Abstract
The relationship between cognitive decline and androgen deprivation therapy (ADT) under luteinizing hormone-releasing hormone (LHRH) analogues is unclear, and there is a scarcity of longitudinal studies considering the interaction between cognition, depressive symptoms and sleep quality in men with prostate cancer (PCa) treated with ADT. This study aimed to determine if there were differences in the scores obtained in cognitive assessment, depressive symptoms, and sleep quality after one year of ADT and determine the interrelations between sleep, mood, and cognitive status. A prospective longitudinal observational study was designed, in which a cohort of men (mean age was 70.8 years) newly treated with androgen-deprivation therapy was assessed in the first six months of treatment and 12 months later. Analysis of cognitive function by the Mini-Mental State Examination (MMSE) scores indicated a significant (p < 0.05) increase after one year of treatment and by the Brief Scale for Cognitive Evaluation (BCog) scores indicated no changes in the scores before and after one year of treatment. Analysis of depressive symptoms with the Geriatric Depression Scale and sleep quality with the Athens Insomnia Scale (AIS) scores showed significant (p < 0.05) changes after one year of treatment with ADT, with men describing more depressive symptoms and more sleep disturbances. No statistically significant differences were found in the cognitive performance between men with impaired sleep or depression results and those without them. Our study showed no clinical evidence of the relationship between ADT under luteinizing hormone-releasing hormone (LHRH) analogues and cognitive deterioration in 1-year follow-up, but there are impairments in the sleep quality in men with PCa undergoing ADT and an increase in depressive symptoms which has important implications for clinicians as they would impair quality of life and adherence to treatment.
Highlights
This study aimed to study a cohort of men newly treated with ADT: to determine if, after one year of androgen deprivation therapy, there were differences between the baseline and the follow-up scores of the cognitive assessments; to measure
We found a correlation between the depressive symptoms and the sleep quality in the baseline assessment, but it was not confirmed in the follow-up
When controlled for age and education level, the follow-up scores of the Brief Scale for Cognitive Evaluation (BCog) were found to be correlated to the depressive symptoms and to the sleep quality
Summary
In 2017, its global estimated incidence was 1.3 million, and it caused 416,000 deaths [2], with marked differences in the rates across different regions and populations [1,3]. In Europe, it was estimated to represent 21.8% of the total cancer incidence and 10% of cancer deaths in 2018 [4]. The diagnosis of cancer is a stressful experience that significantly impacts all spheres of patients’ lives, at the time of diagnosis but can be maintained for many years, even in those patients who have overcome the disease. Not all sequelae in the cognitive-emotional sphere are produced by the impact of the diagnosis and the associated psychological disorders. In recent years, increasing importance has been given to the toxicity produced by oncology treatments, whether acute or late-onset
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