Vasa Devarshi, Guerra Lauren, Feinberg Abigail, Goel Mita S, Harris Yael Tobi, Lin Jenny J, Becker Jacqueline H
Department of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Psychooncology. 2025 May;34(5):e70186. doi: 10.1002/pon.70186.
Breast cancer survivors (BCS) are at greater risk for cognitive impairment due to their cancer status, treatment history, and frequent comorbid illnesses such as diabetes (DM). Given the critical role of cognition in illness beliefs, cognitive impairments can contribute to inaccurate risk perceptions, misunderstanding of information, and limited symptom awareness, which have significant implications for disease self-management. In a cohort of BCS with DM, we investigated the relationship between cognitive impairments and illness beliefs about DM.
We measured illness beliefs in our cohort of BCS with DM using the Illness Perception Questionnaire (IPQ). Cognition was assessed utilizing a well-validated neuropsychological battery (i.e., WAIS-IV, Trail Making Test-A&B, Hopkins Verbal Learning Test) measuring attention, working memory, executive functioning, processing speed, and learning and memory. Cognitive impairment was classified as z-scores ≤ -1.5 standard deviations below the normative mean adjusting for age, sex, and education. Wilcoxon tests assessed the associations between cognitive impairments and illness beliefs, subsequently adjusted for age, race, and breast cancer stage using multivariable regression models.
Of the 244 BCS with DM [mean (SD) age: 66.5 (7) years], 26.3% had impairments in attention, 19.1% in working memory, 24.1% in executive functioning, 9.9% in processing speed, 26.9% in memory recall, and 17.5% in memory retention. Impairments in attention, working memory, or executive functioning were associated with greater belief that DM is episodic (p = 0.003, 0.01, 0.003), short-term (p = 0.04, 0.04, 0.009), and less controllable (p = 0.006, < 0.001, 0.03). Impairments in attention and working memory were also linked to stronger beliefs that DM was due to chance (p = 0.003, 0.02). Those with processing speed impairments more often believed DM was episodic (p = 0.003) and less controllable (p = 0.004). Memory retention impairments were similarly associated with lower perceived control (p = 0.03), and memory recall impairments with the belief that DM is short-term (p = 0.01). All associations remained significant after adjustment for age, race, and breast cancer stage.
BCS with DM and impairments in cognition, particularly in attention, working memory, and executive functioning, are more likely to hold suboptimal beliefs about their DM. These findings highlight the importance of screening for cognitive impairments in these patients in order to identify those at risk for poor disease self-management and outcomes. Future studies should explore interventions or compensatory strategies to best support BCS with DM and cognitive impairments.
乳腺癌幸存者（BCS）由于其癌症状况、治疗史以及诸如糖尿病（DM）等常见合并症，面临认知障碍的风险更高。鉴于认知在疾病认知中的关键作用，认知障碍可能导致风险认知不准确、信息误解以及症状意识有限，这对疾病自我管理具有重大影响。在一组患有DM的BCS中，我们研究了认知障碍与对DM的疾病认知之间的关系。
我们使用疾病认知问卷（IPQ）测量了患有DM的BCS队列中的疾病认知。通过一套经过充分验证的神经心理测试组合（即韦氏成人智力量表第四版、连线测验A和B、霍普金斯词语学习测验）评估认知，该测试组合用于测量注意力、工作记忆、执行功能、处理速度以及学习和记忆。认知障碍被分类为经年龄、性别和教育程度调整后，z分数低于正常均值1.5个标准差。威尔科克森检验评估了认知障碍与疾病认知之间的关联，随后使用多变量回归模型对年龄、种族和乳腺癌分期进行调整。
在244名患有DM的BCS中（平均年龄[标准差]：66.5[7]岁），26.3%的人存在注意力障碍，19.1%存在工作记忆障碍，24.1%存在执行功能障碍，9.9%存在处理速度障碍，26.9%存在记忆回忆障碍，17.5%存在记忆保持障碍。注意力、工作记忆或执行功能障碍与更强烈地认为DM是发作性的（p = 0.003、0.01、0.003）、短期的（p = 0.04、0.04、0.009）以及可控性较低（p = 0.006、<0.001、0.03）相关。注意力和工作记忆障碍还与更强烈地认为DM是由偶然因素导致的信念有关（p = 0.003、0.02）。存在处理速度障碍的人更常认为DM是发作性的（p = 0.003）且可控性较低（p = 0.004）。记忆保持障碍同样与较低的感知可控性相关（p = 0.03），而记忆回忆障碍与认为DM是短期的信念相关（p = 0.01）。在对年龄、种族和乳腺癌分期进行调整后，所有关联仍然显著。
患有DM且存在认知障碍，尤其是注意力、工作记忆和执行功能障碍的BCS，更有可能对其DM持有不太理想的认知。这些发现凸显了对这些患者进行认知障碍筛查的重要性，以便识别出疾病自我管理和预后不佳风险较高的患者。未来的研究应探索干预措施或补偿策略，以更好地支持患有DM和认知障碍的BCS。
