Cerebellar and Prefrontal Structures Associated with Executive Functioning in Pediatric Patients with Congenital Heart Defects

Abstract

ObjectiveChildren, adolescents, and young adults with congenital heart defects (CHD) often display cognitive and behavioral manifestations of executive dysfunction. We consider the prefrontal and cerebellar brain structures as mechanisms for executive dysfunction among those with CHD.Method55 participants with CHD (M age = 13.93) and 95 healthy controls (M age = 13.13) completed magnetic resonance imaging (MRI) of the brain, from which we extracted volumetric data on prefrontal and cerebellar regions. Participants also completed neuropsychological tests of executive functioning; their parents completed behavioral ratings of their executive functions.ResultsCompared to healthy controls, those with CHD had smaller cerebellums and lateral, medial, and orbital prefrontal regions, they performed more poorly on tests of working memory, inhibitory control, and mental flexibility, and their parents rated them as having poorer executive functions across several indices. Across both groups, there were significant correlations for cerebellar and/or prefrontal volumes with cognitive assessments of working memory, mental flexibility, and inhibitory control and with behavioral ratings of working memory, task initiation, and emotional control. Greater prefrontal volumes were associated with better working memory, among those with larger cerebellums (with group differences based on the measure and the prefrontal region). Greater prefrontal volumes were related to better emotional regulation only among participants with CHD with smaller cerebellar volumes, and with poorer inhibition and emotional regulation only among healthy controls with larger cerebellar volumes.ConclusionThe cerebellum modulates the relationships between prefrontal regions and executive functioning differently for pediatric patients with CHD versus health controls.

Development and Validation of a Paralimbic Related Subcortical Brain Dysmaturation MRI Score in Infants with Congenital Heart Disease

“…al found that preterm infants with exposure to morphine in the neonatal period had decreased cerebellar volumes and worse neurodevelopmental outcomes. 79 Additionally, our group has previously shown that CHD children with reduced cerebellar volumes scored worse in tests for working memory, inhibitory control, and mental flexibility 80 . We also demonstrated that the superior surface of the cerebellum, primarily composed of the posterior lobe and the midline vermis, is an area particularly susceptible to alterations in morphology, indicating possible regions specifically affected by dysmaturation in CHD.…”