The Relationship between Executive Dysfunction and Depression in Adult Women with Breast Cancer: A Systematic Review
Abstract
Introduction: Adult women treated for breast cancer frequently exhibit executive function (EF) deficits—particularly in working memory and processing speed—with potential interplay with depressive symptomatology; however, the relationship between depression and EF impairments in this population remains poorly defined.
Methods: We conducted a PRISMA-guided systematic review of literature in the Web of Science and Scopus databases (1998–2023) using the keywords “breast cancer,” “executive function,” and “depression.” After duplicate removal, 143 unique records were screened by title and abstract. Inclusion criteria were: (1) empirical quantitative studies (cross-sectional, cohort, case-control, randomized controlled trials); (2) adult women diagnosed with breast cancer; (3) standardized assessments of both EF (e.g., Trail Making Test, Stroop, Wisconsin Card Sorting Test) and depression (e.g., Beck Depression Inventory-II, HADS); and (4) publications in English or Spanish. Exclusion criteria included: clinical populations with additional psychiatric diagnoses, qualitative-only designs, non-empirical articles, and studies lacking separate EF/depression data. Full-text review yielded 22 eligible studies.
Results: Three primary research domains emerged: (1) Physical activity interventions (n = 6; total N = 2 731) demonstrated moderate-to-vigorous exercise regimens (e.g., HIIT, structured walking) improved EF performance and reduced depressive symptoms. (2) Cognitive-training programs (n = 9; total N = 2 991) showed computerized or therapist-led protocols enhanced cognitive flexibility and processing speed, with mixed effects on mood. (3) Cognitive impairment and quality of life (n = 7; total N = 725) linked EF deficits to declines in daily functioning and health-related quality of life.
Discussion: Findings indicate that both physical activity and cognitive training hold promise for mitigating EF deficits and depressive symptomatology in breast cancer survivors. We recommend future longitudinal, multicenter trials employing standardized EF and depression measures, mechanistic biomarkers, and longer follow-up to determine optimal intervention modalities and inform clinical survivorship care.
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DOI: https://doi.org/10.13129/2282-1619/mjcp-4928
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