Cognitive and attentional functioning in adolescents and young adults with Tetralogy of Fallot and d-transposition of the great arteries

Abstract

Objectives To investigate cognitive and attentional function in adolescents and young adults with operated congenital heart disease. Background Previous research has indicated that children with congenital heart disease have deficits in broad areas of cognitive function. However, less attention has been given to survivors as they grow into adolescence and early adulthood. Method Participants included 18 non-syndromic adolescents and young adults with Tetralogy of Fallot and d-Transposition of the Great Arteries that required cardiac surgery before the age of five and 18 healthy, unaffected siblings (age 11–22 years for both groups). Cases with congenital heart disease and their siblings were administered Wechsler Intelligence scales and reported attention problems using the Achenbach System of Empirically Based Assessments. Cases were compared to both healthy siblings and established norms. Key Findings Cases performed significantly lower than siblings on Full Scale IQ and processing speed, and significantly lower than norms on perceptual reasoning. Cases also reported more attention problems compared to both siblings and norms. Effect sizes varied with medium to large effects for processing speed, perceptual reasoning, working memory, and attention problems. Conclusions Findings suggest that neurocognitive function may continue to be affected for congenital heart disease survivors in adolescence and young adulthood and that comparisons to established norms may underestimate neurocognitive vulnerabilities.

Functional limitations and educational needs among children and adolescents with heart disease

“…These parent‐reported results on functional limitations are consistent with previous literature, based on results of assessment tools and validated questionnaires, which report a higher level of cognitive and motor limitations among children with CHD . While some studies, but not all, have found intelligence is generally within the normal range for individuals with CHD, studies show that executive functioning, problem solving, memory, and attention are impaired more often in children and adolescents with CHD as compared to healthy population controls and siblings .…”

“…While a large percentage of CSHCN with heart disease and functional limitations received special education services, up to 30% These parent-reported results on functional limitations are consistent with previous literature, based on results of assessment tools and validated questionnaires, which report a higher level of cognitive and motor limitations among children with CHD. 5,8,11,20,21 While some studies, 8,22 but not all, 11,20 have found intelligence is generally within the normal range for individuals with CHD, studies show that executive functioning, problem solving, memory, and attention are impaired more often in children and adolescents with CHD as compared to healthy population controls 5,8,[21][22][23][24][25] and siblings. 20 Researchers have found delayed language development in toddlers with CHD, 10 compared to population means, which might be due to decreased brain white matter volume.…”

“…5,8,11,20,21 While some studies, 8,22 but not all, 11,20 have found intelligence is generally within the normal range for individuals with CHD, studies show that executive functioning, problem solving, memory, and attention are impaired more often in children and adolescents with CHD as compared to healthy population controls 5,8,[21][22][23][24][25] and siblings. 20 Researchers have found delayed language development in toddlers with CHD, 10 compared to population means, which might be due to decreased brain white matter volume. 26 Delays in gross and fine motor development have also been reported more commonly in toddlers 23,27,28 and young children 29 with CHD compared to healthy controls, siblings/twins, and population norms.…”

‘Big issues’ in neurodevelopment for children and adults with congenital heart disease

“…Attendance at special schools and lack of final school examination occurs in as many as 12% of adolescents with CHD,26 with up to 65% receiving remedial academic or behavioural services and up to 50% requiring therapeutic services, including physiotherapy, speech therapy, occupational therapy and psychotherapy or counselling 25 27. When compared with sibling controls, outcomes appear worse than when compared with population norms, particularly for full-scale IQ and processing speed28 and may be a better overall assessment.…”

Validity of the Montreal Cognitive Assessment Screener in Adolescents and Young Adults With and Without Congenital Heart Disease

“…Mechanisms contributing to cognitive deficits in CHD are complex and multifactorial including hypoxic/ischemic injury triggered by the CHD condition, hypoperfusion during cardiac surgery, and a wide range of genetic, prenatal, and other pre- and postoperative risk factors (Gaynor et al, 2015; Dominguez, Wernovsky, & Gaynor, 2007; Ballweg, Wernovsky, & Gaynor, 2007). A distinct pattern of mild cognitive and behavioral impairment associated with problems with reasoning, learning, memory, executive function, inattention, and impulsive behavior, language, and social skills has emereged (Bellinger et al, 2015; Bellinger et al, 2011; Cassidy, White, DeMaso, Newburger & Bellinger, 2015; von Rhein et al, 2015; Murphy et al, 2015). However, many of these deficits may not become apparent until school age, when higher-level organizational skills are required.…”