NCOG-48. LONGITUDINAL ASSESSMENT OF SUBJECTIVE COGNITIVE FUNCTION IN A BRAIN TUMOR SAMPLE: IMPROVED CORRESPONDENCE WITH NEUROPSYCHOLOGICAL PERFORMANCE OVER TIME

INTRODUCTION Estimates of subjective cognitive function (SCF) generally show minimal correlation with objective measures of neurocognitive function (NCF). Our group recently validated a new metric of SCF in neuro-oncology patients, creating the Cognitive Index of the Functional Assessment of Cancer Therapy-Brain (FACT-Br-CI). This study examines whether brain tumor (BT) patients evaluated on more than one occasion show improved relationship between SCF and NCF. We hypothesized that change scores in SCF and NCF across evaluation would be more highly correlated than SCF and NCF at either timepoint. METHODS A retrospective study of BT patients who completed two neuropsychological evaluations (baseline, follow-up) was conducted. NCF was measured by the clinical trial battery composite (CTBC), a mean of 6 commonly used neuropsychological test scores. SCF was measured by the FACT-Br-CI. Mood/Anxiety were measured by the Beck scales (BAI/BDI-II). Change over time on each metric was evaluated with paired t-test. Correlational analyses evaluated relationships between NCF, SCF, and mood within and between time points. RESULTS Twenty-nine patients (16 female; mean age=54.6y; mean education=15.5y) completed all CTBC measures and FACT-Br-CI, 28 of whom completed and BDI and/or BAI. On group analyses, there were no significant differences between baseline and follow-up on CTBC (t=-.53;p=ns) or FACT-Br-CI (t=-.98;p=ns). Correlations between CTBC and FACT-Br-CI were nonsignificant at baseline (r=.24;p=ns), but significant at follow-up (r=.56;p=0.002). Change scores over time were unrelated (r=-.104;p=ns). Similar to previous studies, the FACT-BR-CI correlated with the BDI-II at baseline (r=-.38;p=0.04) and follow-up (r=-.59;p< 0.001) and with the BAI at follow-up (r=-.44;p=0.02). CONCLUSION In this small group of brain tumor patients seen for repeated neuropsychological evaluations, we found that agreement between SCF and NCF was much higher on their second than initial evaluation. These findings suggest that patients may develop enhanced awareness of their cognitive function from an initial evaluation that persists over time.

NCOG-20. LONGITUDINAL ASSESSMENT OF SUBJECTIVE COGNITIVE FUNCTION IN ADULTS WITH LOW GRADE GLIOMA TREATED WITH PROTON RADIATION THERAPY

INTRODUCTION Our group previously demonstrated stability in neurocognitive function (NCF) over a 5-year period after proton radiation therapy (PRT) in low grade glioma (LGG) patients. Subjective cognitive function (SCF) had not been previously explored, nor had individual analyses of cognition, which can detect variability in trajectory. We used the newly derived Functional Assessment of Cancer Therapy-Brain Cognitive-Index (FACT-Br-CI) to examine SCF in LGG patients after PRT and compare longitudinal changes in SCF and NCF. METHODS 20 LGG patients (M age =37.5) treated with PRT completed NCF tests and self-report measures annually for 5 years or until tumor progression. Group change in SCF was examined with paired t-test (baseline vs final FACT-Br-CI). Individual change scores were calculated for FACT-Br-CI and NCF tests (clinical trials battery composite; CTBC). Individual deterioration in NCF was defined by reliable change index (RCI) on CTBC, and in SCF was defined as decline of >/=1 SD in FACT-Br-CI. Relationships between change in SCF and NCF were explored with correlations. RESULTS At the group level, no change was observed in FACT-Br-CI between baseline and last follow-up (t(19)=-.91;p=ns). Individual SCF analyses at last follow-up found the number of patients reporting decline=3 (15%), improvement=5 (25%), and no change=12 (60%). Individual changes were observed in SCF in 20% of patients at 3 months, 5.9% at 6 months, 12.5% at 12 months, 13.3% at 24 months, and 11.1% at 36 months. Median time to any deterioration in SCF was 36 months and for NCF was not reached. Correlation between CTBC and FACT-Br-CI change scores did not reach statistical significance (r=.41;p=ns). CONCLUSION Consistent with previous research, group analyses of LGG patients did not show cognitive decline after PRT. However individual analyses of SCF showed variability within the group: some patients experienced cognitive decline during follow up. Consideration of individual differences may yield additional information.

Cross-Sectional Characterization of Local Brain Network Connectivity Pre and Post Breast Cancer Treatment and Distinct Association With Subjective Cognitive and Psychological Function

Objective: We aimed to characterize local brain network connectivity in long-term breast cancer survivors compared to newly diagnosed patients.Methods: Functional magnetic resonance imaging (fMRI) and subjective cognitive and psychological function data were obtained from a group of 76 newly diagnosed, pre-treatment female patients with breast cancer (mean age 57 ± 7 years) and a separate group of 80, post-treatment, female breast cancer survivors (mean age 58 ± 8; mean time since treatment 44 ± 43 months). The network-based statistic (NBS) was used to compare connectivity of local brain edges between groups. Hubs were defined as nodes with connectivity indices one standard deviation or more above network mean and were further classified as provincial (higher intra-subnetwork connectivity) or connector (higher inter-subnetwork connectivity) using the participation coefficient. We determined the hub status of nodes encompassing significantly different edges and correlated the centralities of edges with behavioral measures.Results: The post-treatment group demonstrated significantly lower subjective cognitive function (W = 3,856, p = 0.004) but there were no group differences in psychological distress (W = 2,866, p = 0.627). NBS indicated significantly altered connectivity (p < 0.042, corrected) in the post-treatment group compared to the pre-treatment group largely in temporal, frontal-temporal and temporal-parietal areas. The majority of the regions projecting these connections (78%) met criteria for hub status and significantly less of these hubs were connectors in the post-treatment group (z = 1.85, p = 0.031). Subjective cognitive function and psychological distress were correlated with largely non-overlapping edges in the post-treatment group (p < 0.05).Conclusion: Widespread functional network alterations are evident in long-term survivors of breast cancer compared to newly diagnosed patients. We also demonstrated that there are both overlapping and unique brain network signatures for subjective cognitive function vs. psychological distress.

The effects of neuroplasticity-based auditory information processing remediation in adults with chronic traumatic brain injury

BACKGROUND: Adults with chronic traumatic brain injury (TBI) may experience long-term deficits in multiple cognitive domains. Higher-order functions, such as verbal memory, are impacted by deficits in the ability to acquire verbal information. OBJECTIVE: This study investigated the effects of a neuroplasticity-based computerized cognitive remediation program for auditory information processing in adults with a chronic TBI. METHODS: Forty-eight adults with TBI were randomly assigned to an intervention or control group. Both groups underwent a neuropsychological assessment at baseline and post-training. The Intervention group received 40 one-hour cognitive training sessions with the Brain Fitness Program. RESULTS: The intervention group improved in performance on measures of the Woodcock-Johnson-III Understanding Directions subtest and Trail Making Test Part-A. They also reported improvement on the cognitive domain of the Cognitive Self-Report Questionnaire. CONCLUSIONS: The present study demonstrated that a neuroplasticity-based computerized cognitive remediation program may improve objective and subjective cognitive function in adults with TBI several years post-injury.

Reliability and Validity of a Novel Cognitive Self-Assessment Tool for Patients with Cancer

Background Subjective cognitive function is an important outcome measure in oncology. The Functional Assessment of Cancer Therapy-Brain (FACT-Br) is a quality of life (QoL) measure that includes indices of physical, emotional, social, and neurologic aspects of disease, but does not measure cognitive function. This study seeks to validate a novel index of cognition derived from the FACT-Br. Methods Patients with heterogeneous cancer diagnoses (N=214) completed neuropsychological evaluation and self-report measures. Nine FACT-Br items regarding cognition were combined to form the FACT-Br-Cognitive Index (CI). Reliability was evaluated by exploratory factor analysis and internal consistency. Concurrent validity was assessed by correlating FACT-Br-CI with the Patient-Reported Outcomes Measurement Information System (PROMIS) Cognitive-8 scales. Discriminant validity was assessed by correlating FACT-Br-CI with other FACT-Br indices and the Beck Depression and Anxiety Inventories (BDI, BAI). Exploratory analyses evaluated the impact of cognitive performance and disease variables on FACT-Br-CI. Results The FACT-Br-CI consisted of a single factor that demonstrated high internal consistency (α=.867) and strong concurrent validity, correlating strongly with PROMIS-Cognitive-8 scales (r=.675-.782). The relationship between the FACT-Br-CI and other FACT subscales ranged from moderate to strong (r=.372-.601), as did correlations with measures of depression (BDI, r=-.621) and anxiety (BAI, r=-.450). Modest correlations were observed with neuropsychological measures (r’s=.249-.300). Conclusions The FACT-Br-CI is a reliable and valid measure of self-reported cognition. Studies that included the FACT-Br could be retrospectively analyzed to assess subjective cognitive outcomes, enriching the information from prior research. Integration of the FACT-Br-CI in routine clinical care may be an efficient method of monitoring cognition.

Assessment and Management of Cognitive Symptoms in Patients With Brain Tumors

Cognitive symptoms occur in almost all patients with brain tumors at varying points in the disease course. Deficits in neurocognitive function may be caused by the tumor itself, treatment (surgery, radiation, or chemotherapy), or other complicating factors (e.g., seizures, fatigue, mood disturbance) and can have a profound effect on functional independence and quality of life. Assessment of neurocognitive function is an important part of comprehensive care of patients with brain tumors. In the neuro-oncology clinic, assessment may include cognitive screening tools and inquiry into subjective cognitive function. Neuropsychological assessment is an important adjunct to identify cognitive symptoms and can be used as an opportunity to intervene through transformative feedback and treatment planning. Preventative measures can be taken to reduce cognitive side effects of treatment, such as awake craniotomies with intraoperative mapping during neurosurgery or prophylactic measures during radiation therapy (e.g., hippocampal avoidance, neuroprotectant treatment with memantine). Rehabilitative therapies, including cognitive rehabilitation and computerized cognitive exercise, are options for managing cognitive problems in an individualized manner. Pharmacotherapy, including use of stimulant medications and acetylcholinesterase inhibitors, has shown benefits for patients with brain tumors when tailored to an individual’s cognitive profile. Identification and management of co-occurring issues, such as sleep disturbance, fatigue, and depression, can also improve neurocognitive function. There are promising therapies under development that may provide new options for treatment in the future. Integrating careful assessment and treatment of cognition throughout the disease course for patients with brain tumors can improve functional outcomes and quality of life.

Visual Memory Deficits in Middle-Aged APOE ɛ4 Homozygotes Detected Using Unsupervised Cognitive Assessments

Background: The apolipoprotein E (APOE) ɛ4 allele is associated with dose-response effects on cognitive dysfunction and dementia risk in older adults. However, its effects on cognition in middle-aged adults remains unclear. Objective: We examined effects of ɛ4 heterozygosity and homozygosity on objective and subjective cognition in middle-aged adults enrolled in the Healthy Brain Project (HBP) and in older adults from the Australian Imaging, Biomarkers and Lifestyle (AIBL) study. Methods: HBP participants (1,000 non-carriers; 450 ɛ4 heterozygotes; 50 ɛ4 homozygotes) completed unsupervised assessments of the Cogstate Brief Battery (CBB), ratings of subjective cognitive function and provided a saliva sample. AIBL cognitively normal participants (650 non-carriers; 204 ɛ4 heterozygotes; 31 ɛ4 homozygotes) completed in-person assessments of the CBB, ratings of subjective cognitive function and provided a blood sample. Results: Greater memory impairment was observed in middle-aged ɛ4 homozygotes compared with ɛ4 heterozygotes and non-carriers. When data from middle-aged (HBP) and older (AIBL) adults were pooled, the effect of ɛ4 homozygosity and memory impairment increased with age. In both middle-aged and older adults, ɛ4 heterozygotes did not differ from non-carriers on any measure of objective or subjective cognition. Conclusion: Memory impairment in ɛ4 homozygotes is evident in adults aged 50-60 years, and this can be detected through unsupervised cognitive assessments. The effect of ɛ4 homozygosity increases with older age. APOE ɛ4 homozygosity has a negative impact on memory as early as midlife, but due to the subtle magnitude of effect, our findings support the necessity of online platforms in large cohorts to assess these complex relationships.

Objective and Subjective Cognitive Function, and Relations With Quality of Life and Psychological Distress

Objective and subjective cognitive function have been associated with decreased quality of life and increased psychological distress in older adults. The present study examined relations of objective and subjective cognition with quality-of-life and mental-health outcomes in individuals with amnestic mild cognitive impairment (aMCI). The sample included 98 older adults with aMCI (92.5% male, age = 70.9±9.2 years). Measures included objective cognition (i.e., attention, memory, language, visuospatial abilities, processing speed, executive function, and overall), subjective memory (Multifactorial Memory Questionnaire [MMQ]), quality of life (Dementia Quality of Life [DQoL]), and mental health (Geriatric Depression Scale, Geriatric Anxiety Inventory, and Penn State Worry Questionnaire). Objective and subjective cognition were weakly correlated (range |r| = .00–.23). Objective cognitive measures were largely uncorrelated with quality of life or mental health, with only two significant (p < .05) correlations between Processing Speed and Worry (r = -.24), and Overall Cognition and DQoL Aesthetics (r = .20). Subjective cognition was more strongly correlated with quality of life, including significant (p < .01) correlations between MMQ Abilities and DQoL Negative Affect (r = -.38), and MMQ Contentment and DQoL Positive Affect (r = .28). Additionally, MMQ Contentment and Abilities were significantly (p < .01) negatively correlated with all three mental-health outcomes (range |r| = .28–.43). This study demonstrated that subjective memory, particularly affect and self-appraisal regarding one’s memory capabilities, is more closely related to quality-of-life and mental-health outcomes than objective cognitive performance in an aMCI sample, and, therefore, may represent important targets for intervention.

Sleep quality, neurocognitive performance, and memory self-appraisal in middle-aged and older adults with memory complaints

ABSTRACT Objective: Because of inconsistent findings regarding the relationship between sleep quality and cognitive function in people with age-related memory complaints, we examined how self-reports of sleep quality were related to multiple domains of both objective and subjective cognitive function in middle-aged and older adults. Design: A cross-sectional study involving analysis of baseline data, collected as part of a clinical trial. Measurements: Two hundred and three participants (mean age = 60.4 [6.5] years, 69.0% female) with mild memory complaints were asked to rate their sleep quality using the Pittsburgh Sleep Quality Index (PSQI) and their memory performance using the Memory Functioning Questionnaire (MFQ), which measures self-awareness of memory ability. Neurocognitive performance was evaluated using the Continuous Performance Test (CPT), Trail Making Test, Buschke Selective Reminding Test, and the Brief Visuospatial Test – Revised (BVMT-R). Results: Total PSQI scores were significantly associated with objective measures of sustained attention (CPT hit reaction time by block and standard error by block) and subjective memory loss (MFQ frequency and seriousness of forgetting). The PSQI components of (poorer) sleep quality and (greater) sleep disturbance were related to (worse) sustained attention scores while increased sleep latency and daytime sleepiness were associated with greater frequency and seriousness of forgetting. Conclusions: Sleep quality is related to both objective measures of sustained attention and self-awareness of memory decline. These findings suggest that interventions for improving sleep quality may contribute not only to improving the ability to focus on a particular task but also in reducing memory complaints in middle-aged and older adults.