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Araujo N, Costa A, Conceição-Lopes L, Ferreira A, Carneiro F, Pacheco-Figueiredo L, Morais S, Tedim-Cruz V, Pereira S, Lunet N. Androgen deprivation therapy and cognitive decline in the NEON-PC study. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background/Objective
Androgen deprivation therapy (ADT) has been associated with cognitive decline, but results have been heterogenous. We describe changes in cognitive performance in patients with prostate cancer (PCa), according to treatment with ADT, during the 1st year after PCa diagnosis.
Methods
Between February 2018 and March 2021, 348 patients with PCa treated at the Instituto Português de Oncologia do Porto were evaluated with the Montreal Cognitive Assessment (MoCA), before treatment and after one year (1y). ADT was used in 183 participants, and 165 were treated without ADT (total prostatectomy, radiotherapy, brachytherapy, active surveillance). Cognitive decline was defined as the decrease in MoCA from baseline to the 1y-evaluation below 1.5SD of the distribution of the MoCA variation in the whole cohort. Participants scoring below age- and education-based normative reference values in MoCA were considered to have probable cognitive impairment (PCI). Multivariate logistic regression was used to estimate age- and education-adjusted OR (aOR) of the association between ADT and cognitive decline/incident PCI.
Results/Discussion
PCI was observed in 12.4% of the patients at baseline. Mean MoCA scores increased from baseline to the 1y-evaluation (22.4 vs. 22.9, p = 0.001), and 51.2% of PCI cases at baseline had normal MoCA scores at 1y. Cognitive decline was most frequent in the ADT group (9.3% vs. 3.6%, p = 0.034), although the aOR was 2.44 (95%CI:0.89-6.71). The 1yr cumulative incidence of PCI was 10.4% (95%CI:6.2%-16.2%) in the ADT-group and 2.8% (95%CI:0.8-%-7.1%) in the non-ADT group [aOR=3.15 (95%CI:0.97-10.25)].
Conclusions
ADT was associated with a decrease in the cognitive performance of PCa patients during the 1st year after diagnosis. The completion of the 1y-evaluation in the whole cohort (n = 600) is needed to confirm these preliminary results.
Funding
POCI-01-0145FEDER-032358;PTDC/SAU-EPI/32358/2017; UIDB/4750/2020;SFRH/BD/119390/2016
Key messages
Half of the cases with cognitive impairment at baseline improved at one-year. Patients treated with ADT seem to be affected by cognitive decline more frequently.
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Affiliation(s)
- N Araujo
- Epidemiology Research Unit, Institute of Public Health, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Pop, Institute of Public Health, University of Porto, Porto, Portugal
| | - A Costa
- Epidemiology Research Unit, Institute of Public Health, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Pop, Institute of Public Health, University of Porto, Porto, Portugal
| | - L Conceição-Lopes
- Epidemiology Research Unit, Institute of Public Health, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Pop, Institute of Public Health, University of Porto, Porto, Portugal
- Research Center, Portuguese Institute of Oncology of Porto, Porto, Portugal
| | - A Ferreira
- Neurology Department, Portuguese Institute of Oncology of Porto, Porto, Portugal
| | - F Carneiro
- Urology Department, Portuguese Institute of Oncology of Porto, Porto, Portugal
| | | | - S Morais
- Epidemiology Research Unit, Institute of Public Health, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Pop, Institute of Public Health, University of Porto, Porto, Portugal
- Public Health and Forensic Sciences, and Medical Education D, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - V Tedim-Cruz
- Epidemiology Research Unit, Institute of Public Health, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Pop, Institute of Public Health, University of Porto, Porto, Portugal
- Neurology Department, Pedro Hispano Hospital, Local Health Unit of Matosinhos, Senhora da Hora, Portugal
| | - S Pereira
- Epidemiology Research Unit, Institute of Public Health, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Pop, Institute of Public Health, University of Porto, Porto, Portugal
- Neurology Department, Portuguese Institute of Oncology of Porto, Porto, Portugal
| | - N Lunet
- Epidemiology Research Unit, Institute of Public Health, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Pop, Institute of Public Health, University of Porto, Porto, Portugal
- Public Health and Forensic Sciences, and Medical Education D, Faculty of Medicine of the University of Porto, Porto, Portugal
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