Abstract
Children born with congenital heart disease (CHD) are now living to adulthood in unprecedented
numbers and many will eventually live to become senior citizens. As care goals shift
from surviving to thriving, a new focus on quality of life has emerged. Neurocognition
and the ability to participate fully in society, form meaningful relationships, and
collaborate effectively with the health care system are important considerations.
As adults with CHD age, research regarding their cognitive function becomes prescient.
The focus is now shifting from defining neurocognitive deficits in children with CHD
to preventing neurocognitive decline in adults living with CHD. In this review, we
describe the possible etiologies and predictors of neurocognitive decline in adults
with CHD. We performed a comprehensive literature review to identify all of the current
data available on neurocognitive function in adults with CHD. We summarize the available
evidence by describing common deficits in this patient population and the potential
effects of these deficits on adult functioning, health care decision-making, and long-term
relationships with care providers. We review potential modifiable etiologies for progressive
neurocognitive decline and suggest strategies for surveillance and prevention of the
potential decline. We conclude that the current information available regarding the
aging brain of adults with CHD and the effect of neurocognitive decline on morbidity
and mortality is woefully insufficient. This review, therefore, provides a roadmap
for future research endeavours to study neurocognition in older adults with CHD.
Résumé
Un nombre sans précédent d’enfants nés avec une cardiopathie congénitale atteignent
maintenant l’âge adulte, et bon nombre deviendront des personnes âgées. Alors que
les objectifs thérapeutiques passent de la survie à une vie épanouie, la qualité de
vie suscite un nouvel intérêt. La fonction neurocognitive et la capacité de participer
pleinement à la société, d’établir des relations significatives et de collaborer efficacement
avec le système de soins de santé constituent d’importantes considérations. Au fur
et à mesure que les adultes atteints de cardiopathie congénitale vieillissent, il
devient important de mener des recherches sur leur fonction cognitive. L’intérêt passe
maintenant de la définition des déficits neurocognitifs chez les enfants atteints
de cardiopathie congénitale à la prévention du déclin neurocognitif chez les adultes
présentant une cardiopathie congénitale. Dans cette analyse, nous décrivons les étiologies
et les facteurs de prédiction possibles du déclin neurocognitif chez les adultes atteints
de cardiopathie congénitale. Nous avons effectué un examen approfondi de la littérature
pour relever toutes les données actuelles sur la fonction neurocognitive chez les
adultes présentant une cardiopathie congénitale. Nous avons résumé les données probantes
existantes en décrivant les déficits fréquents chez cette population de patients et
les effets possibles de ces déficits sur la fonction chez l’adulte, la prise de décision
en soins de santé et le lien à long terme avec les dispensateurs de soins. Nous avons
examiné les étiologies possibles modifiables du déclin progressif de la fonction neurocognitive
et proposons des stratégies de surveillance et de prévention d’un déclin possible.
Nous avons conclu que les données actuelles sur le cerveau vieillissant de l’adulte
atteint de cardiopathie congénitale et les effets du déclin neurocognitif sur la morbidité
et la mortalité sont nettement insuffisantes. Par conséquent, cette analyse fournit
une voie à suivre pour des travaux de recherche futurs sur la fonction neurocognitive
chez des adultes plus âgés atteints de cardiopathie congénitale.
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Article info
Publication history
Published online: June 26, 2019
Accepted:
June 18,
2019
Received:
April 29,
2019
Footnotes
See page 1682 for disclosure information.
Identification
Copyright
© 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
