Association Between Androgen Deprivation Therapy and Risk of Dementia
- PMID: 27737437
- DOI: 10.1001/jamaoncol.2016.3662
Association Between Androgen Deprivation Therapy and Risk of Dementia
Abstract
Importance: A growing body of evidence supports a link between androgen deprivation therapy (ADT) and cognitive dysfunction, including Alzheimer disease. However, it is currently unknown whether ADT may contribute to the risk of dementia more broadly.
Objective: To use an informatics approach to examine the association of ADT as a treatment for prostate cancer with the subsequent development of dementia (eg, senile dementia, vascular dementia, frontotemporal dementia, and Alzheimer dementia).
Design, setting, and participants: In this cohort study, a text-processing method was used to analyze electronic medical record data from an academic medical center from 1994 to 2013, with a median follow-up of 3.4 years (interquartile range, 1.0-7.2 years). We identified 9455 individuals with prostate cancer who were 18 years or older at diagnosis with data recorded in the electronic health record and follow-up after diagnosis. We excluded 183 patients with a previous diagnosis of dementia. Our final cohort comprised 9272 individuals with prostate cancer, including 1826 men (19.7%) who received ADT.
Main outcomes and measures: We tested the effect of ADT on the risk of dementia using propensity score-matched Cox proportional hazards regression models and Kaplan-Meier survival analysis.
Results: Among 9272 men with prostate cancer (mean [SD] age, 66.9 [10.9] years; 5450 [58.8%] white), there was a statistically significant association between use of ADT and risk of dementia (hazard ratio, 2.17; 95% CI, 1.58-2.99; P < .001). In sensitivity analyses, results were similar when excluding patients with Alzheimer disease (hazard ratio, 2.32; 95% CI, 1.73-3.12; P < .001). The absolute increased risk of developing dementia among those who received ADT was 4.4% at 5 years (7.9% among those who received ADT vs 3.5% in those who did not receive ADT). Analyses stratified by duration of ADT found that individuals with at least 12 months of ADT use had the greatest absolute increased risk of dementia (hazard ratio, 2.36; 95% CI, 1.64-3.38; P < .001). Kaplan-Meier analysis demonstrated that ADT users 70 years or older had the lowest cumulative probability of remaining dementia free (log-rank P < .001).
Conclusions and relevance: Androgen deprivation therapy in the treatment of prostate cancer may be associated with an increased risk of dementia. This finding should be further evaluated in prospective studies.
Comment in
-
Observational Cohort Studies and the Challenges of In Silico Experiments.JAMA Oncol. 2017 Jan 1;3(1):55-57. doi: 10.1001/jamaoncol.2016.3478. JAMA Oncol. 2017. PMID: 27737433 No abstract available.
-
Androgen Deprivation Therapy and Subsequent Dementia.JAMA Oncol. 2017 Jul 1;3(7):1001. doi: 10.1001/jamaoncol.2017.0509. JAMA Oncol. 2017. PMID: 28472205 No abstract available.
-
Androgen Deprivation Therapy and Subsequent Dementia-Reply.JAMA Oncol. 2017 Jul 1;3(7):1001-1002. doi: 10.1001/jamaoncol.2017.0405. JAMA Oncol. 2017. PMID: 28472237 No abstract available.
-
Androgen Deprivation Therapy and Subsequent Dementia.JAMA Oncol. 2017 Jul 1;3(7):1000-1001. doi: 10.1001/jamaoncol.2016.5854. JAMA Oncol. 2017. PMID: 28472302 No abstract available.
Similar articles
-
Association Between Androgen Deprivation Therapy Use and Diagnosis of Dementia in Men With Prostate Cancer.JAMA Netw Open. 2019 Jul 3;2(7):e196562. doi: 10.1001/jamanetworkopen.2019.6562. JAMA Netw Open. 2019. PMID: 31268539 Free PMC article.
-
Correlation of Androgen Deprivation Therapy with Cognitive Dysfunction in Patients with Prostate Cancer: A Nationwide Population-Based Study Using the National Health Insurance Service Database.Cancer Res Treat. 2019 Apr;51(2):593-602. doi: 10.4143/crt.2018.119. Epub 2018 Jul 18. Cancer Res Treat. 2019. PMID: 30025445 Free PMC article.
-
Androgen Deprivation Therapy and Future Alzheimer's Disease Risk.J Clin Oncol. 2016 Feb 20;34(6):566-71. doi: 10.1200/JCO.2015.63.6266. Epub 2015 Dec 7. J Clin Oncol. 2016. PMID: 26644522 Free PMC article.
-
Androgen deprivation therapy for prostate cancer and dementia risk: a systematic review and meta-analysis.Prostate Cancer Prostatic Dis. 2017 Sep;20(3):259-264. doi: 10.1038/pcan.2017.10. Epub 2017 Mar 28. Prostate Cancer Prostatic Dis. 2017. PMID: 28349979 Review.
-
Androgen Deprivation Therapy for Prostate Cancer: Focus on Cognitive Function and Mood.Medicina (Kaunas). 2023 Dec 30;60(1):77. doi: 10.3390/medicina60010077. Medicina (Kaunas). 2023. PMID: 38256338 Free PMC article. Review.
Cited by
-
A Comprehensive Review and Androgen Deprivation Therapy and Its Impact on Alzheimer's Disease Risk in Older Men with Prostate Cancer.Degener Neurol Neuromuscul Dis. 2024 May 17;14:33-46. doi: 10.2147/DNND.S445130. eCollection 2024. Degener Neurol Neuromuscul Dis. 2024. PMID: 38774717 Free PMC article. Review.
-
Psychosocial Factors Associated with Cognitive Function in Prostate Cancer Survivors on Hormonal Treatments: A Systematic Review.Neuropsychol Rev. 2024 Apr 20. doi: 10.1007/s11065-024-09639-1. Online ahead of print. Neuropsychol Rev. 2024. PMID: 38642173 Review.
-
Ligand-gated ion channels as potential biomarkers for ADT-mediated cognitive decline in prostate cancer patients.Mol Carcinog. 2024 Jun;63(6):1051-1063. doi: 10.1002/mc.23708. Epub 2024 Mar 14. Mol Carcinog. 2024. PMID: 38482990
-
Androgen deprivation therapy for prostate cancer and neurocognitive disorders: a systematic review and meta-analysis.Prostate Cancer Prostatic Dis. 2024 Jan 2. doi: 10.1038/s41391-023-00785-w. Online ahead of print. Prostate Cancer Prostatic Dis. 2024. PMID: 38167924
-
Vortioxetine Reverses Impairment of Visuospatial Memory and Cognitive Flexibility Induced by Degarelix as a Model of Androgen Deprivation Therapy in Rats.Neuroendocrinology. 2024;114(3):279-290. doi: 10.1159/000535365. Epub 2023 Dec 16. Neuroendocrinology. 2024. PMID: 38104552 Free PMC article.
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical