title: Neurocognitive and executive functioning in adult survivors of congenital heart disease.
abstract: OBJECTIVE
  Congenital heart disease (CHD) can affect the developing central nervous system, resulting in neurocognitive and behavioral deficits. Preoperative neurological abnormalities as well as sequelae of the open heart operations required to correct structural abnormalities of the heart contribute to these deficits. There are few studies examining the neurocognitive functioning of adults with CHD. This study sought to investigate multiple domains of neurocognitive functioning in adult survivors of CHD who had childhood cardiac surgery with either moderate or severe disease complexity.
  
  
  METHODS
  A total of 48 adults (18-49 years of age) who had undergone cardiac surgery for CHD prior to five years of age participated in the study. CHD severity was classified as moderate or severe according to the 32nd Bethesda Guidelines. A computerized battery of standardized neurocognitive tests (CNS-Vital Signs), a validated rating scale of executive functioning, and demographic questionnaires were administered.
  
  
  RESULTS
  There were no significant differences between the moderate CHD group and normative data on any cognitive measure. In contrast, the severe CHD group differed from norms in multiple domains: psychomotor speed, processing speed, complex attention, reaction time, and on the overall neurocognitive index. Number of surgeries was strongly related to worse executive functioning. There was no association between age at first surgery or time since last surgery and neuropsychological functioning. Number of surgeries was also unrelated to neurocognitive test performance.
  
  
  CONCLUSIONS
  Patients with severe CHD performed significantly worse on measures of processing speed, attention, and executive functioning. These findings may be useful in the long-term care of adults with congenital heart disease.
authors.affiliation: Department of Pediatrics, Section of Cardiology, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Leda
authors.initials: L
authors.lastname: Klouda
authors.affiliation: Department of Pediatrics, Section of Cardiology, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Wayne J
authors.initials: WJ
authors.lastname: Franklin
authors.affiliation: Department of Pediatrics, Section of Cardiology, Baylor College of Medicine, Houston, Texas, USA.|Department of Medicine, Division of Cardiology, Emory University, Atlanta, Georgia, USA.
authors.forename: Anita
authors.initials: A
authors.lastname: Saraf
authors.affiliation: Department of Pediatrics, Section of Cardiology, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Dhaval R
authors.initials: DR
authors.lastname: Parekh
authors.affiliation: Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Hoston, Texas, USA.
authors.forename: David D
authors.initials: DD
authors.lastname: Schwartz
mesh_terms: D000293:Adolescent; D000328:Adult; D001288:Attention; D006348:Cardiac Surgical Procedures; D016022:Case-Control Studies; D003071:Cognition; D003430:Cross-Sectional Studies; D056344:Executive Function; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000523:psychology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011597:Psychomotor Performance; D011930:Reaction Time; D012720:Severity of Illness Index; D017741:Survivors / Q000523:psychology*; D013997:Time Factors; D055815:Young Adult
keywords: congenital cardiac surgery; congenital heart defect; executive function; neurocognitive outcomes