Subjective cognition and memory lapses in the daily lives of breast cancer survivors: Examining associations with objective cognitive performance, fatigue, and depressed mood

Abstract

Objective: Subjective reports of cancer-related cognitive impairment often far exceed that documented using in-person neuropsychological assessment. This study evaluated whether subjective cognition was associated with real-time objective cognitive performance in daily life versus performance on an in-person neuropsychological battery, as well as fatigue and depressed mood.

Methods: Participants were 47 women (M age = 53.3 years) who completed adjuvant treatment for early-stage breast cancer 6-36 months previously. During an in-person assessment, participants completed a neuropsychological battery and questionnaires on subjective cognition, fatigue, and depressed mood. Over 14 days, participants responded to up to 5 prompts that assessed real-time processing speed and memory and self-reported ratings of depressed mood and fatigue. In the evenings, participants rated their subjective cognition that day and reported on memory lapses (e.g., forgetting a word).

Results: During the in-person assessment, participants who rated their cognition worse reported worse depressed mood, but did not exhibit poorer objective cognitive performance. Women with worse rated daily subjective cognition reported more daily fatigue but did not demonstrate worse real-time objective cognition. Finally, women who reported memory lapses at the end of the day reported more fatigue and depressed mood, demonstrated better real-time performance on processing speed (p = 0.001), and worse in-person processing speed and visuospatial skills (p's ≤ 0.02).

Conclusion: Subjective cognition was consistently associated with self-reported fatigue and depressed mood. Specific memory lapses were related to in-person and daily objective cognitive performance. This suggests that incorporating reports of memory lapses may help clinicians identify those with objectively measured cancer-related cognitive impairment.

Keywords: cancer; cancer-related cognitive impairment; depression; ecological momentary assessment; fatigue; oncology; psycho-oncology; subjective cognition.