Neuropsychological assessment, intervention, and best practices for women with non-Central nervous system cancer: A scoping review of current standards

Objective: Existing literature has sought to characterize the broad cognitive impact of non-central nervous system cancer and its treatment, including chemotherapy, radiation, surgery, and hormonal regulation. However, despite the frequency of women that are diagnosed with breast and gynecological cancer, there is limited research on the specific cognitive experiences of women undergoing cancer treatment. Presently, the current literature lacks concise guidance for neuropsychologists to support the cognitive health of women facing cancer, despite the acknowledged impact of cancer interventions and chronic illness on cognitive outcomes. Method: Applying scoping review criteria outlined by Peters et al. (2015) and adhering to Preferred Reporting Items for Systemic Reviews and Meta-Analysis (PRISMA) guidelines, we conducted a comprehensive examination of literature spanning multiple databases (Google Scholar, PubMed, PsychINFO) with a focus on the cognitive impact of cancer treatment on women. Conclusions: Women are subject to unique treatment-related outcomes due to the impact of hormonal alterations, differences in metabolization of certain chemotherapies, and psychosocial risk factors. Despite the known impact of cancer intervention, chronic illness, and cancer-related sequelae on cognitive outcomes, the current literature does not parsimoniously outline best practices for neuropsychologists to promote the health of women experiencing cancer. The current paper (1) provides an overview of the cognitive implications of cancer treatment with an intentional focus on cancers that are more prevalent in women versus men, (2) addresses the characteristics of this impact for women undergoing cancer intervention(s), and (3) provides possible intervention and treatment strategies for mental health providers and neuropsychologists.

The Effect of Adverse Childhood Experiences on ADHD Symptom Reporting, Psychological Symptoms, and Cognitive Performance Among Adult Neuropsychological Referrals

OBJECTIVE

Adverse childhood experiences (ACEs) are early life experiences that influence mental health outcomes, though there are mixed findings reported in relation to attention deficit hyperactivity disorder (ADHD) symptoms. The current study compared adults who experienced ACEs on measures of ADHD symptom reporting, psychological symptoms, and neurocognitive test performance.

METHOD

The sample (n = 115) had mean age of 28.42 (SD = 6.46); educational attainment of 16.47 years (SD = 1.99); and was 35% male/65% female and racially/ethnically diverse. Participants completed measures of ACEs, ADHD symptoms, psychopathology, and perceived stress, as well as neuropsychological tests.

RESULTS

The high ACEs group endorsed higher levels of childhood/adulthood inattentive, impulsive, and hyperactive symptoms, and overall childhood symptoms when compared to the low ACEs group.

CONCLUSIONS

This study provides a more comprehensive understanding of the association between ACEs and cognitive/mental health outcomes. Greater ACEs resulted in higher ADHD symptom reporting but not significantly greater psychological symptoms or worse neurocognitive performance.

H - 40 The Role of Neuropsychology in Solid Organ Transplantation Candidacy in a Patient with a Diverse Linguistic and Sociocultural Background

OBJECTIVE

Candidates for transplantation with end stage organ failure (ESOF) undergo extensive pre-surgical medical and psychosocial evaluations, however neuropsychology is rarely required. This is concerning, as patients with ESOF often have cognitive deficits that may impact their ability to safely manage post-transplant care and are at increased risk for morbidity/mortality. This case highlights the novel perspective a comprehensive neuropsychological evaluation provides, especially in patients of diverse sociocultural backgrounds.

METHOD

The patient is a 37-year-old monolingual Spanish-speaking woman referred for evaluation in the context of liver transplant candidacy due to apparent inability to follow medical guidance, medication adherence, and continued alcohol consumption. Medical history includes autoimmune hepatitis, multifocal hepatocellular carcinoma, and diabetes. The patient reported problems with remembering information from providers even with compensatory strategies. Her family assists heavily with scheduling and transportation. When asked about alcohol use, she reported recent use of a few beers due to very hot weather, limited access to clean water, and the death of a family member despite providers urging her to remain abstinent. She was not aware of the hazard that even minimal alcohol use presented to her candidacy.

RESULTS

She did not meet criteria for a neurocognitive disorder. The etiology of her noncompliance was secondary to poor social support, limited coping skills, and feeling overwhelmed by team instructions.

CONCLUSIONS

Conducting a culturally informed evaluation in the patient's native language provided clear evidence of intact cognition and a nuanced understanding of her limitations that would not be appreciated in a more limited evaluation.

B - 107 Exploratory Analysis of the Relationship between Health Anxiety (HA) and Neuropsychological Performance in a Validity Controlled Sample of Patients with Post-Acute Sequelae of COVID-19 (PASC)

OBJECTIVE

Since the emergence of COVID-19, research has consistently indicated cognitive difficulties as a primary complaint after infection (Altuna et al., 2021). It is unclear to what extent these cognitive deficits may be attributable to, or exacerbated by, health anxiety (HA) (Venkataramani et al., 2022). This study explored the relationship between HA and cognition in a performance validity controlled sample of patients with PASC complaints.

METHODS

Participants included patients referred for a focused neuropsychological evaluation for persistent cognitive complaints after COVID infection (N = 19). Participants were excluded for Test of Memory Malingering scores below standard cutoff. The sample mean age was 43 years (SD = 12.9), 57.9% were female, and 47.4% were from minority racial/ethnic groups. HA was assessed using the Short Health Anxiety Inventory (SHAI). Cognitive abilities were measured using the Wechsler Adult Intelligence Scale-IV (WAIS-IV: Processing Speed Index [PSI]; Letter-Number Sequencing [LNS]) and Trail Making Test Part-A (TMT-A). Regression analyses were conducted to assess the extent to which HA predicts cognitive performance.

RESULTS

The SHAI main subscale significantly predicted TMT-A [β = -3.93, p < 0.01] and WAIS-IV PSI [β = -4.60, p = 0.04]. The SHAI negative consequences subscale significantly predicted TMT-A [β = -4.64, p = 0.04] and WAIS-IV LNS [β = 0.49, p = 0.048].

CONCLUSIONS

Findings suggest that general HA predicted PSI, while fear of negative health outcomes predicted LNS. Basic attention abilities were predicted by global HA. Future studies will benefit from evaluating the moderating effect of HA on the relationship between subjective symptom severity and cognition.