# Cognitive Impairment in Prostate Cancer Patients Receiving Androgen Deprivation Therapy: A Scoping Review

## TL;DR

This review examines whether hormone therapy for prostate cancer affects cognitive function, finding mixed results and calling for more consistent research methods.

## Contribution

The paper provides a comprehensive synthesis of cognitive effects linked to androgen deprivation therapy in prostate cancer patients.

## Key findings

- Some studies found cognitive impairments in memory and executive function in patients receiving ADT.
- Other studies found no significant cognitive effects, highlighting variability in study designs and methods.
- The review emphasizes the need for standardized assessments and longitudinal studies to clarify ADT's cognitive impact.

## Abstract

Hormone therapy is often used to treat prostate cancer, especially in men with advanced or high-risk disease. While this treatment can slow cancer growth, some patients report difficulties with memory, attention, or thinking after starting therapy. To better understand whether these changes are linked to hormone treatment, we reviewed all available research on how it may affect brain function. The results were mixed—some studies found signs of cognitive decline, while others did not. These differences may be due to the wide variety of study designs, patient groups, and testing methods. Our goals are to raise awareness that hormone therapy may influence cognitive function in some patients and to highlight the importance of regular brain health monitoring. We also aim to encourage future research that uses consistent methods to better understand and address these potential side effects. This review supports informed care and decision-making for men receiving hormone therapy.

Background: Androgen deprivation therapy (ADT) is a primary treatment for prostate cancer (PCa) that effectively reduces androgen levels to suppress tumor progression. However, growing evidence suggests potential cognitive side effects, raising concerns about the long-term neurological consequences of this treatment. Objective: This scoping review aims to synthesize the existing evidence linking ADT to cognitive changes in men with PCa, identifying the key cognitive domains affected and outlining gaps in the existing literature. Methods: A systematic literature search was conducted according to the PRISMA-ScR guidelines in CINAHL, PubMed, Scopus, and Web of Science. Studies investigating cognitive function in ADT-treated PCa patients were included, covering randomized controlled trials (RCTs) and cohort, case–control, and cross-sectional studies. The extracted data included the study design, evaluated cognitive characteristics, measurement tools, and overall findings. Results: A total of 22 studies met the inclusion and exclusion criteria. Cognitive assessments varied across studies. While some studies reported cognitive impairments in ADT-treated patients—particularly in working, verbal, and visual memory and executive function—others found no significant effects. The variability in prostate cancer staging, epidemiological study designs, and treatment regimens; the exclusion of comorbid conditions; and the differences in assessment tools, sample sizes, and study durations hinder definitive conclusions about the cognitive effects of ADT. Conclusions: This scoping review highlights the heterogeneous and often contradictory evidence regarding ADT-associated cognitive dysfunction. While certain cognitive domains may be affected, methodological inconsistencies limit robust conclusions. Standardized cognitive assessments and longer longitudinal studies are required to clarify ADT’s role in cognitive decline. As the PCa survival rate increases with extended ADT use, integrating routine cognitive monitoring into clinical practice should be considered for PCa patients.