Assessment of sensory gating, attention, and executive control in breast cancer

摘要 尽管在理解癌症和癌症治疗相关的认知功能障碍方面取得了重大进展， （CACD），人们对传统神经心理学测试是否足以准确地 检测患者报告的认知变化。记忆缺陷是最常见的认知障碍， 幸存者的问题;然而，用传统的记忆神经心理学方法进行评估， 经常表现在正常范围内。我们认为注意过程的变化 干扰记忆中信息的有效编码。因此，幸存者对 记忆问题是准确的，但与注意力缺陷有关，而不是记忆力。传统 神经心理学测量：1）在临床相关时间范围内的重测信度较低， 2）关注认知功能的粗略定义域，而忽略了 注意力的子成分对后来的回忆至关重要; 3）无法测量前注意过程，如 感觉门控/过滤;和4）与认知问题的自我报告无关。解决这些 局限性，我们已经开发了一系列经过充分研究和验证的认知实验措施， 感官-注意力-执行（SAE）电池，这将允许分解的感官，注意力和 执行子过程，是有效学习和信息编码的基础。我们将研究 绝经后乳腺癌患者辅助治疗相关的认知变化， 化疗（CT+：N=100）和未接受化疗（CT-：N=100）的受试者，将在 辅助治疗，化疗后1个月（CT患者为配对）以及化疗后12和24个月， 采用SAE成套测试和传统神经心理学测量进行入组。匹配的健康对照 （N=100）将在相似的时间范围内进行评估。本提案的目的是评估以下内容 具体目标：目标1：使用SAE检查注意力和执行控制子成分的变化 与匹配的健康对照相比，CT+和CT-治疗前和随时间推移的组合;目的2：检查 治疗前和一段时间后，使用SAE组合与传统治疗相比， CT+和CT-与匹配的健康对照组相比的神经心理学测量;目的3：检查 前注意处理措施与后注意力基于表现的措施之间的关系， SAE和传统电池的记忆;目标4：检查自我报告之间的关联 测量（感官门控清单和FACT-Cog）和SAE电池和传统电池的性能 神经心理学测量。这项研究是重要的，因为使用SAE措施可以更多地 精确识别与CACD相关的认知过程的子成分，从而实现定制治疗 并且是创新的，因为它利用基于认知神经科学的评估， 信息处理链中的认知过程沿着，包括前注意过程。

ABSTRACT Despite significant progress in understanding cancer and cancer-treatment associated cognitive dysfunction (CACD), concerns have been raised about the adequacy of traditional neuropsychological tests to accurately detect cognitive changes reported by patients. Memory deficits are the most commonly reported cognitive problems among survivors; however, assessment with traditional neuropsychological measures of memory has frequently demonstrated performance in the normal range. We propose that changes in attentional processes interfere with efficient and effective encoding of information in memory. Therefore, survivors’ perception of memory problems is accurate, but related to deficits in attention rather than memory. Traditional neuropsychological measures: 1) Can have low test-retest reliability over clinically relevant timeframes leading to large measurement error; 2) Focus on coarsely defined domains of cognitive function while ignoring the subcomponents of attention critical for later recall; 3) Are unable to measure pre-attentive processes like sensory gating / filtering; and 4) Do not correlate with self-report of cognitive problems. To address these limitations, we have developed a battery of well-studied and validated cognitive experimental measures, the Sensory-Attention-Executive (SAE) battery, which will allow for decomposition of sensory, attentional and executive sub-processes that underlie efficient learning and encoding of information. We will examine cognitive changes associated with adjuvant treatment for postmenopausal breast cancer patients treated with chemotherapy (CT+: N=100) and not treated with chemotherapy (CT-: N=100), who will be assessed prior to adjuvant treatment, 1 month post-chemotherapy (yoked for CT- patients) and 12 and 24 months post- enrollment with the SAE battery and traditional neuropsychological measures. Matched healthy controls (N=100) will be assessed over similar timeframes. The objective of this proposal is to evaluate the following specific aims: Aim 1: Examine alterations in subcomponents of attention and executive control using the SAE battery at pretreatment and over time in CT+ and CT- compared to matched, healthy controls; Aim 2: Examine the prevalence of impairment at pretreatment and over time utilizing the SAE battery versus traditional neuropsychological measures in CT+ and CT- compared to matched, healthy controls; Aim 3: Examine the relationship of measures of pre-attentive processing to later, performance-based measures of attention and memory from the SAE and traditional batteries; and Aim 4: Examine associations between self-report measures (Sensory Gating Inventory and FACT-Cog) and performance on the SAE battery and traditional neuropsychological measures. This research is significant because use of the SAE measures could more precisely identify subcomponents of cognitive processes associated with CACD leading to tailored treatments and is innovative because it utilizes assessments base on cognitive neuroscience allowing for assessment of subcomponent cognitive processes along the information processing chain, including pre-attentive processes.