Androgen-deprivation therapy and cognitive decline in the NEON-PC prospective study during the COVID-19 pandemic

Autores da FMUP

• Natália Da Costa Araújo

  Autor

• Andreia Filipa Gomes Da Costa

  Autor

• Maria De Fátima Machado Henriques Carneiro

  Autor

• Nuno Miguel De Sousa Lunet

  Autor

Participantes de fora da FMUP

• Lopes-Conceicao, L
• Ferreira, A
• Oliveira, J
• Braga, I
• Morais, S
• Pacheco-Figueiredo, L
• Ruano, L.
• Cruz, VT
• Ferreira, S.

Unidades de investigação

• Ciências da Saúde Pública e Forenses, e Educação Médica

• Neurociências Clínicas e Saúde Mental

• Patologia

Abstract

Background: 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 and methods: 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. Results: 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). Conclusions: ADT was associated with worse cognitive performance of patients with prostate cancer, mostly among those evaluated after the first COVID-19 lockdown.

Keywords

• prostate cancer; neurocognitive disorders; longitudinal studies; hormones; hormone substitutes; hormone antagonists/analogues and derivatives; COVID-19; complications