Adults with congenital heart disease may experience reduced neurocognitive function
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Adults with congenital heart disease demonstrated poorer neurocognitive function compared with those without it, according to research published in the Journal of the American Heart Association.
After adjustment for prior stroke and CAD, adults with congenital heart disease had poorer performance compared with those without it on tests of neurocognitive function, including fluid intelligence, reaction time, numeric memory, symbol-digit substitution and trail making.
Investigators hypothesized that these findings may be driven by the increased burden of CVD and cerebrovascular disease among adults with congenital heart disease.
“Here we use a cross-sectional approach to show that older adults with mostly mild to moderate complexity adult congenital heart disease have worse performance in tests of neurocognition compared with individuals without adult congenital heart disease,” Melissa L. Perrotta, MD, pediatric cardiologist at the Lucile Packard Children’s Hospital and Stanford University School of Medicine, and colleagues wrote.
“The substantially increased burden of cerebro- and cardiovascular disease in the adult congenital heart disease cohort may be a significant contributor to poor neurocognitive outcomes in this cohort, as demonstrated by the attenuation in neurocognitive differences between the adult congenital heart disease and non-adult congenital heart disease cohorts when excluding individuals with a history of stroke and coronary artery disease,” the researchers wrote. “Atherosclerosis of the carotid arteries has been shown to be a strong risk factor for vascular dementia and Alzheimer’s disease, likely mediated by thromboembolic events and hypoperfusion.”
Investigators included 1,020 individuals with mild to moderate adult congenital heart disease (median age, 58 years) and 497,987 (median age, 57 years) without it from the UK Biobank study. All participants were invited to complete computer-based neurocognitive tests that included a fluid intelligence test that evaluated reasoning; a reaction time test that evaluated processing speed; a numeric memory test that evaluated working memory; a symbol-digit substitution test that evaluated complex processing speed; and numeric trail making, alphanumeric trail making and trail making difference tests that assessed visual attention.
Slower cognitive performance
After adjustment for risk factors, adults with congenital heart disease demonstrated worse performance on the Symbol-Digit Substitution Test (difference in number of correct responses, –0.9; 95% CI, –1.5 to –0.22); were 2.51 seconds slower on the Trail Making Test (95% CI, 0.45-4.58); were 6.47 seconds slower on the Alphanumeric Trail Making Test (95% CI, 3.01-9.94); and were 3.96 seconds slower on the Trail Making Difference Test (95% CI, 1.1-6.82) compared with those without congenital heart disease.
“The most significant deficits were found in symbol-digit substitution and numeric/alphanumeric trail making, indicative of deficits in processing speed, attention and cognitive flexibility, which fall under the broad category of executive functioning,” the researchers wrote. “The [Trail Making Test] has previously been shown to correlate strongly with overall severity of neurological impairment, with predictable age-related decline in performance. Deficits in alphanumeric trail making have been described in school-aged children and adolescents with congenital heart disease following cardiac surgery, demonstrating that differences in cognitive flexibility among individuals with congenital heart disease can be observed much earlier than adulthood.”
Excluding for prior stroke or CAD
After investigators excluded individuals with a history of stroke or CAD, adults with congenital heart disease continued to perform worse than those without it in every category, although none met statistical significance:
- fluid intelligence (mean correct responses, 6.1 vs. 5.9; beta = –0.2; 95% CI, –0.4 to 0.1);
- reaction time (555 ms vs. 555 ms; beta = –0.3; 95% CI, –8.4 to 7.8);
- numeric memory (mean digits remembered, 6.5 vs. 6.4; beta = –0.2; 95% CI, –0.6 to 0.3);
- symbol-digit substitution (mean correct responses, 19.9 vs. 19; beta = –0.9; 95% CI, –1.6 to –0.1);
- numeric trail making (38.84 vs. 40.97 seconds; beta = 2.14; 95% CI, –0.23 to 4.51);
- alphanumeric trail making (66.16 vs. 70.93 seconds; beta = 4.47; 95% CI, 0.82-8.73); and
- trail making difference (27.32 vs. 29.96 seconds; beta = 2.64; 95% CI, –0.63 to 5.9).
“While the differences in neurocognitive function observed in the adult congenital heart disease group may be of nominal clinical significance (eg, 0.9 fewer correct answers in symbol-digit substitution), these findings could suggest the persistence of neurocognitive differences observable in childhood survivors of congenital heart disease into adult life,” the researchers wrote. “Furthermore, differences in education-matched employment rates may be explained by subtle neurocognitive differences such as the ones described in this study that cannot be distinguished by gross measures of cognitive function such as intelligence quotient scores.”
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