Purpose To assess the relative risk of Alzheimer's disease (AD) among patients with prostate cancer who received androgen deprivation therapy (ADT), after adjustment for other cancer therapies. Methods Data from demographics, survival, diagnoses codes, procedure codes, and other information about beneficiaries age 67 years or older in the Medicare claims database was assessed to determine the unadjusted and adjusted risks of AD and of dementia from ADT. The prespecified survival analysis method was competing risk regression. Results Of the 1.2 million fee-for-service Medicare beneficiaries who developed prostate cancer in 2001 to 2014, 35% received ADT. Of these, 109,815 (8.9%) and 223,765 (18.8%) developed AD and dementia, respectively, and 26% to 33% died without either outcome. Unadjusted rates of AD and all-cause mortality per 1,000 patient-years were higher among ADT recipients; the unadjusted rates of AD were 17.0 and 15.5 per 1,000 person-years in recipients and nonrecipients, respectively, and the unadjusted rates of all-cause mortality were 73.0 and 51.6 per 1,000 person-years, respectively. The unadjusted rates for dementia in ADT recipients versus nonrecipients were 38.5 and 32.9, respectively, and the unadjusted rates of mortality were 60.2 versus 40.4, respectively. However, after analysis was adjusted for other cancer therapies and other covariates, patients with ADT treatment had no increased risk of AD (subdistribution hazard ratio [SHR], 0.98; 95% CI, 0.97 to 0.99) and had only a miniscule (1%) risk of dementia (SHR, 1.01; 95% CI, 1.01 to 1.02); patients treated with ADT were more likely to die before progression to AD (SHR, 1.24; 95% CI, 1.23 to 1.24) or dementia (SHR, 1.26; 95% CI, 1.25 to 1.26). The risks of AD and dementia were not associated with duration of ADT (ie, no dose effect). Other secondary analyses confirmed these results. Conclusion These data suggest that ADT treatment has no hazard for AD and no meaningful hazard for dementia among men age 67 years or older who are enrolled in Medicare.

中文翻译：

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接受雄激素剥夺疗法治疗前列腺癌的老年医疗保险受益人患阿尔茨海默病的风险

目的 评估接受雄激素剥夺疗法 (ADT) 的前列腺癌患者在调整其他癌症疗法后患阿尔茨海默病 (AD) 的相对风险。方法 评估来自人口统计学、生存率、诊断代码、程序代码以及 Medicare 索赔数据库中 67 岁或以上受益人的其他信息的数据，以确定未调整和调整后的 AD 和 ADT 痴呆风险。预先指定的生存分析方法是竞争风险回归。结果 在 2001 年至 2014 年发生前列腺癌的 120 万有偿服务医疗保险受益人中，35% 接受了 ADT。其中，109,815 (8.9%) 和 223,765 (18.8%) 分别发展为 AD 和痴呆，26% 至 33% 的人在没有任何结果的情况下死亡。未调整的 AD 率和每 1 人的全因死亡率，ADT 接受者的 000 患者年更高；接受者和非接受者的未调整 AD 发生率分别为每 1,000 人年 17.0 和 15.5 例，未调整的全因死亡率分别为每 1,000 人年 73.0 和 51.6 例。ADT 接受者与非接受者的未调整痴呆率分别为 38.5 和 32.9，未调整死亡率分别为 60.2 和 40.4。然而，在针对其他癌症疗法和其他协变量调整分析后，接受 ADT 治疗的患者患 AD 的风险没有增加（亚分布风险比 [SHR]，0.98；95% CI，0.97 至 0.99），并且只有微不足道的（1% ) 痴呆风险 (SHR, 1.01; 95% CI, 1.01 to 1.02); 接受 ADT 治疗的患者更有可能在进展为 AD 之前死亡（SHR，1.24；95% CI，1.23 比 1。24) 或痴呆症（SHR，1.26；95% CI，1.25 至 1.26）。AD 和痴呆的风险与 ADT 的持续时间无关（即无剂量效应）。其他二次分析证实了这些结果。结论 这些数据表明，ADT 治疗对 67 岁或以上参加医疗保险的男性没有 AD 风险，也没有对痴呆症的有意义的风险。