Ways To Treat Delirium In People With Cancer
Steps that can be taken to treat symptoms related to delirium include:
- Treat the causes of delirium: If medicines are causing delirium, then reducing the dose or stopping them may treat delirium. If conditions such as dehydration, poor nutrition, and infections are causing the delirium, then treating these may help.
- Control surroundings: If the symptoms of delirium are mild, it may help to keep the room quiet and well lit, with a clock or calendar and familiar possessions. Having family members around and keeping the same caregivers, as much as possible, may also help.
- Consider medicines: Medicines are sometimes given to treat the symptoms of delirium. However, these medicines have serious side effects and patients receiving them require careful observation by a doctor.
- Sometimes sedation may help: After discussion with family members, sedation is sometimes used for delirium at the end of life, if it does not get better with other treatments. The doctor will discuss the decisions involved in using sedation to treat delirium with the family.
Risk Of Dementia Rises With Prostate Cancer Hormone
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Prostate cancer patients who received hormone-lowering therapy were at higher risk of developing dementia and Alzheimers disease later on than men who didnt get this treatment, a large U.S. study finds.
Researchers who followed nearly 155,000 men with prostate cancer found that overall, those given so-called androgen-deprivation therapy were at a 20% higher risk of being diagnosed with dementia and at 14% higher risk of an Alzheimers diagnosis in the next 10 years. The risk continued to rise with increasing doses of androgen-deprivation drugs.
The results suggest that in cases where the prostate cancer is localized, androgen-deprivation therapy may not be a good choice, said the studys lead author, Ravishankar Jayadevappa, a research associate professor in the department of medicine at the University of Pennsylvanias Perelman School of Medicine in Philadelphia.
Even in patients at high risk, there needs to be a discussion about the elevated risk of dementia and Alzheimers disease during long-term follow-up, Jayadevappa said.
The most common androgens found in the male body are testosterone and dihydrotestosterone . According to the American Cancer Society, doctors may choose to prescribe androgen-lowering therapy because it can result in slower growth – or even shrinkage – of prostate tumors.
Studies on the cognitive impacts of androgen-deprivation therapy have had mixed results, Jayadevappa and his colleagues note in JAMA Network Open.
How Hormone Therapy Affects Thinking And Memory
Memory and the way we process information is called cognition. Cognitive ability describes how well you can remember and concentrate. This includes how you manage doing more than one task at the same time.
Some people notice changes to how they think and remember after hormone treatment for prostate cancer. It may not affect you every day. You may forget a word during a sentence or struggle to remember a shopping list.
Doctors call this mild cognitive impairment. You may hear it described as chemo brain, or a general fogginess. It doesnt only happen after chemotherapy. It can also be a side effect of hormone treatment.
For many people the changes are very subtle and get better after treatment.
Researchers are trying to find out how hormone treatment affects memory.
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Common Prostate Cancer Treatment Linked To Later Dementia Researcher Says
A new retrospective study of the health records of prostate cancer patients supports an association between androgen deprivation therapy and future risk of dementia.
Men being treated with prostate cancer therapies that reduce their testosterone levels are at greater risk of developing dementia within five years, a new study shows.Alexander Raths/Shutterstock
A new retrospective study of patient medical records suggests that men with prostate cancer who are treated with testosterone-lowering drugs are twice as likely to develop dementia within five years as prostate cancer patients whose testosterone levels are not tampered with.
The study, by researchers at the Stanford University School of Medicine and the University of Pennsylvania Perelman School of Medicine, also demonstrates emerging techniques for extracting biomedical data from ordinary patient medical records.
The paper describing the research was published online Oct. 13 in JAMA Oncology. Kevin Nead, MD, DPhil, a resident at the University of Pennsylvania who got his medical degree at Stanford, is the lead author. Nigam Shah, MBBS, PhD, associate professor of biomedical informatics research at Stanford, is the senior author.
Related: Prostate Cancer Treatment Needs To Get More Personalized
Im working on designing future studies that take a personalized medicine approach to identifying which patients are at greatest risk based on their DNA, he said. Rather than recommending an adjustment to treatment for most patients, I think this information should simply be factored into the risk-benefit conversation that oncologists and patients have before starting hormonal therapy for prostate cancer.
All cancer treatments have side effects, Nead said, and need careful consideration before their implementation. For now, Nead doesnt think treatment courses should be changed. Instead, what a large retrospective study like this offers is a marker of where to perform new research. When you use ADT in appropriate selected men, they live longer, he said. So I think we need to have a really high bar before we start changing the way that we treat people.
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Dementia Risk Doubled For Men Treated With Adt
The researchers came to their latest findings by using a text processing tool to analyze the medical records of 9,272 men of an average age of 67 who were treated for prostate cancer between 1994-2013. Of these, 1,826 were treated with ADT.
The team assessed dementia incidence among the men in the 5 years after treatment, including incidence of Alzheimers disease, vascular dementia, and frontotemporal dementia.
Compared with men who were not treated with ADT, those who did receive the treatment were over 5 years ADT-treated men had an absolute dementia risk of 7.9 percent, compared with 3.5 percent for men not treated with ADT.
The team found that regardless of age, the risk of dementia with ADT was still doubled.
Among men aged 70 and older, the absolute risk of developing dementia was 13.7 percent for those treated with ADT, compared with 6.6 percent for those who did not receive the treatment. For men younger than 70, men treated with ADT had a 2.3 percent risk of dementia, compared with 1 percent for those not treated with the therapy.
While the study was not designed to pinpoint the mechanisms by which ADT might raise dementia risk, the authors point to previous studies that suggest testosterone protects brain cells. As such, reducing levels of this hormone with ADT may eliminate some of the ways in which the brain staves off dementia.
Sex Hormones And Hot Flushes
Some cancer treatments can lower the levels of sex hormones in the body. The sex hormones are oestrogen and progesterone in women, and testosterone in men. The cancer treatments include hormone treatments for prostate cancer.
Prostate cancer needs testosterone to grow. Hormonal treatments aim to:
- stop the testicles from making testosterone
- stop testosterone reaching cancer cells
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Hormone Therapy For Prostate Cancer Tied To Dementia
Androgen deprivation therapy for prostate cancer is associated with an increased risk of Alzheimers disease and other forms of dementia.
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Hormone therapy for prostate cancer is associated with an increased risk for dementia, a new study has found.
Androgen deprivation therapy, or A.D.T., is used to treat prostate cancer of varying degrees of severity. It can significantly reduce the risk for cancer progression and death.
The study, in JAMA Network Open, included 154,089 men whose average age was 74 and who had diagnoses of prostate cancer. Of these, 62,330 received A.D.T. and the rest did not.
In an average follow-up of eight years, the scientists found that compared with men who had no hormone therapy, one to four doses of A.D.T. was associated with a 19 percent increased risk for both Alzheimers disease and other forms of dementia, and the risk increased with the number of doses. At five to eight doses the increased risk was 28 percent for Alzheimers and 24 percent for other dementias.
The study adjusted for socioeconomic status, age, race, severity of prostate cancer and other factors.
About Dr Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
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Tips To Help With Changes To Thinking And Memory
- Keep a diary or calendar to help you remember what you need to do each day
- Write lists of jobs to do, things to buy or where you keep things you use every day
- Use post it notes to remind you to do tasks
- Write down people names with a description to remember them
- Repeat information back to people to check understanding
- Keep your mind active, you could try crosswords, sudoku or puzzles
Reaction To The Studies
Dr. Stuart Holden, a urology oncologist at the University of California Los Angeles and medical director of the Prostate Cancer Foundation, said this information about recent studies does belong in the conversation when recommending hormone therapy to a patient.
I think it should be mentioned, Holden told Healthine. It should be in the conversation, but it has to be placed in the proper context.
That context, for him, would be that the hormone therapy comes with a risk of cognitive impairment and possibly a small increased risk of dementia.
The new study doesnt provide strong enough evidence, on its own, to change medical practice, Heather Snyder, senior director of medical and scientific operations at the Alzheimers Association, told Healthline.
Her organization strongly believes that all discussions about the potential benefits and risks of any treatment including hormone therapy should be had with a doctor. The decision should be made based on the patients unique health needs and circumstances.
Age is the strongest risk factor for Alzheimers, Snyder said, although she noted that research is finding other factors increase susceptibility or trigger the onset of dementia symptoms.
The Prostate Cancer Foundation, which published a new guide for people with prostate cancer last week, helped fund the new research.
Its been a relatively minor occurrence, but one that is worth studying, he said.
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Precision Prostate Cancer Treatment Reduces Adt
Peter Carroll, MD, MPH Senior author of the study and principal investigator of UCSFs Cancer of the Prostate Strategic Urologic Research Endeavor
In a new study, UCSF researchers found that cumulative androgen deprivation therapy exposure was associated with the onset of dementia in a nationwide longitudinal registry of men with prostate cancer. We found a twofold increased likelihood of new-onset dementia among patients on ADT, said study co-author Peter Lonergan, MD, a urologic oncology fellow at UCSF at the time of publication.
This is an important observation, as ADT is commonly used in those with very advanced disease as well as in combination with radiation in those with non-metastatic, higher-risk disease, said Peter Carroll, MD, MPH, senior author of the study and principal investigator of UCSFs Cancer of the Prostate Strategic Urologic Research Endeavor , the longitudinal registry on which the study was based.
The study results further support the need for accurate risk stratification and informed treatment decisions. Its important to follow an evidence-based, targeted treatment paradigm tailored to the individuals risk and overall health, said study co-author Matthew Cooperberg, MD, MPH, urologic cancer surgeon and co-director of the Prostate Cancer Program at the UCSF Helen Diller Family Comprehensive Cancer Center.
The first community urology study on ADT and dementia risk
Impact on treatment decisions
Accurate risk assessment
Weighing The Benefits Of Adt Against The Risks
While the number of individuals who develop dementia from ADT therapy is relatively small, researchers say its a very real risk. When deciding on a plan for prostate cancer treatment, the benefits of receiving ADT must be weighed against potential risks as well as the feasibility of other treatment options. Depending on individual risk factors and possible vulnerability to dementia, doctors may want to consider alternative treatments in some men.
If your senior loved one has been diagnosed with a serious condition and needs help with tasks like meal prep, transportation, bathing, and grooming, reach out to Home Care Assistance, a leading provider of homecare Clearwater, FL, families can trust. We also offer comprehensive care for seniors with dementia, Alzheimers, and Parkinsons.
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Adt Linked To Higher Risk Of Dementia And/or Alzheimer Disease In Patients With Prostate Cancer
The researchers recommend patient counseling on these side effects and routine monitoring of cognitive function in patients receiving ADT.
Androgen-deprivation therapy increases the risk that a patient with prostate cancer will develop dementia and/or Alzheimer disease, according to a systematic review and meta-analysis published in the Journal of Urology.1
Compared with patients not receiving ADT, patients treated with ADT had a 21% higher risk of new onset dementia . The risk of Alzheimer disease among patients receiving ADT was 16% higher compared with those not undergoing the treatment.
The increased risk of dementia was more pronounced with longer ADT duration however, treatment length did not have a significant impact on Alzheimer risk.
Based on these findings, we recommend routine monitoring of cognitive function in patients receiving ADT. In addition, mental/cognitive status assessment should be performed in all patients planned for ADT. Adequate patient counseling about these potential side effects of ADT should be part of the decision making and follow-up strategy, the authors wrote in their conclusion.
Among patients with prostate cancer receiving ADT for 12 months, the risk of dementia was 36% higher versus those not receiving ADT. The risk of dementia in patients treated with ADT for < 12 months was 6% greater than those not receiving ADT however, the difference was not statistically significant .
Reference
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Androgen Deprivation Therapy For Prostate Cancer Ups Dementia Risk
Adult men with prostate cancer who have increasing exposure to androgen deprivation therapy are at greater risk ofdementia, according to a US study.
The potential of a higher risk of dementia in men being treated with ADT should be balanced with a careful and complete discussion of the needs and benefits of ADT in those being considered for such treatment, the researchers said.
This retrospective analysis was performed on 13,570 men aged 50 years from the CaPSURE registry. Onset of dementia following primary treatment was the primary outcome. ADT exposure was articulated as a time-varying independent variable of total ADT exposure.
The researchers used a propensity score to estimate the probability of receiving ADT. They also performed Cox proportional hazards regression to determine the association between ADT exposure and dementia with competing risk of death, adjusted for propensity score and clinical covariates among men receiving various treatments.
Of the men, 317 were diagnosed with dementia after a median of 7.0 years of follow-up. After adjustment, cumulative ADT significantly correlated with dementia .
An association was also observed between ADT use and dementia in a subset of 8,506 men, where propensity score was matched by whether or not they received ADT. On the other hand, no association was seen between primary treatment type and dementia onset in the 8,489 men in the cohort who did not receive ADT.
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Study: Hormone Treatment For Prostate Cancer Linked With Dementia
Researchers from the University of Pennsylvania found that older prostate cancer patients getting hormone treatment, called androgen deprivation therapy , were more likely to be diagnosed later with Alzheimers disease or dementia. The study was published July 3, 2019 in JAMA Network Open.
The study authors looked at records from about 154,000 prostate cancer patients in the National Cancer Institutes SEER database. The men, aged 66 years and older, were diagnosed between 1996 and 2003 and were followed for an average of 8 years. More than 62,000 received ADT within 2 years after their diagnosis, and almost 92,000 did not. Results showed that men treated with ADT were more likely to be diagnosed with Alzheimers disease or dementia compared to men who did not get ADT. They also found the risk was higher for men who received more doses of ADT.
- Of the men in the study who received ADT, 13% were diagnosed with Alzheimers disease compared with 9% who did not receive ADT.
- 22% of men who received ADT were diagnosed with dementia compared with 16% who did not.
- Men who received more than 8 doses of ADT were at significantly higher risk of both Alzheimers disease and dementia diagnoses than those who received fewer than 8 doses.
The Role Of Testosterone
Nead and Nigam Shah, a biomedical informatics researcher at Stanford, looked at medical records from the Stanford University Health System from 1994 to 2013. Of the 9,272 men they found with prostate cancer diagnoses, 1,826 were receiving ADT. The study excluded men with previous dementia diagnoses, and only included those who had records available for follow-up visits.
The results showed that men receiving ADT were almost twice as likely to develop dementia as those without ADT in absolute terms, 7.9 percent of the former group developed the condition, compared to 3.5 percent of the latter.
The researchers previous work showed a correlation between ADT and Alzheimers this study expands that finding to all dementias.
Testosterone is known to offer multiple protections for the brain. It regulates how much amyloid protein is produced and helps regulate amyloid degradation and destruction. Its useful against more general dementia as well: Testosterone decreases levels of brain inflammation, promotes growth and the ability of neurons to survive, and increases neural stem cells.
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