Cognitive Trajectories and Associated Factors in Prostate Cancer Survivors Over a 3-Year Prospective Study

To identify and characterize cognitive trajectories over 3 years in men with prostate cancer (PCa) and their associated sociodemographic, clinical, and treatment-related factors.

This study included 454 men with PCa from the NEON-PC cohort. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), before treatment and at 1- and 3-year follow-ups. Probable cognitive impairment (PCI) was defined using age- and education-adjusted cut-offs. Model-based clustering and clinical interpretability were used to identify cognitive trajectories. Adjusted odds ratios (aORs) were estimated using multinomial logistic regression.

Four cognitive trajectories were identified: (1) consistently high (highest scores throughout follow-up); (2) moderate-stable (stable intermediate scores); (3) moderate-downward (intermediate baseline scores and declining over the follow-up); and (4) consistently low (lowest baseline scores). PCI prevalence increased over time in the moderate-downward trajectory (8.1%-33.3%, p < 0.001) and remained high in the consistently low trajectory (29.8%-32.6%, p = 0.537). Compared with the consistently high trajectory, age (≥ 75 vs. ≤ 65: OR = 4.00; 95% CI: 1.61-9.93), education (≥ 10 vs. ≤ 4 years: aOR = 0.02; 95% CI: 0.01-0.06), and depressive symptoms (per one-point increase in the Hospital Anxiety and Depression Scale: aOR = 1.12; 95% CI: 1.01-1.24) were associated with the consistently low trajectory. Androgen deprivation therapy (ADT) was associated with the moderate-downward trajectory (aOR = 2.33; 95% CI: 1.01-5.36).

Four distinct cognitive trajectories were identified among men with PCa over 3 years, with worse trajectories associated with sociodemographic, psychological distress, and treatment-related factors.