Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-13T01:42:26.532Z Has data issue: false hasContentIssue false
  • English
  • Français

Neuropsychological outcomes in CHD beyond childhood: a meta-analysis

Published online by Cambridge University Press:  06 December 2017

Rónán Mills ,
Christopher G. McCusker ,
Chris Tennyson  and
Donncha Hanna
Rónán Mills
Affiliation:
Community Neurological Rehabilitation Team – NorthSussex Community Foundation NHS Trust, Horsham, England
Christopher G. McCusker*
Affiliation:
School of Applied Psychology, University College Cork, Cork, Ireland
Chris Tennyson
Affiliation:
Department of Clinical Psychology, Northern Health and Social Care Trust, Antrim, Northern Ireland, Northern Ireland
Donncha Hanna
Affiliation:
School of Psychology, The Queen’s University of Belfast, Belfast, Northern Ireland
*
Correspondence to: Dr C. McCusker, School of Applied Psychology, North Mall Enterprise Centre, University College Cork, Cork, Ireland. Tel: +353 21 490 4602; E-mail: Christopher.mccusker@ucc.ie
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Risk for neurodevelopmental delay in infants and children with CHD is well established, but longer-term outcomes are equivocal. A meta-analysis was conducted to establish whether cognitive deficits remain beyond childhood – into teenage and young adult years.

Methods and results

A total of 18 unique samples, involving adolescents, teenagers, and adults with CHD significant enough to require invasive intervention, and sourced through searches of Web of Science, MEDLINE, CINAHL Plus, and PsychInfo, met the inclusion criteria. These included the use of standardised neuropsychology tests across 10 domains of cognitive functioning and the reporting of effect size differences with controls. Reports of patients with chromosomal or genetic abnormalities were excluded. Pooled effect sizes suggested no significant differences between CHD samples and controls in terms of general intellectual ability and verbal reasoning. However, small–medium effects sizes were noted (0.33–0.44) and were statistically significant within the domains of non-verbal reasoning, processing speed, attention, auditory–verbal memory, psychomotor abilities, numeracy, and literacy with executive functioning also emerging as significant when one study outlier was excluded. We also included quality assurance statistics including Cochran’s Q, T, and I2 statistics, leave-one-out analyses, and assessment of publication bias. These often suggested study variability, possibly related to the heterogeneity of diagnostic groups included, and different tests used to measure the same construct.

Conclusions

Heterogeneity indicated that moderators affect cognitive outcomes in CHD. Nevertheless, deficits across cognitive domains were discerned, which are likely to have functional impact and which should inform practice with this clinical population.

Keywords

CHDscognitive impairmentmeta-analysis
Type
Original Articles
Information
Cardiology in the Young , Volume 28 , Issue 3 , March 2018 , pp. 421 - 431
Check for updates
Copyright
© Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Hoffman, JI, Kaplan, S. The incidence of congenital heart disease. J Am Coll Cardiol 2002; 39: 1890–1900.Google Scholar
2. McCusker, CG, Casey, FC. (eds). Congenital Heart Disease and Neurodevelopment: Understanding and Improving Outcomes. Elsevier: Academic Press, London, 2016.Google Scholar
3. Snookes, SH, Gunn, JK, Eldridge, BJ, et al. A systematic review of motor and cognitive outcomes after early surgery for congenital heart disease. Pediatrics 2010; 125: e818–27.CrossRefGoogle ScholarPubMed
4. Hövels-Gürich, HH, McCusker, CG. Neurodevelopmental patterns in congenital heart disease across childhood – longitudinal studies from Europe. In: McCusker CG, Casey FC, (eds). Congenital Heart Disease and Neurodevelopment: Understanding and Improving Outcomes. Elsevier: Academic Press, London, 2016: pp. 41–53.Google Scholar
5. McCusker, CG, Armstrong, MP, Mullen, M, Doherty, NN, Casey, F. A sibling-controlled prospective study of outcomes at home and school in children with severe congenital heart disease. Cardiol Young 2013; 23: 507–516.CrossRefGoogle ScholarPubMed
6. Bellinger, DC, Wypij, D, Rivkin, MJ, et al. Adolescents with d-transposition of the great arteries corrected with the arterial switch procedure: neuropsychological assessment and structural brain imaging. Circulation 2011; 124: 1361–1369.CrossRefGoogle ScholarPubMed
7. Bellinger, DC, Rivkin, MJ, DeMaso, D, et al. Adolescents with tetralogy of Fallot: neuropsychological assessment and structural brain imaging. Cardiol Young 2015; 25: 338–347.Google Scholar
8. McCusker, CG, Doherty, NN, Molloy, B, et al. Determinants of neuropsychological and behavioural outcomes in early childhood survivors of congenital heart disease. Arch Dis Child 2007; 92: 137–141.Google Scholar
9. Volpe, JJ. Encephalopathy of congenital heart disease – destructive and developmental effects intertwined. J Pediatr 2014; 164: 962–965.Google Scholar
10. Marino, BS, Lipkin, PH, Newburger, JW, et al. Neurodevelopmental outcomes in children with congenital heart disease: evaluation and management: a scientific statement from the American Heart Association. Circulation 2012; 126: 1143–1172.Google Scholar
11. Cassidy, AR, White, MT, DeMaso, DR, Newburger, JW, Bellinger, DC. Executive function in children and adolescents with critical cyanotic congenital heart disease. J Int Neuropsychol Soc 2014; 21: 1–16.Google Scholar
12. Tyagi, M, Austin, K, Stygall, J, Deanfield, J, Cullen, S, Newman, SP. What do we know about cognitive functioning in adult congenital heart disease? Cardiol Young 2014; 24: 13–19.CrossRefGoogle ScholarPubMed
13. Anderson, V, Spencer-Smith, M, Wood, A. Do children really recover better? Neurobehavioural plasticity after early brain insult. Brain 2011; 134: awr103.CrossRefGoogle ScholarPubMed
14. Karsdorp, PA, Everaerd, W, Kindt, M, Mulder, BJ. Psychological and cognitive functioning in children and adolescents with congenital heart disease: a meta-analysis. J Pediatr Psychol 2007; 32: 527–541.Google Scholar
15. Alden, B, Gilljam, T, Gillberg, C. Long‐term psychological outcome of children after surgery for transposition of the great arteries. Acta Paediatr 1998; 87: 405–410.Google Scholar
16. Brewster, RC, King, TZ, Burns, TG, Drossner, DM, Mahle, WT. White matter integrity dissociates verbal memory and auditory attention span in emerging adults with congenital heart disease. J Int Neuropsychol Soc 2015; 21: 22–33.CrossRefGoogle ScholarPubMed
17. Heinrichs, AKM, Holschen, A, Krings, T, et al. Neurologic and psycho-intellectual outcome related to structural brain imaging in adolescents and young adults after neonatal arterial switch operation for transposition of the great arteries. J Thorac Cardiovasc Surg 2014; 148: 2190–2199.CrossRefGoogle Scholar
18. Kirshbom, PM, Flynn, TB, Clancy, RR, et al. Late neurodevelopmental outcome after repair of total anomalous pulmonary venous connection. J Thorac Cardiovasc Surg 2005; 129: 1091–1097.Google Scholar
19. Matos, SM, Sarmento, S, Moreira, S, et al. Impact of fetal development on neurocognitive performance of adolescents with cyanotic and acyanotic congenital heart disease. Congnit Heart Dis 2014; 9: 373–381.CrossRefGoogle ScholarPubMed
20. Pereira, MMM, Areias, ME, Areias, JC, da Silva, ED, Peixoto, B. Neurocognitive implications of congenital heart diseases in adolescents. Acta Neuropsychologica 2011; 9: 351.Google Scholar
21. Quartermain, MD, Ittenbach, RF, Flynn, TB, et al. Neuropsychological status in children after repair of acyanotic congenital heart disease. Pediatrics 2010; 126: e351–9.CrossRefGoogle ScholarPubMed
22. Salzer-Muhar, U, Herle, M, Floquet, P, et al. Self-concept in male and female adolescents with congenital heart disease. Clin Pediatr (Phila) 2002; 41: 17–24.CrossRefGoogle ScholarPubMed
23. Schaefer, C, Rhein, M, Knirsch, W, et al. Neurodevelopmental outcome, psychological adjustment, and quality of life in adolescents with congenital heart disease. Dev Med Child Neurol 2013; 55: 1143–1149.CrossRefGoogle ScholarPubMed
24. Spijkerboer, A, Utens, E, Bogers, A, Verhulst, F, Helbing, W. Long‐term intellectual functioning and school‐related behavioural outcomes in children and adolescents after invasive treatment for congenital heart disease. Br J Dev Psychol 2008; 26: 457–470.CrossRefGoogle Scholar
25. Utens, E, Bieman, H, Verhulst, F, Meijboom, F, Erdman, R, Hess, J. Psychopathology in young adults with congenital heart disease. Eur Heart J 1998; 19: 647–651.Google Scholar
26. van der Rijken, R, Hulstijn-Dirkmaat, G, Kraaimaat, F, et al. Open-heart surgery at school age does not affect neurocognitive functioning. Eur Heart J 2008; 29: 2681–2688.CrossRefGoogle Scholar
27. van der Rijken, R, Hulstijn‐Dirkmatt, G, Kraaimaat, F, Naburrs‐Kohrman, L, Daniels, O, Maassen, B. Evidence of impaired neurocognitive functioning in school‐age children awaiting cardiac surgery. Dev Med Child Neurol 2010; 52: 552–558.Google Scholar
28. Visconti, KJ, Bichell, DP, Jonas, RA, Newburger, JW, Bellinger, DC. Developmental outcome after surgical versus interventional closure of secundum atrial septal defect in children. Circulation 1999; 100 (19 Suppl): II145–50.Google Scholar
29. Wernovsky, G, Stiles, KM, Gauvreau, K, et al. Cognitive development after the fontan operation. Circulation 2000; 102: 883–889.Google Scholar
30. Yang, L, Liu, M, Townes, BD. Neuropsychological and behavioral status of Chinese children with acyanotic congenital heart disease. Int J Neurosci 1994; 74: 109–115.CrossRefGoogle ScholarPubMed
31. Wechsler, D. Wechsler Intelligence Scale for Children–III. The Psychological Corporation, New York, 1991.Google Scholar
32. Wechsler, D. Wechsler Adult Intelligence Scale-III. The Psychological Corporation, New York, 1997.Google Scholar
33. Manly, T, Robertson, IH, Anderson, V, Nimmo-Smith, I. Test of Everyday Attention for Children. The Psychological Corporation, New York, 1998.Google Scholar
34. Cohen, M. Children’s Memory Scale. The Psychological Corporation, New York, 1997.Google Scholar
35. Delis, DC, Kaplan, E, Kramer, JH. Delis-Kaplan Executive Function System. The Psychological Corporation, New York, 2001.Google Scholar
36. Meyers, JE, Meyers, KR. Rey Complex Figure Test and Recognition Trial (RCFT). Psychological Assessment Resources, Odessa, FL, 1995.Google Scholar
37. Wilson, BA, Emslie, H, Evans, JJ, Alderman, N, Burgess, PW. Behavioural Assessment of the Dysexecutive Syndrome. Pearson Assessment, London, 1996.Google Scholar
38. Delis, D, Kaplan, E, Kramer, J, Ober, B. California Verbal Learning Test-II. The Psychological Corporation, San Antonio, TX, 2000.Google Scholar
39. Beery, KE. Developmental Test of Visual-Motor Integration: Administration and Scoring Manual. Follett Publishing, Chicago, IL, 1967.Google Scholar
40. The Psychological Corporation. Wechsler Individual Achievement Test. The Psychological Corporation, San Antonio, TX, 1992.Google Scholar
41. Cohen, J. Statistical Power Analysis for the Behavioral Sciences. Academic Press, New York, 1969.Google Scholar
42. Biostat Inc. Comprehensive meta-analysis, 2014 Englewood, NJ.Google Scholar
43. Borenstein, M. Introduction to Meta-Analysis. Wiley, Chichester, 2009.Google Scholar
44. Von Elm, E, Altman, DG, Egger, M, Pocock, SJ, Gotzsche, PC, Vandenbroucke, JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg 2014; 12:1495–1499.CrossRefGoogle Scholar
45. Daliento, L, Mapelli, D, Russo, G, et al. Health related quality of life in adults with repaired tetralogy of Fallot: psychosocial and cognitive outcomes. Heart 2005; 91: 213–218.CrossRefGoogle ScholarPubMed
46. Opic, P, Roos-Hesselink, J, Cuypers, J, et al. Psychosocial functioning of adults with congenital heart disease: outcomes of a 30-43 year longitudinal follow-up. Clin Res Cardiol 2015; 104:388–400.Google Scholar
47. van der Rijken, R, Hulstijn, W, Hulstijn-Dirkmaat, G, Daniëls, O, Maassen, B. Psychomotor slowness in school-age children with congenital heart disease. Dev Neuropsychol 2011; 36: 388–402.Google Scholar
48. Moher, D, Liberati, A, Tetzlaff, J, Altman, DG, The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6: e1000097.Google Scholar