10.1001/jamainternmed.2021.5078.

Authors

Affiliations

¹ Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands.
² Medical School, University of Western Australia, Perth, Western Australia, Australia.
³ Western Australian Centre for Health and Ageing, University of Western Australia, Perth, Western Australia, Australia.
⁴ K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
⁵ Department of Endocrinology, Clinic of Medicine, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.
⁶ HUNT Research Center, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Levanger, Norway.
⁷ Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
⁸ Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
⁹ Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
¹⁰ Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.
¹¹ Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea.
¹² Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge, Cambridge, United Kingdom.
¹³ Division of General Internal Medicine, School of Medicine, University of California, San Francisco.
¹⁴ Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
¹⁵ Department of Medicine and Surgery, University of Parma, Unit of Internal Medicine and Oncological Endocrinology, University Hospital of Parma, Parma, Italy.
¹⁶ Department of Psychiatry, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
¹⁷ GGZ inGeest Specialized Mental Health Care, Research and Innovation, Amsterdam, the Netherlands.
¹⁸ UMR 1219, Bordeaux Population Health Research Center, Inserm, University of Bordeaux, Bordeaux, France.
¹⁹ Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium.
²⁰ Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium.
²¹ Division of Endocrinology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
²² University Center for Geriatric Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
²³ Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, the Netherlands.
²⁴ Atalmedial Diagnostics Centre, Amsterdam, the Netherlands.
²⁵ Department of Clinical Chemistry, Amsterdam UMC, Amsterdam, the Netherlands.
²⁶ Longitudinal Studies Section, Translational Gerontology Branch, Harbor Hospital, Baltimore, Maryland.
²⁷ National Institute on Aging NIA-ASTRA Unit, Baltimore, Maryland.
²⁸ Geriatric Research Education and Clinical Center, VA Healthcare System, Minneapolis, Minnesota.
²⁹ Department of Medicine, University of Minnesota, Minneapolis.
³⁰ Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany.
³¹ German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany.
³² Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
³³ Department of Sociology, VU University Amsterdam, Amsterdam, the Netherlands.
³⁴ Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands.
³⁵ Department of Clinical Studies, Radiation Effects Research Foundation, Hiroshima and Nagasaki, Japan.
³⁶ Department of Internal Medicine and Endocrinology, Amsterdam UMC, Amsterdam, the Netherlands.
³⁷ Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
³⁸ Netherlands Heart Institute, Utrecht, the Netherlands.
³⁹ Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, South Korea.
⁴⁰ Department of Psychiatry, Seoul National University, College of Medicine, Seoul, South Korea.
⁴¹ Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
⁴² Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
⁴³ Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
⁴⁴ Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany.
⁴⁵ DZHK (German Centre for Cardiovascular Research), partner site, Greifswald, Germany.
⁴⁶ Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom.
⁴⁷ Department of Internal Medicine, Erasmus MC, Rotterdam, the Netherlands.
⁴⁸ Academic Center for Thyroid Diseases, Erasmus MC, Rotterdam, the Netherlands.
⁴⁹ Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine, Oregon Health & Science University, Portland.
⁵⁰ Department of Radiology, University Medicine Greifswald, Greifswald, Germany.
⁵¹ Department of Neurology, University Medicine Greifswald, Greifswald, Germany.
⁵² Department of Biomedical Data Sciences, Section of Molecular Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
⁵³ Max Planck Institute for Biology of Ageing, Cologne, Germany.
⁵⁴ Namsos Hospital, Nord-Trøndelag Hospital Trust, Namsos, Norway.
⁵⁵ Department of Mental Health, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
⁵⁶ Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.
⁵⁷ Department of Public Health, Section of Epidemiology, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark.
⁵⁸ Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Western Australia, Australia.
⁵⁹ Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.

PMID: 34491268
PMCID: PMC8424529
DOI: 10.1001/jamainternmed.2021.5078

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.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr van Vliet reported grants from European Commission Horizon 2020 program during the conduct of the study. Dr van Heemst reported grants from European Commission during the conduct of the study; grants from Velux Stiftung (grant No. 1156) outside the submitted work. Dr Almeida reported grants from National Health and Medical Research Council of Australia during the conduct of the study and outside the submitted work. Dr Brayne reported grants from Medical Research Council during the conduct of the study. Dr Degryse reported grants from Fondation Louvain during the conduct of the study. Dr Flicker reported grants to the University of Western Australia from Australian National Health and Medical Research Council during the conduct of the study. Dr Grabe has received travel grants and speakers honoraria from Fresenius Medical Care, Neuraxpharm, Servier, and Janssen Cilag as well as research funding from Fresenius Medical Care outside the submitted work. Dr Huisman reported grants from Ministry of Health, Welfare and Sport for setting up and maintaining a prospective cohort study, of which data were used during the conduct of the study. Dr Lopez reported personal fees for consulting from Biogen and Grifols outside the submitted work. Dr Mooijaart reported nonfinancial support (provision of medication free of charge) from Merck during the conduct of the study. Dr Nauck reported grants from Federal Ministry of Education and Research, Germany, European Union Interreg IVa grants No. 01ZZ9603, 01ZZ0103, 01ZZ0403, 81Z7400171, 81Z7400173, INT-10-0008; personal fees for advisory boards and presentations from Radiometer, Becton Dickinson, AstraZeneca, Technopath Clinical Diagnostics, Novartis, Sysmex, Tosoh, medpoint Medizinkommunikations GmbH, ProteinT, and MDI Limbach; and travel/accommodations expenses covered or reimbursed from German Medical Association (BÄK), German Centre for Cardiovascular Research (GCCR), National Cohort, German Society for Clinical Chemistry and Laboratory Medicine e.V. (DGKL), ISBER, DAkkS, Deutsche Forschungsgemeinschaft (DFG), European Association for the Study of Diabetes (EASD), and Max Rubner-Institut outside the submitted work. Dr Yeap reported grants from National Health and Medical Research Council of Australia during the conduct of the study. Dr Rodondi reported grants from Swiss National Science Foundation during the conduct of the study. No other disclosures were reported.

Figures

**Figure 1.. Cross-sectional Association Between Thyroid Dysfunction and Cognitive Function Test Scores**
Standardized mean differences were adjusted for age and sex. Error bars indicate 95% CIs.

**Figure 2.. Longitudinal Association Between Thyroid Dysfunction and Cognitive Function Test Scores**
Standardized mean differences were adjusted for age, sex, and baseline cognitive function. Error bars indicate 95% CIs.

**Figure 3.. Longitudinal Association Between Thyroid Dysfunction and Incident Dementia**
Hazard ratios were adjusted for age and sex. Error bars indicate 95% CIs.

See this image and copyright information in PMC

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References

1. Knopman DS, DeKosky ST, Cummings JL, et al. . Practice parameter: diagnosis of dementia (an evidence-based review). report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2001;56(9):1143-1153. doi:10.1212/WNL.56.9.1143 - DOI - PubMed
1. Sorbi S, Hort J, Erkinjuntti T, et al. ; EFNS Scientist Panel on Dementia and Cognitive Neurology . EFNS-ENS Guidelines on the diagnosis and management of disorders associated with dementia. Eur J Neurol. 2012;19(9):1159-1179. doi:10.1111/j.1468-1331.2012.03784.x - DOI - PubMed
1. Cognitive Decline Partnership Centre . Clinical practice guidelines and principles for people with dementia. Published February 2016. Accessed August 2, 2021. https://cdpc.sydney.edu.au/research/clinical-guidelines-for-dementia/
1. Muangpaisan W, Petcharat C, Srinonprasert V. Prevalence of potentially reversible conditions in dementia and mild cognitive impairment in a geriatric clinic. Geriatr Gerontol Int. 2012;12(1):59-64. doi:10.1111/j.1447-0594.2011.00728.x - DOI - PubMed
1. Ritchie M, Yeap BB. Thyroid hormone: influences on mood and cognition in adults. Maturitas. 2015;81(2):266-275. doi:10.1016/j.maturitas.2015.03.016 - DOI - PubMed

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[1] Knopman DS, DeKosky ST, Cummings JL, et al. . Practice parameter: diagnosis of dementia (an evidence-based review). report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2001;56(9):1143-1153. doi:10.1212/WNL.56.9.1143 - DOI - PubMed

[2] Knopman DS, DeKosky ST, Cummings JL, et al. . Practice parameter: diagnosis of dementia (an evidence-based review). report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2001;56(9):1143-1153. doi:10.1212/WNL.56.9.1143 - DOI - PubMed

[3] Sorbi S, Hort J, Erkinjuntti T, et al. ; EFNS Scientist Panel on Dementia and Cognitive Neurology . EFNS-ENS Guidelines on the diagnosis and management of disorders associated with dementia. Eur J Neurol. 2012;19(9):1159-1179. doi:10.1111/j.1468-1331.2012.03784.x - DOI - PubMed

[4] Sorbi S, Hort J, Erkinjuntti T, et al. ; EFNS Scientist Panel on Dementia and Cognitive Neurology . EFNS-ENS Guidelines on the diagnosis and management of disorders associated with dementia. Eur J Neurol. 2012;19(9):1159-1179. doi:10.1111/j.1468-1331.2012.03784.x - DOI - PubMed

[5] Cognitive Decline Partnership Centre . Clinical practice guidelines and principles for people with dementia. Published February 2016. Accessed August 2, 2021. https://cdpc.sydney.edu.au/research/clinical-guidelines-for-dementia/

[6] Cognitive Decline Partnership Centre . Clinical practice guidelines and principles for people with dementia. Published February 2016. Accessed August 2, 2021. https://cdpc.sydney.edu.au/research/clinical-guidelines-for-dementia/

[7] Muangpaisan W, Petcharat C, Srinonprasert V. Prevalence of potentially reversible conditions in dementia and mild cognitive impairment in a geriatric clinic. Geriatr Gerontol Int. 2012;12(1):59-64. doi:10.1111/j.1447-0594.2011.00728.x - DOI - PubMed

[8] Muangpaisan W, Petcharat C, Srinonprasert V. Prevalence of potentially reversible conditions in dementia and mild cognitive impairment in a geriatric clinic. Geriatr Gerontol Int. 2012;12(1):59-64. doi:10.1111/j.1447-0594.2011.00728.x - DOI - PubMed

[9] Ritchie M, Yeap BB. Thyroid hormone: influences on mood and cognition in adults. Maturitas. 2015;81(2):266-275. doi:10.1016/j.maturitas.2015.03.016 - DOI - PubMed

[10] Ritchie M, Yeap BB. Thyroid hormone: influences on mood and cognition in adults. Maturitas. 2015;81(2):266-275. doi:10.1016/j.maturitas.2015.03.016 - DOI - PubMed

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

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

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