EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal.
EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
ESMO Open. 2022 Apr;7(2):100448. doi: 10.1016/j.esmoop.2022.100448. Epub 2022 Mar 7.
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 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.
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).
ADT was associated with worse cognitive performance of patients with prostate cancer, mostly among those evaluated after the first COVID-19 lockdown.
雄激素剥夺疗法（ADT）与认知能力下降有关，但结果存在争议。本研究描述了前列腺癌患者在前列腺癌诊断后第一年中，根据 ADT 接受治疗后认知表现的变化。
在葡萄牙波尔图肿瘤研究所（n=366）接受治疗的前列腺癌患者在治疗前和治疗后 1 年接受蒙特利尔认知评估（MoCA）评估。所有基线评估均在冠状病毒病 2019（COVID-19）大流行之前进行，69.7%的 1 年评估是在第一次封锁之后完成的。认知能力下降被定义为 MoCA 从基线到 1 年评估的下降低于整个队列变化分布的 1.5 个标准差。MoCA 评分低于年龄和教育特定正常参考值的参与者被认为存在认知障碍。计算了 ADT 与认知结果之间关联的年龄和教育调整优势比（aOR）。
MoCA 平均评分从基线增加到 1 年评估（22.3 比 22.8，P<0.001）。ADT 组认知能力下降更为常见，在 COVID-19 大流行开始后更为常见（aOR 6.81 比 1.93，P 交互作用=0.233）。认知障碍的 1 年累积发生率为 6.9%（大流行前为 9.1%，大流行后为 3.7%），在接受 ADT 的患者中更高，但仅在大流行后（aOR 5.53 比 0.49，P 交互作用=0.044）。
ADT 与前列腺癌患者的认知表现下降相关，主要是在第一次 COVID-19 封锁后接受评估的患者中。
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