Adults with congenital heart disease exhibit neurocognitive deficits

10 Nov 2020

Individuals with mild‐to‐moderate congenital heart disease (CHD) appear to have impaired neurocognitive function, which is similar to deficits observed in children with CHD, a study has found. This deficit is attributed to increased burden of cerebro‐ and cardiovascular disease.

The analysis included 1,020 adults with (A)CHD (median age, 57 years; 47.3 percent male) and 497,987 healthy controls (median age, 58 years; 45.5 percent male). All participants underwent neurocognitive tests for fluid intelligence, reaction time, numeric memory, symbol‐digit substitution, and trail making at baseline and follow‐up.

Compared with controls, those with ACHD tended to have greater socioeconomic deprivation (median Townsend Deprivation Index, −1.89 vs −2.14; p<0.001), decreased alcohol consumption (37.6 percent vs 30.8 percent reported “seldom” drinking; p<0.001), and lower blood pressure (BP; median systolic BP, 134 vs 137 mm Hg; p<0.001; median diastolic BP, 79 vs 82 mm Hg; p<0.001).

Individuals with ACHD performed significantly poorly on measures of visual attention and cognitive flexibility and processing speed. They spent 6.4 seconds longer on alpha‐numeric trail making (p=0.002) and 2.5 seconds longer on numeric trail making (p=0.034) compared with controls.

The ACHD group also had poorer performance on symbol‐digit substitution, a measure of processing speed, with 0.9 fewer correct substitutions (p=0.021).

Individuals with ACHD had substantially higher burden of cerebro‐ and cardiovascular disease, and this might have contributed to poor neurocognitive outcomes, as demonstrated by the attenuation in neurocognitive differences between the ACHD and control groups in an analysis that excluded individuals with a history of stroke and coronary artery disease.

Given the impact of neurocognition on quality of life measures such as employability, more studies evaluating neurocognitive function in the ACHD population are needed to facilitate better preventive clinical care.

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