Cognitive effects of androgen deprivation therapy in an older cohort of men with prostate cancer☆

Abstract 

Objective

To determine the baseline prevalence of cognitive impairment in older men treated with ADT and to assess changes in cognitive performance over time.

Methods and results

Thirty-two patients (median age of 71 years, range 51–87) were administrated an extensive neuropsychological testing battery prior to ADT initiation, with 21 (65%) completing post-treatment evaluations 6 months later. At baseline, 45% scored >1.5 standard deviations below the mean on ≥2 neuropsychological measures. Using standardized inferential statistics, no change in cognition was documented following treatment. The Reliable Change Index revealed that, on a case-by-case basis, 38% demonstrated a decline in measures of executive functioning and 48% showed improvement on measures of visuospatial abilities. Within exploratory analyses, patients who scored below expectation at baseline displayed no change in cognition, while patients with average or better scores at baseline displayed improvements in visuospatial planning and timed tests of phonemic fluency.

Conclusions

We found a high prevalence of lower than expected cognitive performance among a sample of patients just starting ADT for prostate cancer. Assessment of baseline cognitive function should be taken into account for future research and to inform clinical management.

Keywords: Cognition, Androgen deprivation, Prostate, Elderly