Impact of Androgen deprivation therapy on cognitive function of elderly men with Prostate Cancer

Abstract Background Prostate cancer affects millions of men worldwide. Androgen deprivation therapy (ADT) is the most prescribed medication for elderly men with prostatic cancer to slow and suppress the disease progression. ADT works on decreasing testosterone level and that can cause multiple side effects including potential cognitive affection, in the form of accelerating cognitive aging, and potentially increasing risk of dementia. Which in our elderly population requires careful consideration. Aim evaluation of the effect of androgen-deprivation therapy (ADT) on the cognitive function of elderly men recently diagnosed with prostate cancer (PC). Methods and Results The current research is a prospective cohort study conducted on 85 elderly recently diagnosed with prostate cancer and are about to start ADT within 2 weeks of the diagnosis. These patients were recruited from the Oncology and Geriatrics outpatient clinics of Ain Shams University hospitals and are expected to be followed up on ADT for at least 6 months. Cognitive and depression assessments were done using the Montreal cognitive assessment test (MoCA) and MoCA-basic according to their education and Geriatric Depression Scale (GDS) and the Patient Health Questionnaire-9 (PHQ-9). The cases were assessed at the start, after 2 months and after 6 months of ADT use. Cognitively impaired or depressed patients were excluded at the start of the study. This study showed that 57.6% of the studied participants had a lower MoCA score average after 6 months and indicating Mild cognitive impairment. Cognitive domains such as visuospatial, language, recall and attention were affected, 27.0 % were diagnosed with depression after 6 months of the ADT therapy. All of the depressed participants had cognitive impairment. Conclusion The use of androgen deprivation therapy caused cognitive decline, regression of some of the cognitive domains and depression in elderly patients with prostate cancer who received androgen deprivation therapy for a period of 6 months. It is recommended that the cognitive function and depression screening is to be assessed regularly to all cancer prostate patients receiving ADT and cognitive training must be advised and prescribed to preserve or improve the patients' cognitive abilities. Key words Prostate cancer, Androgen Deprivation Therapy, Cognitive decline, Elderly.