Executive functions in children with heart disease: a systematic review and meta-analysis

Abstract

Context: People with CHD are at increased risk for executive functioning deficits. Meta-analyses of these measures in CHD patients compared to healthy controls have not been reported. Objective: To examine differences in executive functions in individuals with CHD compared to healthy controls. Data sources: We performed a systematic review of publications from 1 January, 1986 to 15 June, 2020 indexed in PubMed, CINAHL, EMBASE, PsycInfo, Web of Science, and the Cochrane Library. Study selection: Inclusion criteria were (1) studies containing at least one executive function measure; (2) participants were over the age of three. Data extraction: Data extraction and quality assessment were performed independently by two authors. We used a shifting unit-of-analysis approach and pooled data using a random effects model. Results: The search yielded 61,217 results. Twenty-eight studies met criteria. A total of 7789 people with CHD were compared with 8187 healthy controls. We found the following standardised mean differences: −0.628 (−0.726, −0.531) for cognitive flexibility and set shifting, −0.469 (−0.606, −0.333) for inhibition, −0.369 (−0.466, −0.273) for working memory, −0.334 (−0.546, −0.121) for planning/problem solving, −0.361 (−0.576, −0.147) for summary measures, and −0.444 (−0.614, −0.274) for reporter-based measures (p < 0.001). Limitations: Our analysis consisted of cross-sectional and observational studies. We could not quantify the effect of collinearity. Conclusions: Individuals with CHD appear to have at least moderate deficits in executive functions. Given the growing population of people with CHD, more attention should be devoted to identifying executive dysfunction in this vulnerable group.

Perioperative Course and Socioeconomic Status Predict Long-Term Neurodevelopment Better Than Perioperative Conventional Neuroimaging in Children with Congenital Heart Disease

“…1 In recent decades, the survival rate has increased to 85% to 90% due to improved surgical and perioperative management. [2][3][4] However, CHD patients are at risk of delayed neurodevelopment affecting cognition, language, motor function, [5][6][7][8] and executive function 8,9 during childhood and into adolescence [5][6][7][8][9] and adulthood. 10 Evidence is increasing that brain immaturity, 11 smaller brain volumes, [12][13][14][15] and perioperative brain injury 12,[16][17][18] are related to altered neurobehavior during the neonatal period 14,15 and delayed neurodevelopment during early childhood.…”

Social cognition and competence in preschoolers with congenital heart disease.

“…Alternatively, it is possible that Tower test is less sensitive to differences between individuals with CHD compared to their healthy peers, as observed by Cassidy et al (2015) in a cohort of adolescents with CHD using the D-KEFS battery. Moreover, 5-year-old children with CHD may have problems in other EF domains not tested here, such as inhibitory control, working memory, or cognitive flexibility (Calderon, Jambaqué, et al, 2014; Jackson et al, 2021). Future research should consider a more comprehensive assessment of EF using more sensitive measures.…”

“…It is now established that individuals with complex CHD are at high risk for neurodevelopmental delays (Gaudet et al, 2021; Ilardi et al, 2020; Ware et al, 2020), due to reduced fetal cerebral blood flow or oxygenation, sequelae of the heart condition itself (e.g., severe cyanosis, cardiac arrests), and medical and surgical therapies required (e.g., perioperative hypoxic ischemic injury, prolonged hospitalization; Marelli et al, 2007; McQuillen et al, 2010; Nattel et al, 2017). Developmental delays arise in multiple domains, such as gross and fine motor skills (Bolduc et al, 2020; Fourdain et al, 2020; Majnemer et al, 2006), language and core communication skills (Fourdain et al, 2019; Hövels-Gürich et al, 2008; Majnemer et al, 2008; Sananes et al, 2012; Sommariva et al, 2020), attention and executive abilities (Calderon, Jambaqué, et al, 2014; Cassidy et al, 2015; Jackson et al, 2021; Sanz et al, 2017, 2018), and global intellectual functioning (Bellinger, Wypij, et al, 2003; Forbess et al, 2001; Gaynor et al, 2014; Majnemer et al, 2008) leading to academic underachievement (Bellinger, Bernstein, et al, 2003; Hövels-Gürich et al, 2002; Oster et al, 2017; Wypij et al, 2003) and behavioral maladjustment (internalizing and externalizing problems) (Abda et al, 2019; Bellinger et al, 2009; Hövels-Gürich et al, 2002; Sarrechia et al, 2016). While an extensive body of literature addresses neurocognitive delays in this population, very few studies have explored the implications of CHD for social cognition and competence, especially in early childhood (Clancy et al, 2019).…”

Memory Problems in Children With Congenital Heart Disease: A Narrative Review

“…In brief, we included the search results identified for full-text review from a systematic review of studies examining neurodevelopmental outcomes in children with CHD. 7 The original search covered the period from January 1, 1986 to November 19, 2019 and used this search term: (Neur* OR cognit* OR intellect* OR behavior* OR psych*) AND ((congenital AND heart) OR CHD OR transposition OR tetralogy). This systematic review included all studies that had a measure of cognition in any person older than 3 years of age with CHD.…”