Abstract
Adolescents and young adults with congenital heart disease (CHD) show a range of memory deficits, which can dramatically impact their clinical outcomes and quality of life. However, few studies have identified predictors of these memory changes. The purpose of this investigation was to identify predictors of memory deficits in adolescents and young adults with CHD after surgical palliation compared to healthy controls. One hundred fifty-six adolescents and young adults (80 CHD and 76 controls; age 14-21 years) were recruited and administered an instrument to assess memory [Wide Range Assessment of Memory and Learning Second Edition - general memory index (GMI) score] and completed questionnaires that measure anxiety, depression, sleepiness, health status, and self-efficacy. Descriptive and non-parametric statistics were used to assess group differences, and logistic regression to identify predictors of memory deficits. CHD subjects consisted of 58% males, median age 17 years, 43% Hispanic, and medians of 2 previous heart surgeries and 14 years since last surgery. Memory deficits (GMI ≤ 85) were identified in 50% CHD compared to 4% healthy controls (median GMI 85 vs. 104, p < 0.001). Of GMI subscale medians, CHD subjects had significantly worse memory performance vs. healthy controls (verbal 88 vs. 105, p < 0.001; attention 88 vs. 109, p < 0.001; working memory 86 vs. 108, p < 0.001). No significant differences appeared between groups for visual memory. Multiple clinical and psychosocial factors were identified which were statistically different on bivariate analyses between the subjects with and without memory deficits. By multivariate analysis, male gender, number of surgeries, anxiety, and self-efficacy emerged as independent predictors of memory deficits. Adolescents and young adults with CHD, more than a decade since their last surgery, show significant verbal, attention, and working memory deficits over controls. To enhance patient memory/self-care, clinicians should explore ways to reduce anxiety, improve self-efficacy, and increase use of visual patient education material, especially in CHD males.
Highlights
Memory is an important part of cognition and is inter-related with executive function skills
Public insurance was higher in the congenital heart disease (CHD) group (68%) compared to controls (10%) and the incidence of having attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD) (21%) compared to controls (4%)
Our study identified male gender and number of surgical procedures with additional behavioralrelated factors emerging as independent predictors of memory deficits
Summary
Memory is an important part of cognition and is inter-related with executive function skills. The mechanisms contributing to memory or neurocognitive deficits are multifactorial and are likely to include factors that are related to the CHD, including cyanosis, early cardiac surgery, a wide range of genetic syndromes or gene mutations, and prenatal and other pre- and postoperative factors that can have significant adverse effects on brain development and/or injury [6,7,8,9] These deficits may not become apparent until school-age, when higher-level organizational skills are required and can be especially problematic in adolescents who must eventually take responsibility for their health during the transition to adulthood. Our specific aim of this study was to identify predictors (including clinical and behavioral factors) of memory deficit in adolescents and young adults with CHD after surgical palliation compared to age- and gendermatched healthy controls
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