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J Clin Oncol. 2016 Feb 20;34(6):566-71. doi: 10.1200/JCO.2015.63.6266. Epub 2015 Dec 7.

Androgen Deprivation Therapy and Future Alzheimer's Disease Risk.

Author information

1
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.
2
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.

Abstract

PURPOSE:

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).

CONCLUSION:

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.

PMID:
26644522
PMCID:
PMC5070576
DOI:
10.1200/JCO.2015.63.6266
[Indexed for MEDLINE]
Free PMC Article

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