Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States of America.
Digital Artefacts, LLC, Iowa City, IA, United States of America.
PLoS One. 2023 Apr 13;18(4):e0284189. doi: 10.1371/journal.pone.0284189. eCollection 2023.
Increasing evidence suggests rural breast cancer survivors (BCS) may experience greater burden in symptoms known to be associated with cancer-associated cognitive decline (CACD). Yet, little is known about CACD in rural BCS. This study (1) examined differences in cognitive function, moderate-to-vigorous physical activity (MVPA), and other CACD correlates and (2) tested the effects of MVPA on cognitive function in rural versus urban BCS.
Rural and urban BCS (N = 80), matched on age, education, and time since diagnosis from a larger study, completed cognitive tasks assessing processing speed (Trails-B, Mazes, Task-Switch) and working memory (spatial working memory) and questionnaires assessing subjective memory impairment (SMI), MVPA, and CACD correlates (i.e., sleep quality, fatigue, anxiety/depression). Some participants (n = 62) wore an accelerometer to objectively estimate MVPA. Multiple linear regression and multivariate analysis of covariance were used to test study aims.
Rural BCS (n = 40, M = 61.1±8.4 years-old) performed significantly slower on Trails-B (p<0.01) compared with urban BCS (n = 40, M = 61.0±8.2 years-old) and engaged in less objectively-estimated daily MVPA (mean difference = 13.83±4.73 minutes; p = 0.01). No significant differences in SMI, self-reported MVPA, or CACD correlates were observed (all p>0.28). Regression models did not reveal a significant interaction between MVPA and cognitive performance (all p>0.1); however, estimated marginal means models indicated that the effect of MVPA on processing speed was evident only among rural BCS (Trails-B, p = 0.04; Mazes, p = 0.03).
Findings suggest rural BCS may suffer greater CACD and engage in less MVPA. Additional research is warranted to further examine CACD and more effectively promote MVPA in rural BCS.
越来越多的证据表明，农村乳腺癌幸存者（BCS）可能在与癌症相关认知衰退（CACD）相关的症状方面承受更大的负担。然而，农村 BCS 中 CACD 的情况知之甚少。本研究（1）比较了认知功能、中高强度体力活动（MVPA）和其他 CACD 相关因素的差异，以及（2）测试了 MVPA 对农村与城市 BCS 认知功能的影响。
从一项更大的研究中，根据年龄、教育程度和诊断后时间，对农村和城市 BCS（N=80）进行匹配，完成认知任务评估处理速度（Trails-B、Mazes、Task-Switch）和工作记忆（空间工作记忆）以及问卷调查主观记忆障碍（SMI）、MVPA 和 CACD 相关因素（即睡眠质量、疲劳、焦虑/抑郁）。一些参与者（n=62）佩戴了加速度计来客观估计 MVPA。使用多元线性回归和协方差分析来检验研究目的。
农村 BCS（n=40，M=61.1±8.4 岁）在 Trails-B 上的表现明显慢于城市 BCS（n=40，M=61.0±8.2 岁）（p<0.01），并且每天进行的客观估计 MVPA 较少（平均差异=13.83±4.73 分钟；p=0.01）。在 SMI、自我报告的 MVPA 或 CACD 相关因素方面没有观察到显著差异（所有 p>0.28）。回归模型没有显示 MVPA 和认知表现之间存在显著的交互作用（所有 p>0.1）；然而，估计边际均值模型表明，MVPA 对处理速度的影响仅在农村 BCS 中明显（Trails-B，p=0.04；Mazes，p=0.03）。
研究结果表明，农村 BCS 可能患有更严重的 CACD 并进行较少的 MVPA。需要进一步研究以进一步检查农村 BCS 中的 CACD 并更有效地促进 MVPA。
