Neurocognition in adult congenital heart disease: how to control and prevent progressive decline

Neurocognition in adult congenital heart disease:

As the goals of health care shift from surviving to thriving, a new approach to quality of life for patients has emerged: neurocognition and the ability to fully participate in society.

This means that the focus is shifting from defining neurocognitive deficits in children with complex congenital heart disease (CCC), to preventing neurocognitive impairment in adults living with CCC. 
In this sense, researchers have carried out arduous studies in which we have the following findings:

Neurodevelopment before adulthood with complex congenital heart disease:

The presence of difficulties around 

1- Isolation:

frequent hospitalizations, recoveries from surgery generate an interruption in daily social contact, especially in the schooling stage.

2- Schooling:

there is evidence of presenting a greater risk of academic delays and in the areas of language, visuospatial and motor.

In turn, educational institutions have difficulties in implementing inclusion programs with people who require it.

3- Behavior:

The focus is shifting from defining neurocognitive deficits in children with CHD to preventing neurocognitive impairment in adults living with CHD.

4- Transition Process:

The move from pediatric to adult care is a turbulent time that can exacerbate a patient's psychosocial functioning as well as medical treatment.

What is neurocognitive functioning like in adults with CCC?  

Based on analysis of 11 studies published between 1998 and 2018, what we know so far focuses on the presence of:  

1- Executive dysfunction:

 refers to a decrease in skills such as problem solving, planning, memory and attention.

2- Psychopathology:

presence of mood disorders such as depression, generalized anxiety and difficulty in adhering to treatment.

And as for the associated risk factors, it is found:  having a cyanotic heart disease, structural complexity of the CHD and having faced a greater number of surgeries.

Although there is a lack of studies that evaluate this stage of the life cycle, it has been possible to determine so far that:

  •  The risk of developing dementia  is doubled .   
  •  The prevalence of Cerebrovascular Accident is increasing.
  •  It is determined as risk factors for neurocognitive impairment: atrial arrhythmias, heart failure and diabetes.

What strategies are proposed? 

1- From transition throughout life:  

- Modify Appointment Modify traditional cardiology appointment, which has a primary focus on physical symptomatology.
- Requirement of a multidisciplinary care team to assess and provide services to patients struggling with academic, occupational, and/or psychosocial functioning.

2- Promotion of physical activity:

- Low physical activity in adolescence has been linked to early-onset dementia.  
- Physical activity for 20 minutes on 3 or more days a week, or 30 minutes on 5 days a week, has been shown to reduce the risk of cognitive decline.

3- Weight control throughout life:

- Obesity in patients with HNC should not be overlooked. 
- Dietary interventions, obesity management programs, and referrals for surgery as warranted.

4- Evaluation:

- About the beliefs and expectations of patients regarding social function, they can be routinely explored in clinics.

5- Mental health:

- Patients with CCC in whom anxiety, depression, and substance abuse are identified should be referred for mental health services.

6- More prospective studies:

- They will make it possible to discover and learn more about cognitive functioning in adults with CCC throughout life, in order to develop intervention strategies.