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How Does Fetal Development Affects Neuropsychological Abilities In Adolescents with Congenital Heart Disease?

Friday, October 19, 2012
Room 275-277 (Morial Convention Center)
Sofia M. Sarmento1, Sara F. Moreira1, Samanta S. Matos1, Bruno M. Peixoto1, Josť C. Areias2 and Maria E. Areias1, (1)Psychology, Cespu, Porto, Portugal, (2)Pediatric Cardiology, Hospital S. Jo„o, Porto, Portugal

Purpose: Patients with congenital heart disease (CHD) may show neuropsychological deficits in pre-school and school ages. Surgeries and anoxia have been studied as main variables in these disorders but recently the focus has been turned to fetal cardiac and circulatory conditions that may affect neurodevelopment. The purpose of this investigation was to evaluate the neurocognitive performance in adolescents with CHD and to determine whether parameters of fetal development evaluated in neonates, such as head circumference, length, weight and Apgar scores, are somehow related to their neurocognitive performance.

Methods: 61 CHD patients (34 males) aged from 13 to 18 years old (mean=15.08 ± 1.72), 37 cyanotic (20 Tetralogy of Fallot, 17 Transposition of the Great Arteries) and 24 acyanotic (Ventricular Septal Defect), enrolled in this study. We assessed also a control group with 16 healthy children (11 males and 5 females) ages ranging from 13 and 18 (mean=15.69 ± 1.44).  All assessment measures for CHD patients were once obtained in a tertiary hospital; the control group was evaluated in school. Demographic information and clinical history were collected. Neuropsychological assessment included Wechsler’s Digit Test (direct and reverse) and Symbol Search, Rey’s Complex Figure, BADS’s Key Searching Test, Color-Word Stroop Test, Trail Making Test and Logical Memory Task.

Results: CHD patients compared to control group showed lower scores in the Wechsler’s Digit Test, in direct (u=192.000; p<0,001) and reverse (u=104.000; p<0.001) versions, in Rey’s Complex Figure, copy (u=132.500; p<0,001) and memory (u=127.500; p<0.001), in Symbol Search (u= 650.000; p=0.042), in BADS’s Key Searching Test (u= 128.000; p<0.001) in Stroop Test, words (u=119.000; p<0.001), colors (u=182.500; p<0.001) and interference (u=104,500; p<0.001) and in Trail Making Test, A (u=906.000; p<0.001) and B (u=895.500; p<0.001). Cyanotic compared to acyanotic patients showed lower scores in Wechler’s Digit Test, in direct form (u=593.500; p=0,026), in Rey’s Complex Figure, memory (u=627.500; p=0.007), in Stroop Test, words (u=606.500; p=0.016), colors (u=633.000; p=0.005) and interference (u=645,000; p=0.003), and in Trail Making Test, A (u=285.000; p=0.019) and B (u=296.500; p=0.029). Several correlations were apparent between fetal/ neonatal parameters and neuropsychological abilities in each type of CHD. However, the circumference of the head at birth stands as a main correlation with cognitive development later on in all kinds of CHD (Direct Digit: rho=0.437, p=0.004; BADS: rho=0.346, p=0.021; Stroop Words: rho=0.366, p=0.014; Stroop Colours: rho=0.408, p=0.006; Stroop Interference: rho=0.397, p=0.008; Trail Making Test A: rho=0.390, p=0.009).

Conclusion: Adolescents with CHD have worse neuropsychological performance than the control group, and the cyanotic worse than the acyanotic patients. The fetal anomalies in heart and circulation seem to have impact in delaying cerebral and somatic growth, predicting cognitive impairment in adolescents with CHD.