If you’ve been following this blog for the last few years, you’ve seen several reviews of papers exploring the question of whether ADT, with drugs like Lupron and Zoladex, increases the risk of depression and cognitive impairment. A new paper from researchers in Spain revisits these topics. The data are from 33 men (average age 70.8 years) starting on ADT, who took a battery of psychological tests and were tested again a year later.
Let’s start with cognition…
Although the majority of papers suggest that men on ADT have a slightly elevated risk of cognitive impairment, there is not a consensus in the literature. The authors of this new study did not find any across-the-board significant evidence of cognitive impairment from ADT. There were slight differences in cognitive test scores between subsets of younger (<75 years) versus older men (>75 years), with the younger men demonstrating slightly better cognitive function on one of the tests. But with a sample this small, it was not possible to tease out any definitive patterns.
One can see this as positive news, but there are some problems with the study. The researchers used just two cognitive tests, and they were not particularly discriminatory or sensitive ones. A challenging problem when one is looking for the psychological impact of medications in longitudinal studies is the potential for a learning effect. That is to say, in order to document a change through time one must test and then retest the participants. That means that the participants can learn with each test how to do better on the same text next time around…and that can influence results. One way to reduce such a problem is to not rely on one or two simple tests, but to use a large battery of diverse tests. That, however, is time-consuming for both participants and researchers.
In terms of other psychological parameters, the authors did document that ADT is associated with an increased risk of depression and poorer sleep. That is consistent with the findings of the majority of previous studies for men on ADT.
To read the full study, see: https://www.mdpi.com/2075-1729/11/3/227
Sánchez-Martínez, V., Buigues, C., Navarro-Martínez, R., García-Villodre, L., Jeghalef, N., Serrano-Carrascosa, M., ... & Cauli, O. (2021). Analysis of Brain Functions in Men with Prostate Cancer under Androgen Deprivation Therapy: A One-Year Longitudinal Study. Life, 11(3), 227.