Korean Journal of Psychosomatic Medicine (정신신체의학)

Korean Psychosomatic Society (한국정신신체의학회)
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Factors Associated with Cognitive Function in Breast Cancer Patients Complaining Cognitive Decline

인지 저하를 호소하는 유방암 환자들의 인지 기능 관련 요인

  • Lee, Sun Ah (Yonsei University, School of Medicine) ;
  • Park, Kyung Mee (Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine) ;
  • Kim, Tae Ho (Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine) ;
  • Lee, Eun (Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine)
  • 이선아 (연세대학교 의학전문대학원) ;
  • 박경미 (연세대학교 의과대학 정신과학교실/의학행동과학연구소) ;
  • 김태호 (연세대학교 의과대학 정신과학교실/의학행동과학연구소) ;
  • 이은 (연세대학교 의과대학 정신과학교실/의학행동과학연구소)
  • Received : 2017.07.24
  • Accepted : 2017.10.19
  • Published : 2017.12.31
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Abstract

Objectives : Cognitive complaints are reported frequently after breast cancer treatments. The causes of cognitive decline are multifactorial, a result of the effect of cancer itself, chemotherapy, and psychological factors such as depression and anxiety. However, cognitive decline does not always correlate with neuropsychological test performance. The purpose of this study was to examine the relationship of subjective cognitive decline with objective measurement and to explore associated factors of cognitive function in breast cancer survivors. Methods : We included 29 breast cancer survivors who complain cognitive decline at least 6 months after treatment and 20 age-matched healthy controls. Neuropsychological tests were performed in all participants. Multivariable regression analysis evaluated associations between neuropsychological test scores and psychological distress including depression and anxiety, also considering age, education, and comorbidity. Results : There were no statistically significant differences in neuropsychological test performances. However, the breast cancer survivors showed a significantly higher depression(p=0.002) and anxiety(p<0.001) than the healthy controls did. Among the cancer survivors, poorer executive function was strongly associated with higher depression(${\beta}=-0.336$, p=0.001) and anxiety(${\beta}=-0.273$, p=0.009), after controlling for age, education, and comorbidity. In addition, poorer attention was also significantly related with depression(${\beta}=-0.375$, p=0.023) and anxiety (${\beta}=-0.404$, p=0.013). Conclusions : The results of this study showed the discrepancies between subjective complaints and objective measures of cognitive function in breast cancer survivors. It suggests that subjective cognitive decline could be indicators of psychological distress such as depression and anxiety.

연구목적 치료를 마친 유방암 환자들에서 인지 저하가 나타난다는 것이 알려져 있다. 인지 저하는 항암치료, 암이라는 질병 자체의 영향, 우울과 불안을 포함하는 정서요인 등의 다양한 원인들에 의해 나타날 수 있다고 알려져 있다. 그러나 인지 저하가 항상 신경심리검사 결과와 일치하는 것은 아니었다. 이에 본 연구는 주관적 인지 저하가 객관적 인지기능 검사와 관련성이 있는지, 인지 저하의 관련요인은 무엇인지 알아보고자 하였다. 방 법 치료 종료 후 6개월이 지난 유방암 환자들 중 인지 저하를 호소하는 29명의 환자군과 동일한 연령대의 20명의 정상 대조군이 연구에 참여하였다. 모든 연구 참여자들을 대상으로 신경심리검사를 시행하였고, 이후 다중회귀분석을 통해 신경심리검사 점수와 우울, 불안을 포함하는 정서 요인과의 관련성을 평가하였고, 연령, 교육수준, 공존 질환과의 연관성도 함께 알아보았다. 결 과 유방암 환자군과 정상 대조군 간 신경심리검사 결과의 차이는 없었다. 정상 대조군에 비해 유방암 환자군에서 우울(p=0.002) 및 불안(p<0.001) 의 정도가 유의하게 높았다. 유방암 환자군 내에서 연령, 교육수준, 공존 질환을 통제하였을 때 실행기능의 저하는 높은 우울(${\beta}=-0.336$, p=0.001), 불안(${\beta}=-0.273$, p=0.009)의 정도와 유의한 관련이 있었다. 마찬가지로 주의력 저하도 높은 우울(${\beta}=-0.375$, p=0.023) 및 불안(${\beta}=-0.404$, p=0.013)의 정도와 유의한 상관관계를 보였다. 결 론 연구 결과 환자들의 주관적 인지 저하와 객관적 인지기능 검사 결과가 일치하지 않는다는 것을 알 수 있었다. 이는 주관적 인지 저하가 우울이나 불안과 같은 정서적 스트레스의 지표로 나타날 수 있음을 시사한다.

Keywords

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