Date of Conferral

2018

Degree

Ph.D.

School

Public Health

Advisor

Naoyo Mori

Abstract

Alzheimer's disease (AD) is the most common progressive, neurodegenerative disease and form of dementia. The hallmarks of AD are extracellular accumulation of amyloid beta protein, resulting in neuritic, senile plaques and intracellular accumulation of tau protein. AD mainly arises from imbalance of amyloid beta protein production and its clearance in the brain. Testosterone modulates production of amyloid beta protein by decreasing its accumulation. Prostate cancer remains a substantial public health challenge in the United States. While androgen deprivation therapy (ADT) is an effective treatment for prostate cancer, it may be associated with cognitive impairment due to decreased levels of testosterone. The purpose of this study was to explore the association between ADT and the development of AD. This study was a retrospective, quantitative cohort study of subjects diagnosed with prostate cancer from a large population database, SEER Medicare-linked database. Data were analyzed using descriptive statistics along with correlation and multiple logistic regression analysis to evaluate the association between ADT use for prostate cancer and AD risk. The sample consisted of 27,913 men with a mean age of 72 years, majority being Caucasian with multiple comorbidities. Subjects who had received ADT were 20% more likely to develop AD than subjects who had not received ADT (OR, 1.20; 95% CI, 1.09, 1.32; p < .001) after controlling for race, ethnicity, prostate cancer stage, prostate cancer risk groups, and comorbidities. This association did not appear to vary by race or PCa risk group. Given an aging population and increased incidence and prevalence of prostate cancer and AD, these results may lead to positive social change by furthering AD prevention.

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