Altered frontal white matter microstructure is associated with working memory impairments in adolescents with congenital heart disease: A diffusion tensor imaging study

Ehrler, Melanie; Latal, Beatrice; Kretschmar, Oliver; Rhein, Michael von; O’Gorman, Ruth L.

doi:10.1016/j.nicl.2019.102123

Cited by 45 publications

(37 citation statements)

References 47 publications

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“…Furthermore, various studies have shown that alterations of white matter microstructure are still present in adolescents with CHD: In adolescents with repaired transposition of the great arteries, FA was significantly lower compared to controls in the bilateral deep white matter, cerebral cortex, cerebellum and mid-brain ( Rivkin et al , 2013 ) and white matter network topology was altered ( Panigrahy et al , 2015 ). Tract-based spatial statistics analyses in two cohorts of Fontan patients ( Watson et al , 2018 ) and patients with different types of cyanotic and acyanotic CHD ( Ehrler et al , 2020 ) have revealed widely overlapping reduced FA in almost every cortical and sub-cortical white matter tract. From studies in emerging adults, there is evidence that alterations in the white matter may persist into adulthood ( Brewster et al , 2015 ; Easson et al , 2020 ).…”

Section: Discussionmentioning

confidence: 99%

“…A study by Birca and colleagues (2016) has shown that microstructural alterations are associated with reduced functional connectivity measured with EEG. Studies in adolescents with CHD have further demonstrated associations between reduced local white matter anisotropy and cognitive impairments in domains such as working memory ( Ehrler et al , 2020 ), intelligence ( Watson et al , 2018 ), executive function and behaviour ( Rollins et al , 2014 ), attention and learning ( Brewster et al , 2015 ). In light of the large extent of persisting alterations in projection, commissural and association tracts connecting various brain regions, the associated impact of these structural changes on different aspects of neurodevelopmental (i.e.…”

Section: Discussionmentioning

confidence: 99%

“…Cognitive impairments in adolescents and emerging adults with CHD have been related to cerebral changes such as reduced brain volume ( Von Rhein et al , 2014 ; Latal et al , 2016 ; Semmel et al , 2018 ), white matter diffusivity and anisotropy ( Rollins et al , 2014 ; Brewster et al , 2015 ; Watson et al , 2018 ; Ehrler et al , 2020 ) and connectivity alterations ( Panigrahy et al , 2015 ). However, it remains unclear to what extent these brain alterations persist into adulthood and whether these alterations continue to have an impact on cognitive functioning.…”

Section: Introductionmentioning

confidence: 99%

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Altered white matter microstructure is related to cognition in adults with congenital heart disease

Ehrler

Schlosser

Brugger

et al. 2020

Brain Communications

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Adults with congenital heart disease are at risk for persisting executive function deficits, which are known to affect academic achievement and quality of life. Alterations in white -matter microstructure are associated with cognitive impairments in adolescents with congenital heart disease. This study aimed to identify microstructural alterations potentially associated with executive function deficits in adults with congenital heart disease. Diffusion tensor imaging and tract-based spatial statistics were conducted in 45 patients (18 females) and 54 healthy controls (26 females) aged 18–32 years. Fractional anisotropy of white matter diffusion was compared between groups and correlated with an executive function score, derived from an extensive neuropsychological test battery. Patients showed widespread bilateral reduction in fractional anisotropy (P < 0.05, multiple comparison corrected) compared to controls. Lower fractional anisotropy was driven by patients with moderate and severe defect complexity (compared to controls: P < 0.001). Executive function scores were lower in patients (P < 0.05) and associated with lower fractional anisotropy in the left superior corona radiata and the corticospinal tract (corrected P < 0.05). Our findings confirm alterations of white matter microstructure in adults with congenital heart disease, mainly in those patients of moderate to severe complexity. These alterations are associated with impairments in executive functioning. A better understanding of the neurocognitive deficits may help counselling and care of patients with congenital heart disease across their lifespan and have the potential to improve their outcome and quality of life.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Altered white matter microstructure is related to cognition in adults with congenital heart disease

Ehrler

Schlosser

Brugger

et al. 2020

Brain Communications

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“…The reduced WM axonal packing could impair communication between different brain regions [ 86 ]. The degree of global WM network topology disturbances correlates with overall neurocognitive performance, WMI in the uncinate fasciculus correlates with verbal memory impairments, WMI in the frontal lobe associates with working memory deficits, and WMI of the middle cerebellar peduncle correlates with auditory attention span [ 30 , 31 , 87 ].…”

Section: Factors That Predict Neurological Injury and Neurodevelopmenmentioning

confidence: 99%

“…By adolescence, the neurodevelopmental delay persisted and manifested as impairments of neuromotor, intellectual, executive function, visuomotor, perception and integration skills. Lasting cerebral WMI and microstructural alterations, cerebellar white matter and cerebellar volume loss contributed to the neurodevelopmental deficits [ 27 – 30 ].…”

Section: Introductionmentioning

confidence: 99%

Antenatal and Perioperative Mechanisms of Global Neurological Injury in Congenital Heart Disease

et al. 2020

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Congenital heart defects (CHD) is one of the most common types of birth defects. Thanks to advances in surgical techniques and intensive care, the majority of children with severe forms of CHD survive into adulthood. However, this increase in survival comes with a cost. CHD survivors have neurological functioning at the bottom of the normal range. A large spectrum of central nervous system dysmaturation leads to the deficits seen in critical CHD. The heart develops early during gestation, and CHD has a profound effect on fetal brain development for the remainder of gestation. Term infants with critical CHD are born with an immature brain, which is highly susceptible to hypoxic-ischemic injuries. Perioperative blood flow disturbances due to the CHD and the use of cardiopulmonary bypass or circulatory arrest during surgery cause additional neurological injuries. Innate patient factors, such as genetic syndromes and preterm birth, and postoperative complications play a larger role in neurological injury than perioperative factors. Strategies to reduce the disability burden in critical CHD survivors are urgently needed.

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White matter microstructure is differently associated with executive functioning in youth born with congenital heart disease and youth born preterm

Easson,

Khairy,

Rohlicek

et al. 2023

Brain and Behavior

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IntroductionExecutive function deficits and adverse psychological outcomes are common in youth with congenital heart disease (CHD) or born preterm. Association white matter bundles play a critical role in higher order cognitive and emotional functions and alterations to their microstructural organization may result in adverse neuropsychological functioning. This study aimed to examine the relationship of myelination and axon density and orientation alterations within association bundles with executive functioning, psychosocial well‐being, and resilience in youth with CHD or born preterm.MethodsYouth aged 16 to 26 years born with complex CHD or preterm at ≤33 weeks of gestational age and healthy controls completed a brain MRI and self‐report assessments of executive functioning, psychosocial well‐being, and resilience. Multicomponent driven equilibrium single‐pulse observation of T1 and T2 and neurite orientation dispersion and density imaging were used to calculate average myelin water fraction (MWF), neurite density index (NDI), and orientation dispersion index values for eight bilateral association bundles. The relationships of bundle‐average metrics with neuropsychological outcomes were explored with linear regression and mediation analyses.ResultsIn the CHD group, lower MWF in several bundles was associated with poorer working memory and behavioral self‐monitoring and mediated self‐monitoring deficits relative to controls. In the preterm group, lower NDI in several bundles was associated with poorer emotional control and lower MWF in the left superior longitudinal fasciculus III mediated planning/organizing deficits relative to controls. No significant relationships were observed for psychosocial well‐being or resilience.ConclusionThe findings of this study suggest that microstructural alterations to association bundles, including lower myelination and axon density, have different relationships with executive functioning in youth with CHD and youth born preterm. Future studies should aim to characterize other neurobiological, social, and environmental influences that may interact with white matter microstructure and neuropsychological functioning in these at‐risk individuals.

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Altered frontal white matter microstructure is associated with working memory impairments in adolescents with congenital heart disease: A diffusion tensor imaging study

Cited by 45 publications

References 47 publications

Altered white matter microstructure is related to cognition in adults with congenital heart disease

Altered white matter microstructure is related to cognition in adults with congenital heart disease

Antenatal and Perioperative Mechanisms of Global Neurological Injury in Congenital Heart Disease

White matter microstructure is differently associated with executive functioning in youth born with congenital heart disease and youth born preterm

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