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. 2022 Apr;7(2):100448.
doi: 10.1016/j.esmoop.2022.100448. Epub 2022 Mar 7.

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

N Araújo  1 , A Costa  1 , L Lopes-Conceição  2 , A Ferreira  3 , F Carneiro  3 , J Oliveira  3 , I Braga  3 , S Morais  4 , L Pacheco-Figueiredo  5 , L Ruano  6 , V T Cruz  1 , S Pereira  7 , N Lunet  8
Affiliations

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

N Araújo et al. ESMO Open. 2022 Apr.

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

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Conflict of interest statement

Disclosure The authors have no relevant financial or nonfinancial interests to disclose. Data sharing The datasets generated and analysed in this study will not be publicly available given that the included patients do not specifically provide their consent for public sharing of their data and that anonymization is unlikely to be feasible, because the identification of patients treated in only one institution within a relatively short period may be possible when taking sociodemographic and clinical characteristics into account. Ethics approval and consent to participate Ethics approval was obtained from the Ethics Committee of the Portuguese Institute of Oncology of Porto (Ref. CES 89/017) and by the Portuguese Data Protection Authority (Authorisation 3478/2017). The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments. Written informed consent was obtained from all participants after the project’s aims and procedures had been fully explained by a member of the research team. Consent for publication Not applicable.

Figures

Figure 1
Figure 1
Association of age, education, anxiety, and depression, and treatments with cognitive decline and with incident cognitive impairment. 95% CI, 95% confidence interval; ADT, androgen-deprivation therapy; CD, cognitive decline defined as a variation in cognitive performance [Montreal Cognitive Assessment (MoCA) at 1 year minus MoCA at baseline] below 1.5 standard deviations of the variation in the whole cohort; COVID-19, coronavirus disease 2019; incCI, incident cognitive impairment defined as a score below age- and education-specific values from normative data at the 1-year evaluation in participants without cognitive impairment at baseline. aAdjusted for age. bNone of the participants had the outcome (cognitive decline/incident cognitive impairment). cAdjusted for age and education.
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