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Original Investigation
January 2017

Association Between Androgen Deprivation Therapy and Risk of Dementia

Author Affiliations
  • 1Stanford Center for Biomedical Informatics Research, Stanford University School of Medicine, Stanford, California
  • 2Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia
  • 3Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California
  • 4Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
JAMA Oncol. 2017;3(1):49-55. doi:10.1001/jamaoncol.2016.3662
Key Points

Questions  Is there evidence of an association between use of androgen deprivation therapy in the treatment of prostate cancer and future dementia and can applied clinical informatics tools help identify relevant population cohorts?

Findings  This cohort study applied a novel text-processing analytic approach to the electronic medical records of 9272 individuals with prostate cancer. There was a statistically significant association between androgen deprivation therapy and increased risk of dementia.

Meaning  Future prospective studies are needed to further investigate the association of androgen deprivation therapy and risk of dementia.

Abstract

Importance  A growing body of evidence supports a link between androgen deprivation therapy (ADT) and cognitive dysfunction, including Alzheimer disease. However, it is currently unknown whether ADT may contribute to the risk of dementia more broadly.

Objective  To use an informatics approach to examine the association of ADT as a treatment for prostate cancer with the subsequent development of dementia (eg, senile dementia, vascular dementia, frontotemporal dementia, and Alzheimer dementia).

Design, Setting, and Participants  In this cohort study, a text-processing method was used to analyze electronic medical record data from an academic medical center from 1994 to 2013, with a median follow-up of 3.4 years (interquartile range, 1.0-7.2 years). We identified 9455 individuals with prostate cancer who were 18 years or older at diagnosis with data recorded in the electronic health record and follow-up after diagnosis. We excluded 183 patients with a previous diagnosis of dementia. Our final cohort comprised 9272 individuals with prostate cancer, including 1826 men (19.7%) who received ADT.

Main Outcomes and Measures  We tested the effect of ADT on the risk of dementia using propensity score–matched Cox proportional hazards regression models and Kaplan-Meier survival analysis.

Results  Among 9272 men with prostate cancer (mean [SD] age, 66.9 [10.9] years; 5450 [58.8%] white), there was a statistically significant association between use of ADT and risk of dementia (hazard ratio, 2.17; 95% CI, 1.58-2.99; P < .001). In sensitivity analyses, results were similar when excluding patients with Alzheimer disease (hazard ratio, 2.32; 95% CI, 1.73-3.12; P < .001). The absolute increased risk of developing dementia among those who received ADT was 4.4% at 5 years (7.9% among those who received ADT vs 3.5% in those who did not receive ADT). Analyses stratified by duration of ADT found that individuals with at least 12 months of ADT use had the greatest absolute increased risk of dementia (hazard ratio, 2.36; 95% CI, 1.64-3.38; P < .001). Kaplan-Meier analysis demonstrated that ADT users 70 years or older had the lowest cumulative probability of remaining dementia free (log-rank P < .001).

Conclusions and Relevance  Androgen deprivation therapy in the treatment of prostate cancer may be associated with an increased risk of dementia. This finding should be further evaluated in prospective studies.

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