Androgen Deprivation Therapy and Future Alzheimer's Disease Risk.

PURPOSE - To test the association of androgen deprivation therapy (ADT) in the treatment of prostate cancer with subsequent Alzheimer's disease risk.

METHODS - We used a previously validated and implemented text-processing pipeline to analyze electronic medical record data in a retrospective cohort of patients at Stanford University and Mt.

Sinai hospitals. Specifically, we extracted International Classification of Diseases-9th revision diagnosis and Current Procedural Terminology codes, medication lists, and positive-present mentions of drug and disease concepts from all clinical notes. We then tested the effect of ADT on risk of Alzheimer's disease using 1:5 propensity score-matched and traditional multivariable-adjusted Cox proportional hazards models. The duration of ADT use was also tested for association with Alzheimer's disease risk.

RESULTS - There were 16,888 individuals with prostate cancer meeting all inclusion and exclusion criteria, with 2,397 (14. 2%) receiving ADT during a median follow-up period of 2. 7 years (interquartile range, 1. 0-5. 4 years). Propensity score-matched analysis (hazard ratio, 1. 88; 95% CI, 1. 10 to 3. 20; P = . 021) and traditional multivariable-adjusted Cox regression analysis (hazard ratio, 1. 66; 95% CI, 1. 05 to 2. 64; P = . 031) both supported a statistically significant association between ADT use and Alzheimer's disease risk. We also observed a statistically significant increased risk of Alzheimer's disease with increasing duration of ADT (P = . 016).

CONCLUSIONS - Our results support an association between the use of ADT in the treatment of prostate cancer and an increased risk of Alzheimer's disease in a general population cohort. This study demonstrates the utility of novel methods to analyze electronic medical record data to generate practice-based evidence.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2015 Dec 07 [Epub ahead of print]

Kevin T Nead, Greg Gaskin, Cariad Chester, Samuel Swisher-McClure, Nicholas J Leeper, Nigam H Shah

Kevin T. Nead, Greg Gaskin, and Nigam H. Shah, Stanford University; Cariad Chester and Nicholas J. Leeper, Stanford University School of Medicine, Stanford, CA; Kevin T. Nead and Samuel Swisher-McClure, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. Kevin T. Nead, Greg Gaskin, and Nigam H. Shah, Stanford University; Cariad Chester and Nicholas J. Leeper, Stanford University School of Medicine, Stanford, CA; Kevin T. Nead and Samuel Swisher-McClure, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. , Kevin T. Nead, Greg Gaskin, and Nigam H. Shah, Stanford University; Cariad Chester and Nicholas J. Leeper, Stanford University School of Medicine, Stanford, CA; Kevin T. Nead and Samuel Swisher-McClure, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. , Kevin T. Nead, Greg Gaskin, and Nigam H. Shah, Stanford University; Cariad Chester and Nicholas J. Leeper, Stanford University School of Medicine, Stanford, CA; Kevin T. Nead and Samuel Swisher-McClure, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. , Kevin T. Nead, Greg Gaskin, and Nigam H. Shah, Stanford University; Cariad Chester and Nicholas J. Leeper, Stanford University School of Medicine, Stanford, CA; Kevin T. Nead and Samuel Swisher-McClure, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. , Kevin T. Nead, Greg Gaskin, and Nigam H. Shah, Stanford University; Cariad Chester and Nicholas J. Leeper, Stanford University School of Medicine, Stanford, CA; Kevin T. Nead and Samuel Swisher-McClure, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.

PubMed