Pupillary response: cognitive effort for breast cancer survivors
The purpose of this cross-sectional comparative pilot study was to evaluate cognitive effort, indexed by pupillary response (PR), for breast cancer survivors (BCS) with complaints of cognitive dysfunction following chemotherapy.
Compare the cognitive effort employed by BCS to healthy controls (HC) during neuropsychological tests (NPT) for memory, sustained attention, verbal fluency, visuospatial ability, processing speed and executive function; and Investigate the relationship between PR-indexed cognitive effort and participants’ self-report of cognitive function.
Self-report of cognitive function was collected from 23 BCS and 23 HC. PR was measured during NPT. Independent two-sample t tests or Wilcoxon rank sum tests were used to compare group scores. Between-group effect size (Cohen’s d) was calculated for each outcome. Correlation between mean self-report scores and PR values, as well as 95% confidence intervals, was calculated.
No group differences were demonstrated for NPT performance. BCS reported more issues with cognitive function than HC (p < .0001). A group effect for BCS was seen with PR-indexed cognitive effort for components of most NPT (p < .05). PR was correlated with most self-report measures of cognitive function (r = 0.33–0.45).
PR sensitivity to cognitive effort across a variety of NPT and correlation with self-report of cognitive function was demonstrated. The portability, affordability, and “real-time” aspects of PR are attractive for potential use in the clinic setting to assess cognitive function. A larger study is needed to confirm these results. Prospective investigation of PR in BCS is needed to demonstrate sensitivity to cognitive function changes over time.
KeywordsBreast cancer Cognitive dysfunction Cognitive neuroscience Pupillary response
The study was funded by the University of Kansas Medical Center Frontiers Pilot & Collaborative Studies Award.
Compliance with ethical standards
Approval from the University of Kansas Human Subjects Committee was obtained, and all procedures were performed in accordance with institutional ethical standards and the 1964 Helsinki declaration and its later amendments.
Informed consent was obtained from all individual participants included in the study.
Conflict of interest
The authors have no financial relationships to disclose. The first author and Primary Investigator for the study have full control of all primary data. However, data sharing agreement execution would be necessary if the journal requests data review.
- 1.Asher A, Myers JS (2015) The effect of cancer treatment on cognitive function. Clin Adv Hematol Oncol 13(7):441–450Google Scholar
- 6.Alibhai SM, Breunis H, Timilshina N, Johnston C, Tomlinson G, Tannock I, Krahn M, Fleshner NE, Warde P, Canning SD, Klotz L, Naglie G (2010) Impact of androgen-deprivation therapy on physical function and quality of life in men with nonmetastatic prostate cancer. J Clin Oncol 28:5038–5045CrossRefGoogle Scholar
- 9.Bernstein LJ, McCreath GA, Nyhof-Young J, Dissanayake D, Rich JB (2018) A brief psychoeducational intervention improves memory contentment in breast cancer survivors with cognitive concerns: results of a single-arm prospective study. Support Care Cancer 26:2851–2859. https://doi.org/10.1007/s00520-018-4135-z CrossRefGoogle Scholar
- 13.Hermelink K, Kuchenhoff H, Untch M, Bauerfeind I, Lux MP, Buhner M, Manitz J, Fensterer V, Munzel K (2010) Two different sides of ‘chemobrain’: determinants and nondeterminants of self-perceived cognitive dysfunction in a prospective, randomized, multicenter study. Psychooncology 19:1321–1328. https://doi.org/10.1002/pon.1695 CrossRefGoogle Scholar
- 16.Kahneman D (1973) Attention and effort. Prentice Hall, EnglewoodGoogle Scholar
- 18.McDonald BC, Conroy SK, Ahles TA, West JD, Saykin AJ (2012) Alterations in brain activation during working memory processing associated with breast cancer and treatment: a prospective functional magnetic resonance imaging study. J Clin Oncol 30(20):2500–2508. https://doi.org/10.1200/jco.2011.38.5674 CrossRefGoogle Scholar
- 21.Marshall SP (2007) Identifying cognitive state from eye metrics. Aviat Space Environ Med 78(5 Suppl):B165–B175Google Scholar
- 23.Wang CA, McInnis H, Brien DC, Pari G, Munoz DP (2016) Disruption of pupil size modulation correlates with voluntary motor preparation deficits in Parkinson’s disease. Neuropsychologia 80:176–184. https://doi.org/10.1016/j.neuropsychologia.2015.11.019 CrossRefGoogle Scholar
- 32.Strauss E, Sherman EM, Spreen O (2006) A compendium of neuropsychological tests: administration, norms, and commentary, 3rd edn. Oxford University Press, New YorkGoogle Scholar
- 36.Massar SAA, Lim J, Sasmita K, Chee MWL (2018) Sleep deprivation increases the costs of attentional effort: performance, preference and pupil size. Neuropsychologia. https://doi.org/10.1016/j.neuropsychologia.2018.03.032
- 37.Reddy LF, Reavis EA, Wynn JK, Green MF (2018) Pupillary responses to a cognitive effort task in schizophrenia. Schizophr Res. https://doi.org/10.1016/j.schres.2018.03.005