Prevalence of cognitive impairment before treatments for prostate cancer

Background/Objective

Up to 30% of patients with cancer may present cognitive impairment (CI) before treatment but data are scarce regarding prostate cancer (PCa). We aim to estimate the prevalence of CI in patients with PCa, before cancer treatment.

Methods

Between February 2018 and April 2021, the NEON-PC cohort included 609 patients with a recent PCa diagnosis to be treated at Instituto Português de Oncologia do Porto. Previous history of chemotherapy, radiotherapy, androgen deprivation therapy, and neurologic or psychyatric conditions impairing cognitive performance were exclusion criteria. The Montreal Cognitive Assessment (MoCA) was used to assess cognitive performance before any treatment for PCa. Participants with a MoCA at least 1.5 SD below age- and education-specific norms were considered to have probable cognitive impairment (PCI) and were proposed for a comprehensive neuropsychological (NP) assessment. Participants scoring <2.0 SD age-corrected norms in at least one cognitive test, or < 1.5 SD age-corrected norms in ≥ 2 cognitive tests were classified as having CI. Data from the population-based cohort EPIPorto (n = 351 men, evaluated in 2013-2015) were used for comparison.

Results/Discussion

Prevalence of PCI was 17.4% in the EPIPorto and 15.1% in the NEON-PC cohort (age- and education-adjusted OR = 1.02,95% confidence interval: 0.70,1.50). NP assessment was performed in 65 patients with PCa: 38.5% had normal cognitive function; 7.7% had a light deficit (<1.0 SD of age-corrected norms in ≥ 1 cognitive tasks); and 53.9% had CI.

Conclusions

PCI was as frequent in patients recently diagnosed with PCa as in the general population. Prevalence of CI was lower than in previous reports, which may be explained by differences in the assessment and definition of CI and of the type of cancer.

Funding

POCI-01-0145FEDER-032358;PTDC/SAU-EPI/32358/2017;UIDB/4750/2020; SFRH/BD/119390/2016

Key messages

Patients with prostate cancer and the general population had similar odds of having a score below normative values in the MoCA. Differences in the prevalence of CI between this study and others suggest that the type of cancer may affect patients’ cognitive performance differently, which deserves further confirmation.

Androgen deprivation therapy and cognitive decline in the NEON-PC study

Background/Objective

Androgen deprivation therapy (ADT) has been associated with cognitive decline, but results have been heterogenous. We describe changes in cognitive performance in patients with prostate cancer (PCa), according to treatment with ADT, during the 1st year after PCa diagnosis.

Methods

Between February 2018 and March 2021, 348 patients with PCa treated at the Instituto Português de Oncologia do Porto were evaluated with the Montreal Cognitive Assessment (MoCA), before treatment and after one year (1y). ADT was used in 183 participants, and 165 were treated without ADT (total prostatectomy, radiotherapy, brachytherapy, active surveillance). Cognitive decline was defined as the decrease in MoCA from baseline to the 1y-evaluation below 1.5SD of the distribution of the MoCA variation in the whole cohort. Participants scoring below age- and education-based normative reference values in MoCA were considered to have probable cognitive impairment (PCI). Multivariate logistic regression was used to estimate age- and education-adjusted OR (aOR) of the association between ADT and cognitive decline/incident PCI.

Results/Discussion

PCI was observed in 12.4% of the patients at baseline. Mean MoCA scores increased from baseline to the 1y-evaluation (22.4 vs. 22.9, p = 0.001), and 51.2% of PCI cases at baseline had normal MoCA scores at 1y. Cognitive decline was most frequent in the ADT group (9.3% vs. 3.6%, p = 0.034), although the aOR was 2.44 (95%CI:0.89-6.71). The 1yr cumulative incidence of PCI was 10.4% (95%CI:6.2%-16.2%) in the ADT-group and 2.8% (95%CI:0.8-%-7.1%) in the non-ADT group [aOR=3.15 (95%CI:0.97-10.25)].

Conclusions

ADT was associated with a decrease in the cognitive performance of PCa patients during the 1st year after diagnosis. The completion of the 1y-evaluation in the whole cohort (n = 600) is needed to confirm these preliminary results.

Funding

POCI-01-0145FEDER-032358;PTDC/SAU-EPI/32358/2017; UIDB/4750/2020;SFRH/BD/119390/2016

Key messages

Half of the cases with cognitive impairment at baseline improved at one-year. Patients treated with ADT seem to be affected by cognitive decline more frequently.

Trajectories of cognitive performance over 5 years in a cohort of breast cancer patients (NEON-BC)

Purpose

Cancer-related cognitive impairment may affect 30-70% of cancer patients, either at baseline or during and after treatment. We aimed to identify trajectories of cognitive performance, from before any treatment to 5 years later, in a cohort of breast cancer (BCa) patients.

Methods

BCa women admitted to the Portuguese Institute of Oncology, Porto, were included in the NEON-BC study during 2012. They were evaluated with the Montreal Cognitive Assessment (MoCA) before any treatment, and after 1, 3 and 5 years (N = 506, 503, 475 and 466, respectively). Nlme R package was used to fit a mixed-effect model of the trends in MoCA scores over time, with age and education as fixed effect. Coefficients of this model were retrieved to calculate an age- and education-modified MoCA score (mMoCA). Mclust was used to obtain clusters of trajectories of mMoCA.

Results

Two trajectories were identified, one with higher scores and increasing over time, and the other showing a continuous decline (25.9% of the participants and 84% of the women with cognitive impairment confirmed by neuropsychological tests and clinical examination by neurologist at the 5 year follow-up). Each trajectory was split into 2, according to scoring above or below to the median value of mMoCA at baseline to account for the possibility of patients being in a declining pathway before treatment. In addition to trajectories characterized by the highest and lowest scores, respectively, relatively stable over time, two trajectories with middle-range scores were observed, one increasing over time and the other decreasing (12.7% of the participants); being older than 65 years, suffering from anxiety, depression or poor sleep after treatment were more frequent among the latter.

Conclusions

One quarter of the 5-year breast cancer survivors had a declining trajectory in cognitive performance. Anxiety, depression and sleep quality should be considered as targets for preventive or curative interventions of cognitive decline.

Key messages

Cognitive decline occurs during breast cancer care, affecting one quarter of the patients. Anxiety, depression and sleep quality should be considered as targets for preventive or curative interventions of cognitive decline.

Seropositivity for NT5c1A antibody in sporadic inclusion body myositis predicts more severe motor, bulbar and respiratory involvement

OBJECTIVES

To explore phenotypic differences between individuals with sporadic inclusion body myositis (sIBM) who are seropositive for the NT5c1A antibody compared with those who are seronegative.

METHODS

Cross-sectional clinical, serological and functional analysis in 25 consecutive participants with sIBM.

RESULTS

All participants met criteria for clinically defined or probable sIBM. 18 of 25 participants with sIBM (72%) were seropositive for the NT5c1A antibody. No differences between median age and duration of illness between the two groups were seen. Females have higher odds of being seropositive (OR=2.30). Participants with seropositive sIBM took significantly longer to get up and stand (p=0.012). There were no significant differences between the two groups in terms of distance covered on a 6 min walk. Seropositive participants were more likely to require assistive devices such as a walker or wheelchair for mobility (OR=23.00; p=0.007). A number of secondary (exploratory) outcomes were assessed. NT5c1A seropositive sIBM cases had lower total Medical Research Council (MRC) sum score and MRC sum score on the right (p=0.03 and 0.02, respectively). Participants with the NT5c1A antibody were significantly more likely to have symptoms of dysphagia (OR=10.67; p=0.03) and reduced forced vital capacity (p=0.005). Facial weakness occurred in 50% of seropositive participants while it was only seen in 14% of seronegative participants.

CONCLUSIONS

Even though the small sample size limits definite conclusions, our cross-sectional study showed seropositivity to the NT5c1A antibody is associated with greater motor and functional disability in sIBM. The study also suggests more prominent bulbar, facial and respiratory involvement in individuals positive for NT5c1A antibodies.

Antibodies are involved in the protective immunity induced in mice by Schistosoma mansoni schistosomula tegument (Smteg) immunization

The Schistosoma mansoni schistosomula tegument (Smteg) plays an important role in triggering the host immune response and mice immunization with Smteg formulated with Freunds adjuvant or alum + CpG induce partial protection against S. mansoni infection associated with an increased antibody production. In this study, we investigated the role of these antibodies in parasite killing both in vitro and in vivo. We demonstrated that these antibodies were able to bind to the surface of S. mansoni recently transformed schistosomula and that these antibodies significantly increase the percentage of schistosomula killed in vitro by complement activation. Passive transference of immune sera decreased the parasite burden and the number of eggs trapped in the organs of mice that received sera containing anti-Smteg antibodies. These results demonstrate that antibodies specific to surface tegumental antigens are involved in parasite elimination in mice immunized with Smteg.

Diels–Alder/thiol–olefin co-oxygenation approach to antimalarials incorporating the 2,3-dioxabicyclo[3.3.1]nonane pharmacophore

A Diels-Alder/thiol-olefin co-oxygenation approach to the synthesis of novel bicyclic endoperoxides 17a-22b is reported. Some of these endoperoxides (e.g., 17b, 19b, 22a and 22b) have potent nanomolar in vitro antimalarial activity equivalent to that of the synthetic antimalarial agent arteflene. Iron(II)-mediated degradation of sulfone-endoperoxide 19b and spin-trapping with TEMPO provide a spin-trapped adduct 25 indicative of the formation of a secondary carbon centered radical species 24. Reactive C-radical intermediates of this type may be involved in the expression of the antimalarial effect of these bicyclic endoperoxides.

[Chemoprophylactic activity on Schistosomiasis mansoni of soaps containing essential oil from the fruits of Pterodon pubescens]

The chemoprophylactic action of the essential oil of the fruit of Pterodon pubescens Benth (Leguminosae), incorporated in different soap formulations, was studied in experimental schistosomiasis. The formulations were used locally on the tails of mice which were exposed to Schistosoma mansoni cercariae immediately, 24, 72 or 168 hours later by the method of tail immersion. Protection was evaluated 45 days after exposure when the mice were sacrificed and the worms collected by perfusion. The results showed levels of protection varying from 0.0 to 100% depending on the formulation used. A methodology that allowed the evaluation of soap protection of mice exposed to natural infection in snail infested streams on the outskirts of Belo Horizonte, MG, was also developed. Promising results were obtained in that protection of between 57.5 and 31.1% was observed in field trials when soap was applied to the animals 24 and 48 hours earlier. Preliminary studies evaluating irritation and toxicity were favorable and showed that this new prophylactic weapon could contribute to the control of schistosomiasis.

Genomic variability in field populations of Schistosoma mansoni in Brazil as detected with a ribosomal gene probe

A cloned fragment of the ribosomal gene of Schistosoma mansoni, pSM 389, which contains part of the small rRNA gene plus a portion of the nontranscribed intergenic spacer, was used in Southern hybridization analyses to investigate genomic variation in natural populations of S. mansoni in Brazil. Genomic DNAs were isolated from schistosomes from infected patients (some of whom did not respond to antischistosomal chemotherapy), and from snails from disparate geographic locations in Brazil. Restriction fragment length polymorphisms (RFLPs) were evident in Southern blot hybridizations of these schistosome DNAs, and the RFLPs indicated that the genomic profiles of a number of Brazilian strains were more similar to each other than they were to parasites from two laboratory reference strains of Puerto Rican origin. In addition, the Brazilian isolates could generally be separated from each other based on these RFLPs. Isolates from the southeastern state of Minas Gerais were more similar to each other than they were to parasites isolated in the northeastern states of Alagoas and Pernambuco. Variation was evident among individual worms from some of the isolates, and these individual variations contributed to the complex RFLP patterns that were characteristic for particular isolates. The variation within a natural population isolated directly from snails at Ressaca, Belo Horizonte, may be more marked than that exhibited by more established strains maintained in the laboratory for numerous generations.

[Resistance of Biomphalaria schrammi of Arcos, Minas Gerais, Brazil, to infection with 2 strains of Schistosoma mansoni]

The descendants of planorbid snail Biomphalaria schrammi Crosse, 1864, collected in the region of Arcos, State of Minas Gerais, Brazil, were exposed to miracidia of two strains of Schistosoma mansoni: the "LE" strain from Belo Horizonte, Minas Gerais State and the "SJ" strain from São José dos Campos, State of São Paulo. Of the 172 snails exposed to miracidia of both strains, none were infected. On the other hand, 100 Biomphalaria glabrata snails of the control group showed infection rates of 88% ("LE" strain) and 40% ("SJ" strain). The mortality rates of B. schrammi and B. glabrata were 40% and 10%, respectively.

[A stock of infected snails for the mass breeding of cercariae and schistosomules]

A routine to maintain infected snails Biomphalaria glabrata able to produce 1-2 million cercariae per week and a mean shedding of about 3,500 cercariae per snail was quantitatively described. To a monthly production of about 5.3 and 6.5 million cercariae during the years of 1982 and 1983 it was necessary to expose an average of 1,557 and 1,957 snails, respectively. The efficiency described was maintained by infecting 2,000 snails per month (infectivity index of about 60%). A maximal production of 6,000 cercariae/snail was obtained in the period between 56-70 days after the snail infection by miracidia. By this period, however, 90% of the infected snails were dead. In the summer of 1982-1983 it was observed an impairment on the daily cercarial harvests which was related to ambient temperature increase, and the presence of rotifers in the aquaria water. When the cercariae were transformed into schistosomula in vitro, a yield of 55% schistosomula was obtained, with 7% of tail contamination. Lyophilization of cercariae produced 50.9 +/- 63 g dry weight per 1,000 cercariae.

Susceptibility to chemotherapeutic agents of strains of Schistosoma mansoni isolated from treated and untreated patients

Seven strains of Schistosoma mansoni were isolated from the feces of patients. Three of the patients had been unsuccessfully treated with hycanthone or oxamniquine; the remaining four had not been given any specific treatment. Mice infected with these strains were treated 45 days later with niridazole (50 or 100 mg/kg body weight per day for 5 days, per os), hycanthone (single dose of 80 or 160 mg/kg, intramuscularly), or oxamniquine (single dose of 50 or 100 mg/kg, per os). Significant differences in the strains' responses to the schistosomicidal agents used were observed. Oogram changes in mice treated with the same drug ranged from 10--100%, and percentages of dead worms from 0--45. Such differences seemed to be dependent on the strain's specific characters rather than t their having been exposed to schistosomicidal drugs.