Neurocognitive deficits in adult congenital heart disease patients

Individuals with mild-to-moderate adult congenital heart disease (ACHD) had poorer neurocognitive performance, most significantly in tests of alphanumeric trail- making.

Individuals with mild-to-moderate adult congenital heart disease (ACHD) had poorer neurocognitive performance, most significantly in tests of alphanumeric trail-making, in a recent study published in the Journal of the American Heart Association.

Deficits in alphanumeric trail-making may translate to issues with multitasking, prioritizing, maintaining information in working memory, planning and organizing.

“That may be why ACHD patients sometimes have trouble finding jobs appropriate for their educational level and experience more socioeconomic deprivation as a result,” said the lead author of the study, Melissa L. Perrotta, M.D., an adult congenital heart disease specialist and pediatric cardiologist with Norton Children’s Heart Institute, affiliated with the UofL School of Medicine.

Making matters worse, acquired cardiovascular disease affects more than 19% of the ACHD population (compared with about 5% in the general, non‐ACHD population), and at much younger ages than the non‐ACHD population, according to Dr. Perrotta.

The differences appear to be driven by increased burden of cerebrovascular and cardiovascular disease among individuals with ACHD.

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“Prevention of acquired cardiovascular disease in the ACHD population may be critical to avoid further impairment to neurocognitive functioning so that these patients can achieve and maintain a good quality of life well into adulthood,” Dr. Perrotta said.

The study compared 1,020 individuals with mild-to-moderate ACHD with those without ACHD. The subjects underwent neurocognitive tests for fluid intelligence, reaction time, numeric memory, symbol-digit substitution and trail-making at enrollment and follow-up.

Individuals in the study with ACHD spent 6.4 seconds longer on alphanumeric trail-making. They spent 2.5 seconds longer on numeric trail-making, a measure of visual attention and processing speed. Such deficits may translate to difficulty with brief attention to tasks, searching efficiently and putting numbers in order.

The ACHD cohort had modestly lower performance on symbol-digit substitution, a measure of processing speed, with 0.9 fewer correct substitutions. Individuals with these deficits may have issues with paying attention, learning and applying that information to everyday life and performing routine tasks efficiently.

“Adults With Mild-to-Moderate Congenital Heart Disease Demonstrate Measurable Neurocognitive Deficits”


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