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Compensatory frontal activity in cancer survivors associated with accurate memory performance but inaccurate metamemory judgments: an ERP study

Poster Session D - Monday, March 9, 2026, 8:00 – 10:00 am PDT, Fairview/Kitsilano Ballroom

Alexandra Gaynor¹, Pangzhongyuan Pei², Dishari Azad³, Maria Estelle⁴, Isabella Mohr⁴, Tim Ahles⁴, James Root⁴, Jennifer Mangels^3,5; ¹Department of Psychology, Montclair State University, ²Department of Cognitive and Psychological Sciences, Brown University, ³The Graduate Center, The City University of New York, ⁴Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, ⁵Baruch College, The City University of New York

Cancer survivors often self-report subjectively greater difficulties with “forgetting” than are found on objective memory metrics. Emerging evidence, including neuroimaging research finding that survivors with comparable recognition memory to controls engage prefrontal regions to a greater extent, suggests that discrepancy between subjective complaints and objective performance may reflect strategic compensation for early attentional deficits at encoding and/or at retrieval. To date, no studies have examined the time course of encoding and retrieval processes in survivors compared to controls. In the present study, we recorded EEG in 23 breast cancer survivors (BCS) and 23 non-cancer controls (NCC) during 6 study/test runs of a verbal old/new recognition task. For each item, participants made judgments of learning (JOLs) at encoding and retrospective confidence judgments (RCJs) at retrieval. On self-report measures of attention and memory abilities, BCS reported significantly higher subjective impairment than NCC. Despite comparable memory performance and JOLs on the recognition task, BCS showed an underconfidence bias at retrieval compared to NCC. ERPs at encoding found no significant group differences in mid-latency posterior attentional effects (200-300ms), but BCS had significantly greater frontal activity 400-600ms post-stimulus onset for subsequent hits. ERPs at retrieval found that while both groups demonstrated a similar posterior old/new effect (500-700ms), BCS showed greater late positive frontal activity overall during this period. Taken together, these findings suggest compensatory frontal activity during encoding and retrieval may preserve performance despite underlying cancer-related cognitive deficits, but subjective beliefs about memory difficulties may persist even when recognition is accurate, leading to metamemory inaccuracies.

Topic Area: LONG-TERM MEMORY: Episodic