SUN-029 - Cognitive and Neuropsychological Changes in Patients with Acromegaly: Effects of Transsphenoidal Adenomectomy

Introduction
Patients with acromegaly suffer from multiple symptoms, ranging from somatic disorders to cognitive impairments.
The aim of this prospective study was to identify factors that significantly influence cognitive function and quality of life in patients with pituitary GH-secreting adenomas.
To this end, patients with acromegaly were assessed for neurocognitive functions and neuropsychological parameters prior to transsphenoidal adenomectomy and three months postoperatively.

Material and Methods
A total of 20 patients (12 females, 8 males) with an average age of 51.8 years were included. They underwent nine neuropsychological tests to assess neurocognitive functions: intellectual abilities, memory, processing speed, attention, concentration, visual recall, executive functioning, alertness, cognitive flexibility, and vigilance.
In addition, they completed seven questionnaires focusing on demographic data, sleep quality, daytime sleepiness, depression, subjective cognitive performance, and quality of life, including one specifically addressing acromegaly.

Results
Compared to the preoperative group, the postoperative group achieved better scores on most neurocognitive tests.
With regard to fluid intelligence, there was an improvement postoperatively, although it was not statistically significant (CFT20R, p= 0.234).
In attention and concentration (d2R), work speed significantly increased (BZO, p= 0.046), and the concentration performance also showed a notable enhancement (p= 0.003), while the error rate improved as well but not significantly (p= 0.13).
In the Trail Making Test, a significant increase was also noted. (TMT A; p= 0.049; TMT B; p= 0.01).
In working memory (DS) and processing speed (CD), no significant differences were observed. The attention test battery (TAP) also did not reveal any major significant changes (alertness, cognitive flexibility, vigilance).
Sleep quality showed a significant improvement (PSQI, p< 0.001), accompanied by a reduction in daytime sleepiness (ESS, p= 0,005). Depressive symptoms significantly decreased postoperatively (BDI, p< 0.001).
Subjective assessment of mental performance also demonstrated a notable enhancement (FLEI, p = 0.012). Overall quality of life was markedly better after surgery (SF36, p= 0.002), a trend that was also evident in the Acromegaly Quality of Life Questionnaire (AcroQoL, p= 0.001).

Discussion
In summary, we have shown that patients achieved better results on several neurocognitive tests postoperatively. Following adenomectomy, there was an overall improvement in sleep quality, as well as in associated daytime sleepiness and mood. This was also reflected in quality of life. Sleep quality appears to be a key factor in optimizing quality of life and cognitive function, which improved in correlation with the decreasing symptoms of sleep apnea syndrome (such as snoring, p < 0.001).

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