Prostate medications can reduce the risk of Lewy body dementia

Researchers have found that certain medications commonly prescribed to treat prostate health may also reduce the risk of Lewy body dementia, a difficult neurodegenerative disease for which there are currently no effective treatments.

The study focused on older men taking drugs such as terazosin, doxazosin and alfuzosin. The researchers concluded that these drugs may help prevent the disease, opening up a promising new research avenue for dementia prevention.

Prostate medications and dementia risk

Certain medications used to treat urinary tract problems due to an enlarged prostate may be associated with a reduced risk of dementia with Lewy bodies, According to a recently published study in neurologythe medical journal of the American Academy of Neurology. Lewy body dementia is a progressive neurodegenerative disease that can cause memory and thinking problems, movement disorders, and problems such as hallucinations.

The results do not prove that these drugs reduce the risk of Lewy body dementia; they merely show a connection.

“These results are exciting because there are currently no drugs to prevent or treat dementia with Lewy bodies, the second most common neurodegenerative form of dementia after Alzheimer disease,” said study author Jacob E. Simmering, PhD, of the University of Iowa in Iowa City. “If we can find that an existing drug provides protection against this debilitating disease, there is the potential to significantly reduce its impact.”

Research methodology and preliminary results

The study looked at male participants who were taking various medications to treat urinary problems due to an enlarged prostate, a common problem in older men. The drugs, terazosin, doxazosin and alfuzosin, may block brain cell death by activating an enzyme important for energy production in brain cells. Previous studies have shown a link between these drugs and Parkinson's disease, which is similar to Lewy body dementia.

For the study, researchers examined a database of health information from male participants who had started taking one of these three drugs. They were compared with people taking two other types of prostate medications that do not activate the same enzyme – tamsulosin and the 5α-reductase inhibitors finasteride and dutasteride, the so-called 5ARIs.

Comparative analysis and statistical results

In total, 126,313 people took terazosin, doxazosin or alfuzosin, 437,045 people took tamsulosin and 80,158 people took a 5ARI. The researchers followed the participants for an average of three years to see who developed Lewy body dementia.

Among patients taking terazosin, doxazosin, or alfuzosin, 195 people developed the disease, a rate of 5.21 cases per 10,000 people per year. Among patients taking tamsulosin, there were 1,286 cases, a rate of 10.76 cases per 10,000 people per year. Among patients taking 5ARIs, there were 193 cases, a rate of 7.78 cases per 10,000 people per year.

After researchers matched the groups by age, other health conditions, and other factors that might explain the differences between the groups, they found that people taking terazosin, doxazosin, or alfuzosin were 40% less likely to develop dementia with Lewy bodies than people taking tamsulosin, and 37% less likely than people taking the 5ARIs. The risk of developing the disease was similar in those taking tamsulosin and the 5ARIs.

Conclusion and future research directions

“More research is needed to follow people over a longer period of time to determine whether there is a cause-and-effect relationship here, but it is promising to think that these drugs could have a protective effect on this disease, which is likely to affect a larger number of people as the population ages,” Simmering said.

Because only male participants participated in the study, the results may not be applicable to female participants. Another limitation of the study is that dementia with Lewy bodies can be difficult to diagnose. Therefore, it is possible that not all people with dementia with Lewy bodies were correctly diagnosed.

For more information about this research, see Prostate drugs offer new hope in dementia prevention.

Reference: “Association of Terazosin, Doxazosin, or Alfuzosin Use and Risk of Dementia With Lewy Bodies in Men” by Alexander Hart, Georgina Aldridge, Qiang Zhang, Nandakumar S. Narayanan and Jacob E. Simmering, June 19, 2024, neurology.
DOI: 10.1212/WNL.0000000000209570