{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T15:31:23Z","timestamp":1789486283519,"version":"build-2803163510"},"reference-count":37,"publisher":"Walter de Gruyter GmbH","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,24]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_cclm-2025-1356_abs_001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Hypercalcemia has been associated with various non-specific minor neuropsychological symptoms but mainly in patient cohorts. Whether hypercalcemia is the cause or an innocent bystander in relation to these symptoms remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_cclm-2025-1356_abs_002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We included 5,917 individuals from the Copenhagen City Heart Study (CCHS) and 106,025 individuals from the Copenhagen General Population Study (CGPS) with baseline plasma ionized calcium available and tested the hypothesis that high plasma ionized calcium is associated with self-reported minor neuropsychological symptoms in a cross-sectional design. We used parathyroidectomy and kidney stones during follow-up as positive control outcomes. Minor neuropsychological symptoms were self-reported based on baseline questionnaires on well-being, energy, mood, and sleep, while information on parathyroidectomy and kidney stones was from Danish health registries. We used logistic regression for cross-sectional analyses and Cox regression for prospective analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_cclm-2025-1356_abs_003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>No association was found between high plasma ionized calcium and self-reported minor neuropsychological symptoms at baseline in either study. In contrast, in individuals with plasma ionized calcium &gt;1.40\u202fmmol\/L the multivariable adjusted hazard ratios for parathyroidectomy during follow-up were 214 (95\u202f% CI: 52\u2013873) in the CCHS and 206 (54\u2013277) in the CGPS; corresponding hazard ratios for kidney stones were 1.71 (0.54\u20135.44) and 2.97 (1.96\u20134.49).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_cclm-2025-1356_abs_004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Hypercalcemia was not associated with minor neuropsychological symptoms, while it was associated with higher risk of parathyroidectomy and kidney stones in the general population. Thus, in patients with hypercalcemia, minor neuropsychological symptoms are likely linked to other causes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/cclm-2025-1356","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T22:34:22Z","timestamp":1777502062000},"page":"2055-2066","source":"Crossref","is-referenced-by-count":0,"title":["No association between high plasma ionized calcium and minor neuropsychological symptoms in two general population cohorts"],"prefix":"10.1515","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9562-2897","authenticated-orcid":false,"given":"Camilla J.","family":"Kobylecki","sequence":"first","affiliation":[{"name":"Department of Clinical Biochemistry , Copenhagen University Hospital\u00a0\u2013\u00a0Herlev Gentofte , Herlev , Denmark"},{"name":"The Copenhagen General Population Study , Copenhagen University Hospital\u00a0\u2013\u00a0Herlev Gentofte , Herlev , Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B\u00f8rge G.","family":"Nordestgaard","sequence":"additional","affiliation":[{"name":"Department of Clinical Biochemistry , Copenhagen University Hospital\u00a0\u2013\u00a0Herlev Gentofte , Herlev , Denmark"},{"name":"The Copenhagen General Population Study , Copenhagen University Hospital\u00a0\u2013\u00a0Herlev Gentofte , Herlev , Denmark"},{"name":"Copenhagen City Heart Study , Bispebjerg and Frederiksberg Hospital , Frederiksberg , Denmark"},{"name":"Faculty of Health and Medical Sciences , Institute of Clinical Medicine, University of Copenhagen , Copenhagen , Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shoaib","family":"Afzal","sequence":"additional","affiliation":[{"name":"Department of Clinical Biochemistry , Copenhagen University Hospital\u00a0\u2013\u00a0Herlev Gentofte , Herlev , Denmark"},{"name":"The Copenhagen General Population Study , Copenhagen University Hospital\u00a0\u2013\u00a0Herlev Gentofte , Herlev , Denmark"},{"name":"Faculty of Health and Medical Sciences , Institute of Clinical Medicine, University of Copenhagen , Copenhagen , Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2026,4,29]]},"reference":[{"key":"2026091512595711990_j_cclm-2025-1356_ref_001","doi-asserted-by":"crossref","unstructured":"Insogna, KL. Primary hyperparathyroidism. N\u00a0Engl J Med 2018;379:1050\u20139. https:\/\/doi.org\/10.1056\/nejmcp1714213.","DOI":"10.1056\/NEJMcp1714213"},{"key":"2026091512595711990_j_cclm-2025-1356_ref_002","doi-asserted-by":"crossref","unstructured":"Joborn, C, Hetta, J, Johansson, H, Rastad, J, Agren, H, Akerstrom, G, et al.. Psychiatric morbidity in primary hyperparathyroidism. World J Surg 1988;12:476\u201381. https:\/\/doi.org\/10.1007\/bf01655425.","DOI":"10.1007\/BF01655425"},{"key":"2026091512595711990_j_cclm-2025-1356_ref_003","doi-asserted-by":"crossref","unstructured":"Talpos, GB, Bone, HG3rd, Kleerekoper, M, Phillips, ER, Alam, M, Honasoge, M, et al.. Randomized trial of parathyroidectomy in mild asymptomatic primary hyperparathyroidism: patient description and effects on the SF-36 health survey. Surgery 2000;128:1013\u201320. https:\/\/doi.org\/10.1067\/msy.2000.110844.","DOI":"10.1067\/msy.2000.110844"},{"key":"2026091512595711990_j_cclm-2025-1356_ref_004","doi-asserted-by":"crossref","unstructured":"Walker, MD, McMahon, DJ, Inabnet, WB, Lazar, RM, Brown, I, Vardy, S, et al.. Neuropsychological features in primary hyperparathyroidism: a prospective study. J\u00a0Clin Endocrinol Metab 2009;94:1951\u20138. https:\/\/doi.org\/10.1210\/jc.2008-2574.","DOI":"10.1210\/jc.2008-2574"},{"key":"2026091512595711990_j_cclm-2025-1356_ref_005","doi-asserted-by":"crossref","unstructured":"Espiritu, RP, Kearns, AE, Vickers, KS, Grant, C, Ryu, E, Wermers, RA. Depression in primary hyperparathyroidism: prevalence and benefit of surgery. 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