Different androgen deprivation therapies might have a differential impact on cognition - An analysis from a population-based study using time-dependent exposure model
Journal
Cancer Epidemiology
Journal Volume
64
Date Issued
2020
Author(s)
Abstract
Background: Androgen deprivation therapy (ADT) remains the mainstay treatment for locally advanced or metastatic prostate cancer (PC). However, potential effects of ADT treatment on neurocognitive dysfunction remain unclear. The present study was conducted to assess the relation between ADT treatment and risk of cognitive decline in Asian men with PC. Methods: A population-based cohort of 24,464 men with PC, each newly diagnosed between 2000 and 2008, was selected from the Taiwan National Health Insurance Database. Subjects were further grouped by treatment as non-ADT (n = 4685) or ADT (n = 12,740), members of the latter subjected to bilateral orchiectomy or medical treatment (ie, luteinizing hormone-releasing hormone agonists, antiandrogens, or combination therapy). A multivariable Cox proportional hazard model with ADT as time-dependent covariate was used to generate adjusted hazard ratios (HRs) of subsequent cognitive decline, including dementia, Alzheimer's disease (AD), and Parkinson's disease (PD). Results: ADT showed a significant association with overall risk of cognitive decline (HR = 1.51, 95 % CI: 1.31–1.74), especially for PD, dementia, and non-Alzheimer dementia (non-AZD). When stratified by various ADT regimens, antiandrogen-only recipients displayed significantly heightened risks of subsequent AD, non-AZD, and PD. However, combined androgen blockade also imposed an increased risk of PD. There was no apparent correlation between duration of ADT exposure and cognitive dysfunction. Conclusions: Various ADT therapies may have disparate impacts on cognitive function. Prospective studies exploring pertinent clinical characteristics more fully are needed to confirm these findings. ? 2019 Elsevier Ltd
SDGs
Other Subjects
antiandrogen; gonadorelin agonist; antiandrogen; antineoplastic hormone agonists and antagonists; gonadorelin; aged; Alzheimer disease; androgen deprivation therapy; Article; cognitive defect; correlation analysis; dementia; hazard ratio; human; longitudinal study; major clinical study; male; orchiectomy; Parkinson disease; population health; priority journal; proportional hazards model; prostate cancer; risk assessment; Taiwan; very elderly; adverse event; cognition; cognitive defect; cohort analysis; drug effect; factual database; middle aged; multimodality cancer therapy; pathology; prospective study; prostate tumor; Aged; Aged, 80 and over; Androgen Antagonists; Antineoplastic Agents, Hormonal; Cognition; Cognitive Dysfunction; Cohort Studies; Combined Modality Therapy; Databases, Factual; Gonadotropin-Releasing Hormone; Humans; Male; Middle Aged; Orchiectomy; Proportional Hazards Models; Prospective Studies; Prostatic Neoplasms; Taiwan
Type
journal article