Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Mar;45(3):529-543.
doi: 10.1007/s00246-023-03376-7. Epub 2024 Jan 23.

Cognitive Functioning and Psychosocial Outcomes in Adults with Complex Congenital Heart Disease: A Cross-sectional Pilot Study

Charlotte E Verrall  1   2   3   4 , Derek L Tran  5   6   7   8 , Nadine A Kasparian  9   10 , Tracey Williams  11 , Vincent Oxenham  12   13 , Julian Ayer  5   14 , David S Celermajer  5   6   7 , Rachael L Cordina  5   6   7
Affiliations

Cognitive Functioning and Psychosocial Outcomes in Adults with Complex Congenital Heart Disease: A Cross-sectional Pilot Study

Charlotte E Verrall et al. Pediatr Cardiol. 2024 Mar.

Abstract

Adults with complex congenital heart disease (CHD) are at risk for cognitive dysfunction. However, associations between cognitive dysfunction and psychosocial outcomes are poorly defined. Between June and November 2022, we prospectively recruited 39 adults with complex CHD who completed a computerized cognitive assessment (Cogstate) and validated psychosocial scales measuring psychological distress, health-related quality of life (HRQOL), and resilience. Participants had a mean age of 36.4 ± 11.2 years. Over half (62%) were women, most (79%) had complex biventricular CHD, and 21% had Fontan physiology. Prevalence of cognitive dysfunction was greatest in the domains of attention (29%), working memory (25%), and psychomotor speed (21%). Adjusting for age and sex, Pearson partial correlations between Cogstate z-scores and self-reported cognitive problems were small. Participants who lived in the most disadvantaged areas and those with a below-average annual household income had lower global cognitive z-scores (p = 0.02 and p = 0.03, respectively). Two-thirds (64%) reported elevated symptoms of depression, anxiety, and/or stress. Small correlations were observed between psychological distress and cognitive performance. Greater resilience was associated with lower psychological distress (r ≥ -0.5, p < 0.001) and higher HRQOL (r = 0.33, p = 0.02). Our findings demonstrate that adults with complex CHD have a high risk of cognitive dysfunction, though may not recognize or report their cognitive challenges. Lower socioeconomic status may be an indicator for those at risk of poorer cognitive functioning. Psychological distress is common though may not be a strong correlate of performance-based cognitive functioning. Formal cognitive evaluation in this patient population is essential. Optimizing resilience may be a protective strategy to minimize psychological distress and bolster HRQOL.

Keywords: Adult congenital heart disease; Cognition; Psychological distress; Psychosocial functioning; Quality of life; Resilience.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The manuscript has not previously been published in print or electronic form and is not under consideration by any another publication.

Figures

Fig. 1
Fig. 1
Proportion of mild and severe dysfunction in the cognitive domains assessed
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Plappert L, Edwards S, Senatore A, De Martini A. The epidemiology of persons living with Fontan in 2020 and projections for 2030: development of an epidemiology model providing multinational estimates. Adv Ther. 2021;39(2):1004–1015. doi: 10.1007/s12325-021-02002-3. - DOI - PMC - PubMed
    1. d’Udekem Y, Iyengar AJ, Galati JC, Forsdick V, Weintraub RG, Wheaton GR, et al. Redefining expectations of long-term survival after the Fontan procedure: twenty-five years of follow-up from the entire population of Australia and New Zealand. Circulation. 2014;130(11 Suppl 1):S32–S38. - PubMed
    1. Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, et al. 2018 AHA/ACC guideline for the management of adults with congenital heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;73(12):1494–1563. doi: 10.1016/j.jacc.2018.08.1028. - DOI - PubMed
    1. Kovacs AH, Brouillette J, Ibeziako P, Jackson JL, Kasparian NA, Kim YY, et al. Psychological outcomes and interventions for individuals with congenital heart disease: a scientific statement from the American Heart Association. 2022;15(8):e000110. - PubMed
    1. Butler SC, Sadhwani A, Stopp C, Singer J, Wypij D, Dunbar-Masterson C, et al. Neurodevelopmental assessment of infants with congenital heart disease in the early postoperative period. Congenit Heart Dis. 2019;14(2):236–245. doi: 10.1111/chd.12686. - DOI - PubMed