Androgen-deprivation therapy (ADT) has been associated with cognitive decline, but results are conflicting. This study describes changes in cognitive performance in patients with prostate cancer, according to ADT, during the first year after prostate cancer diagnosis.
Patients with prostate cancer treated at the Portuguese Institute of Oncology of Porto (n = 366) were evaluated with the Montreal Cognitive Assessment (MoCA), before treatment and after 1 year. All baseline evaluations were performed before the coronavirus disease 2019 (COVID-19) pandemic and 69.7% of the 1-year assessments were completed after the first lockdown. Cognitive decline was defined as the decrease in MoCA from baseline to the 1-year evaluation below 1.5 standard deviations of the distribution of changes in the whole cohort. Participants scoring below age- and education-specific normative reference values in the MoCA were considered to have cognitive impairment. Age- and education-adjusted odds ratios (aORs) were computed for the association between ADT and cognitive outcomes.
Mean MoCA scores increased from baseline to the 1-year evaluation (22.3 versus 22.8, P < 0.001). Cognitive decline was more frequent in the ADT group, and even more after the onset of the COVID-19 pandemic (aOR 6.81 versus 1.93, P for interaction = 0.233). The 1-year cumulative incidence of cognitive impairment was 6.9% (9.1% before and 3.7% after the pandemic onset), which was higher among patients receiving ADT, but only after the pandemic (aOR 5.53 versus 0.49, P for interaction = 0.044).
ADT was associated with worse cognitive performance of patients with prostate cancer, mostly among those evaluated after the first COVID-19 lockdown.
ESMO open. 2022 Mar 07 [Epub ahead of print]
N Araújo, A Costa, L Lopes-Conceição, A Ferreira, F Carneiro, J Oliveira, I Braga, S Morais, L Pacheco-Figueiredo, L Ruano, V T Cruz, S Pereira, N Lunet
EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal., EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal., Instituto Português de Oncologia do Porto, Rua Dr. António Bernardino de Almeida, Porto, Portugal., EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal. Electronic address: https://twitter.com/samanthafmorais., Instituto de Investigação em Ciências da Vida e Saúde, Escola de Medicina da Universidade do Minho, Campus de Gualtar, Braga, Portugal., EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal. Electronic address: https://twitter.com/lmruano., EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal; Instituto Português de Oncologia do Porto, Rua Dr. António Bernardino de Almeida, Porto, Portugal., EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, Porto, Portugal. Electronic address: .