Despite evidence that cancer survivors frequently report difficulties with long-term memory, traditional neuropsychological test batteries often fail to detect significant memory deficits in this population. Instead, recent research has suggested that complaints of `forgetfulness' often associated with cancer-related cognitive dysfunction (CRCD) can actually be attributed to failures during initial learning that result from attentional difficulties, rather than memory decay. However, no studies to date have directly tested how attentional failures in CRCD impact downstream memory processes such as initial learning success and subsequent retrieval performance. Moreover, the finding that survivors often mischaracterize attention problems as memory problems during retrieval raises the question of whether survivors have accurate awareness of their own cognitive failures in real time (metamemory). Accurate awareness of errors is critical to the efficacy of current cognitive remediation methods that rely on survivors' ability to accurate detect errors as they occur. To address these gaps in knowledge, we have developed an experiment that draws on methods from cognitive neuroscience of memory and metacognition to examine effects of attention on initial learning and subsequent retrieval in CRCD, as well as assess survivors' awareness of their own cognitive processes throughout the task. We will use electroencephalography (EEG) to examine the cognitive and neural underpinnings of attention and memory processes in breast cancer patients treated with chemotherapy and radiation (N=24), as compared to age-matched healthy adults (N=24). Participants will undergo EEG recording while completing a long-term memory task, including on-line subjective assessments of their own learning and retrieval performance. The objective of this proposal is to use EEG in conjunction with a cognitive-experimental paradigm to evaluate the following specific aims:
Aim 1 : Examine whether cancer survivors demonstrate abnormal ERP components during initial learning, and whether these are correlated with subsequent retrieval failures;
and Aim 2 : Use a metamemory task to assess the accuracy of survivors' subjective confidence in their initial learning and retrieval ability. This research is significant because use of cognitive-experimental measures could more precisely identify effects of attentional failures on initial learning in CRCD and evaluate whether survivors are deficient in the ability to accurately detect these failures in real time, which will inform the development of effective treatment interventions. This research is innovative because it uses cognitive neuroscience-based methods to test both neural and cognitive mechanisms involved in attention, learning, and retrieval, and utilizes a metamemory paradigm to evaluate survivors' accuracy in detecting cognitive errors during learning. The use of these tasks allows for measurement of both objective and subjective cognitive processes along the learning and memory timeline which, to date, have not been evaluated in cancer survivors suffering from CRCD.
Despite significant progress in understanding cognitive change associated with breast cancer treatments, concerns remain about the adequacy of current clinical measures to accurately describe cancer-related cognitive impairment; specifically, there is a growing body of research suggesting learning and memory problems in cancer survivors stem from early attentional deficits, which traditional neuropsychological tests are unable to detect. The overall goal of this proposal is to develop a new approach to assessing specific neural and cognitive processes by using cognitive neuroscience-based performance-based tests and metamemory measures. This research is significant because use of cognitive neuroscience-based measures could more precisely identify subcomponents of cognitive processes affected by cancer and cancer treatments, leading to tailored preventive and treatment interventions.
