title: Effects of long-term androgen deprivation therapy on cognitive function over 36 months in men with prostate cancer.
abstract: Many men with prostate cancer (PC) require long-term androgen deprivation therapy (ADT), but to the authors' knowledge, its effects on cognitive function beyond 1 year are not described.
  
  
  
  Three groups of men aged ≥50 years who were matched based on age and education were enrolled: 77 patients with nonmetastatic PC who initiated continuous ADT, 82 patients with PC who were not receiving ADT (PC controls), and 82 healthy controls. A battery of 14 neuropsychological tests, examining 8 cognitive domains, was administered on 5 occasions over 36 months. Changes in cognitive scores over time were analyzed using 3 approaches: linear mixed effects regression, the percentage of participants per group with declines in ≥1/2 cognitive tests, and a global summary of cognitive change.
  
  
  
  The mean age of the study subjects was 68.9 years, with a median of 16 years of education. In mixed effects models adjusted for age and education, ADT use was not found to be associated with significant changes over time in any cognitive test compared with healthy controls. The percentage of participants declining by ≥1.5 standard deviations in ≥2 tests or ≥2 standard deviations in ≥1 tests was similar across groups. A global summary of cognitive change found no statistically significant worsening of cognitive function among ADT users compared with controls. Sensitivity analyses adjusting for duration of ADT and using multiple imputation for missing data did not materially alter the study findings.
  
  
  
  The ongoing use of ADT for up to 36 months does not appear to be associated with cognitive decline. Cancer 2017;123:237-244. © 2016 American Cancer Society.
authors: Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada.|Department of Medicine, University of Toronto, Toronto, Ontario, Canada.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.|Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada.
authors: Shabbir M H
authors: SM
authors: Alibhai
authors: Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors: Narhari
authors: N
authors: Timilshina
authors: Krembil Neuroscience Program, Division of Neurology, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors: Sarah
authors: S
authors: Duff-Canning
authors: Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors: Henriette
authors: H
authors: Breunis
authors: Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.|Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada.
authors: Ian F
authors: IF
authors: Tannock
authors: Department of Medicine, University of Toronto, Toronto, Ontario, Canada.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.|Department of Medicine and Rotman Research Institute, Baycrest Health Sciences, University of Toronto, Toronto, Ontario, Canada.
authors: Gary
authors: G
authors: Naglie
authors: Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors: Neil E
authors: NE
authors: Fleshner
authors: Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada.|Department of Medicine, University of Toronto, Toronto, Ontario, Canada.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
authors: Murray D
authors: MD
authors: Krahn
authors: Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
authors: Padraig
authors: P
authors: Warde
authors: Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors: Shireen
authors: S
authors: Marzouk
authors: Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.|Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada.
authors: George A
authors: GA
authors: Tomlinson
mesh_terms: D000368:Aged; D000726:Androgen Antagonists / Q000009:adverse effects* / Q000627:therapeutic use*; D016022:Case-Control Studies; D003071:Cognition / Q000187:drug effects*; D003072:Cognition Disorders / Q000139:chemically induced*; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D011471:Prostatic Neoplasms / Q000188:drug therapy*
chemical_list: D000726:Androgen Antagonists
keywords: adverse effects; androgen deprivation therapy; cognitive function; cohort study; neuropsychological testing; prostate cancer