Common prostate drugs may protect against dementia with Lewy bodies

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A new study suggests that certain drugs used to treat enlarged prostate may also reduce the risk of developing dementia with Lewy bodies (DLB).

This surprising finding, published on June 19, 2024, in Neurology, builds on previous research from the University of Iowa Health Care team linking these drugs to a protective effect against Parkinson’s disease.

DLB is a neurodegenerative disease that causes significant and rapid cognitive decline. Although less common than Parkinson’s disease, DLB affects about one in 1,000 people per year and accounts for 3 to 7% of all dementia cases.

With an aging population, DLB is likely to become more prevalent.

The UI researchers think a specific side effect of the drugs targets a biological flaw shared by DLB, Parkinson’s disease, and possibly other neurodegenerative diseases.

This raises the potential for these drugs to be used more broadly to treat or prevent various neurodegenerative conditions.

“Conditions like DLB, Parkinson’s disease, and Alzheimer’s disease are debilitating, and we currently have no treatments that can modify their progression. We can only treat symptoms,” says Jacob Simmering, Ph.D., the study’s lead author and assistant professor of internal medicine at UI.

“Our study finds a neuroprotective effect similar to what we saw in Parkinson’s disease. If there is a broadly protective mechanism, these medications could potentially manage or prevent other neurodegenerative diseases.”

For their study, the UI researchers analyzed a large database of patient information, identifying over 643,000 men with no history of DLB who began taking one of six drugs used to treat benign prostatic hyperplasia (enlarged prostate).

Three of these drugs—terazosin, doxazosin, and alfuzosin (Tz/Dz/Az)—boost energy production in brain cells, which may help slow or prevent diseases like PD and DLB. The other drugs—tamsulosin and two 5-alpha-reductase inhibitors (5ARIs) called finasteride and dutasteride—do not enhance brain energy production and served as comparison drugs.

The researchers followed the men for an average of three years, tracking whether they developed DLB. By comparing men taking Tz/Dz/Az drugs to those taking tamsulosin or 5ARIs, the researchers found that men on Tz/Dz/Az drugs had about a 40% lower risk of developing DLB compared to those on tamsulosin, and about a 37% lower risk compared to those on 5ARIs. There was no significant difference in risk between men taking tamsulosin and 5ARIs.

While the study shows an association between Tz/Dz/Az drugs and reduced DLB risk, it does not prove a causal relationship. Additionally, the study only included men, so it is unclear if the findings apply to women.

Despite these limitations, Simmering and his colleagues are excited about the potential of these FDA-approved, inexpensive, and long-used drugs. “If terazosin and similar medications can slow or prevent DLB progression, it would significantly preserve cognitive function and quality of life for those affected,” Simmering says.

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