I have written a fair amount over the life of this blog about the cognitive impairment that many of us experience when we are on an androgen blockade (ADT). I have share my experiences about getting lost on the NYC subway, forgetting where I was going and why I was going there. I also have described how I was unable to remember what I read, so I went off to Barnes and Nobel and bought an adolescent type adventure novel about sailing ships. Each night I read the same beginning three to four chapters and each night these chapters were brand new and exciting!
When I described my symptoms, my doctors often responded by winking and nodding, but not believing what I told them.
At the James Wilmot Cancer Center, at University of Rochester in Rochester, NY, some researchers have finally started to take seriously our complaints about cognitive impairment accompanying ADT. They designed a study to evaluate the baseline prevalence of cognitive impairment in older men treated with ADT and to assess changes in cognitive performance over time in these men.
Thirty-two men (median age of 71 years, range 51-87) were administrated an extensive neuropsychological testing battery prior to their beginning ADT. Of these men in the sample, 21 (65%) completed the post-treatment evaluations 6 months later. At baseline, 45% scored >1.5 standard deviations below the mean on >/=2 neuropsychological measures. Using standardized inferential statistics, no change in cognition was documented following treatment. The Reliable Change Index revealed that, on a case-by-case basis, 38% demonstrated a decline in measures of executive functioning and 48% showed improvement on measures of visuospatial abilities.
Within exploratory analyses, patients who scored below expectation at baseline displayed no change in cognition, while patients with average or better scores at baseline displayed improvements in visuospatial planning and timed tests of phonemic fluency.
The conclusion of this study was that there was a high prevalence of lower than expected cognitive performance among a sample of men just starting ADT for prostate cancer. Assessment of baseline cognitive function should be taken into account for future research as well as informed clinical management.
Men should be warned that they may experience cognitive impairment so that they do not panic thinking that there is something else wrong with them.
Mohile SG, Lacy M, Rodin M, Bylow K, Dale W, Meager MR, Stadler WM Crit Rev; Oncol Hematol. 2009 May 13. Epub ahead of print.
Joel T Nowak MA, MSW