title: Androgen Deprivation Therapy and Future Alzheimer's Disease Risk.
abstract: OBJECTIVE
  To test the association of androgen deprivation therapy (ADT) in the treatment of prostate cancer with subsequent Alzheimer's disease risk.
  
  
  METHODS
  We used a previously validated and implemented text-processing pipeline to analyze electronic medical record data in a retrospective cohort of patients at Stanford University and Mt. Sinai hospitals. Specifically, we extracted International Classification of Diseases-9th revision diagnosis and Current Procedural Terminology codes, medication lists, and positive-present mentions of drug and disease concepts from all clinical notes. We then tested the effect of ADT on risk of Alzheimer's disease using 1:5 propensity score-matched and traditional multivariable-adjusted Cox proportional hazards models. The duration of ADT use was also tested for association with Alzheimer's disease risk.
  
  
  RESULTS
  There were 16,888 individuals with prostate cancer meeting all inclusion and exclusion criteria, with 2,397 (14.2%) receiving ADT during a median follow-up period of 2.7 years (interquartile range, 1.0-5.4 years). Propensity score-matched analysis (hazard ratio, 1.88; 95% CI, 1.10 to 3.20; P = .021) and traditional multivariable-adjusted Cox regression analysis (hazard ratio, 1.66; 95% CI, 1.05 to 2.64; P = .031) both supported a statistically significant association between ADT use and Alzheimer's disease risk. We also observed a statistically significant increased risk of Alzheimer's disease with increasing duration of ADT (P = .016).
  
  
  CONCLUSIONS
  Our results support an association between the use of ADT in the treatment of prostate cancer and an increased risk of Alzheimer's disease in a general population cohort. This study demonstrates the utility of novel methods to analyze electronic medical record data to generate practice-based evidence.
authors.affiliation: Kevin T. Nead, Greg Gaskin, and Nigam H. Shah, Stanford University; Cariad Chester and Nicholas J. Leeper, Stanford University School of Medicine, Stanford, CA; Kevin T. Nead and Samuel Swisher-McClure, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; and Joel T. Dudley, Icahn School of Medicine at Mount Sinai, New York, NY. kevin.nead@uphs.upenn.edu.
authors.forename: Kevin T
authors.initials: KT
authors.lastname: Nead
authors.affiliation: Kevin T. Nead, Greg Gaskin, and Nigam H. Shah, Stanford University; Cariad Chester and Nicholas J. Leeper, Stanford University School of Medicine, Stanford, CA; Kevin T. Nead and Samuel Swisher-McClure, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; and Joel T. Dudley, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Greg
authors.initials: G
authors.lastname: Gaskin
authors.affiliation: Kevin T. Nead, Greg Gaskin, and Nigam H. Shah, Stanford University; Cariad Chester and Nicholas J. Leeper, Stanford University School of Medicine, Stanford, CA; Kevin T. Nead and Samuel Swisher-McClure, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; and Joel T. Dudley, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Cariad
authors.initials: C
authors.lastname: Chester
authors.affiliation: Kevin T. Nead, Greg Gaskin, and Nigam H. Shah, Stanford University; Cariad Chester and Nicholas J. Leeper, Stanford University School of Medicine, Stanford, CA; Kevin T. Nead and Samuel Swisher-McClure, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; and Joel T. Dudley, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Samuel
authors.initials: S
authors.lastname: Swisher-McClure
authors.affiliation: Kevin T. Nead, Greg Gaskin, and Nigam H. Shah, Stanford University; Cariad Chester and Nicholas J. Leeper, Stanford University School of Medicine, Stanford, CA; Kevin T. Nead and Samuel Swisher-McClure, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; and Joel T. Dudley, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Joel T
authors.initials: JT
authors.lastname: Dudley
authors.affiliation: Kevin T. Nead, Greg Gaskin, and Nigam H. Shah, Stanford University; Cariad Chester and Nicholas J. Leeper, Stanford University School of Medicine, Stanford, CA; Kevin T. Nead and Samuel Swisher-McClure, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; and Joel T. Dudley, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Leeper
authors.affiliation: Kevin T. Nead, Greg Gaskin, and Nigam H. Shah, Stanford University; Cariad Chester and Nicholas J. Leeper, Stanford University School of Medicine, Stanford, CA; Kevin T. Nead and Samuel Swisher-McClure, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; and Joel T. Dudley, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Nigam H
authors.initials: NH
authors.lastname: Shah
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000453:epidemiology*; D000726:Androgen Antagonists / Q000627:therapeutic use*; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage / Q000627:therapeutic use*; D039702:Current Procedural Terminology; D057286:Electronic Health Records; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists / Q000037:antagonists & inhibitors; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D016016:Proportional Hazards Models; D011471:Prostatic Neoplasms / Q000188:drug therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
chemical_list: D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal; D007987:Gonadotropin-Releasing Hormone