Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-23T00:49:35.075Z Has data issue: false hasContentIssue false
  • English
  • Français

Executive functions in children with heart disease: a systematic review and meta-analysis

Published online by Cambridge University Press:  26 March 2021

William M. Jackson Open the ORCID record for William M. Jackson [Opens in a new window] ,
Nicholas Davis ,
Johanna Calderon ,
Jennifer J. Lee ,
Nicole Feirsen ,
David C. Bellinger  and
Lena S. Sun
William M. Jackson*
Affiliation:
Department of Anesthesiology, Columbia University, New York, NY, USA
Nicholas Davis
Affiliation:
Department of Anesthesiology, Columbia University, New York, NY, USA Department of Anesthesiology and Perioperative Care, University of California, San Francisco, CA, USA
Johanna Calderon
Affiliation:
Department of Psychiatry, Boston Children’s Hospital, Boston, MA, USA Department of Psychiatry, Harvard Medical School, Boston, MA, USA
Jennifer J. Lee
Affiliation:
Department of Anesthesiology, Columbia University, New York, NY, USA
Nicole Feirsen
Affiliation:
Department of Psychiatry & Behavioral Sciences, Montefiore Medical Center, Bronx, NY, USA
David C. Bellinger
Affiliation:
Department of Psychiatry, Boston Children’s Hospital, Boston, MA, USA Department of Neurology, Boston Children’s Hospital, Boston, MA, USA Department of Neurology, Harvard Medical School, Boston, MA, USA
Lena S. Sun
Affiliation:
Department of Anesthesiology, Columbia University, New York, NY, USA
*
Author for correspondence: W. M. Jackson, MD, MS, Department of Anesthesiology, Columbia University, 622 W. 168th St., PH5-505, New York, NY 10032, USA. Tel: +1 (212) 305-2413; Fax: +1 (212) 305-5920. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Context:

People with CHD are at increased risk for executive functioning deficits. Meta-analyses of these measures in CHD patients compared to healthy controls have not been reported.

Objective:

To examine differences in executive functions in individuals with CHD compared to healthy controls.

Data sources:

We performed a systematic review of publications from 1 January, 1986 to 15 June, 2020 indexed in PubMed, CINAHL, EMBASE, PsycInfo, Web of Science, and the Cochrane Library.

Study selection:

Inclusion criteria were (1) studies containing at least one executive function measure; (2) participants were over the age of three.

Data extraction:

Data extraction and quality assessment were performed independently by two authors. We used a shifting unit-of-analysis approach and pooled data using a random effects model.

Results:

The search yielded 61,217 results. Twenty-eight studies met criteria. A total of 7789 people with CHD were compared with 8187 healthy controls. We found the following standardised mean differences: −0.628 (−0.726, −0.531) for cognitive flexibility and set shifting, −0.469 (−0.606, −0.333) for inhibition, −0.369 (−0.466, −0.273) for working memory, −0.334 (−0.546, −0.121) for planning/problem solving, −0.361 (−0.576, −0.147) for summary measures, and −0.444 (−0.614, −0.274) for reporter-based measures (p < 0.001).

Limitations:

Our analysis consisted of cross-sectional and observational studies. We could not quantify the effect of collinearity.

Conclusions:

Individuals with CHD appear to have at least moderate deficits in executive functions. Given the growing population of people with CHD, more attention should be devoted to identifying executive dysfunction in this vulnerable group.

Keywords

CHDcognitionexecutive functionmeta-analysis
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 12 , December 2021 , pp. 1914 - 1922
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Gilboa, SM, Devine, OJ, Kucik, JE, et al. Congenital heart defects in the United States. Circulation 2016; 134: 101–109.CrossRefGoogle ScholarPubMed
Hoffman, JI, Kaplan, S. The incidence of congenital heart disease. J Am Coll Cardiol 2002; 39: 1890–1900.CrossRefGoogle ScholarPubMed
Reller, MD, Strickland, MJ, Riehle-Colarusso, T, Mahle, WT, Correa, A. Prevalence of congenital heart defects in metropolitan Atlanta, 1998–2005. J Pediatr 2008; 153: 807–813.CrossRefGoogle Scholar
Best, KE, Rankin, J. Long-term survival of individuals born with congenital heart disease: a systematic review and meta-analysis. J Am Heart Assoc 2016; 5(6). pii: e002846.CrossRefGoogle ScholarPubMed
Stevenson, JG, Stone, EF, Dillard, DH, Morgan, BC. Intellectual development of children subjected to prolonged circulatory arrest during hypothermic open heart surgery in infancy. Circulation 1974; 50(2 Suppl): II-54–II-59.Google ScholarPubMed
Messmer, BJ, Schallberger, U, Gattiker, R, Senning, A. Psychomotor and intellectual development after deep hypothermia and circulatory arrest in early infancy. J Thorac Cardiovasc Surg 1976; 72: 495–502.CrossRefGoogle ScholarPubMed
Clarkson, PM, MacArthur, BA, Barratt-Boyes, BG, Whitlock, RM, Neutze, JM. Developmental progress after cardiac surgery in infancy using hypothermia and circulatory arrest. Circulation 1980; 62: 855–861.CrossRefGoogle ScholarPubMed
Kussman, BD, Laussen, PC, Benni, PB, McGowan, FX Jr, McElhinney, DB. Cerebral oxygen saturation in children with congenital heart disease and chronic hypoxemia. Anesth Analg 2017; 125: 234–240.CrossRefGoogle ScholarPubMed
Mitting, R, Marino, L, Macrae, D, Shastri, N, Meyer, R, Pathan, N. Nutritional status and clinical outcome in postterm neonates undergoing surgery for congenital heart disease. Pediatr Crit Care Med 2015; 16: 448–452.CrossRefGoogle ScholarPubMed
Wallenstein, MB, Harper, LM, Odibo, AO, et al. Fetal congenital heart disease and intrauterine growth restriction: a retrospective cohort study. J Matern Fetal Neonatal Med 2012; 25: 662–665.CrossRefGoogle ScholarPubMed
Anand, KJ, Hansen, DD, Hickey, PR. Hormonal-metabolic stress responses in neonates undergoing cardiac surgery. Anesthesiology 1990; 73: 661–670.CrossRefGoogle ScholarPubMed
Bashir, AS, Scavuzzo, A. Children with language disorders: natural history and academic success. J Learn Disabil 1992; 25: 53–65.CrossRefGoogle ScholarPubMed
Gathercole, SE, Pickering, SJ, Knight, C, Stegmann, Z. Working memory skills and educational attainment: evidence from national curriculum assessments at 7 and 14 years of age. Appl Cognit Psychol 2004; 18: 1–16.CrossRefGoogle Scholar
Pike, NA, Evangelista, LS, Doering, LV, Eastwood, JA, Lewis, AB, Child, JS. Quality of life, health status, and depression: comparison between adolescents and adults after the fontan procedure with healthy counterparts. J Cardiovasc Nurs 2012; 27: 539–546.CrossRefGoogle ScholarPubMed
Heusch, A, Calaminus, G, Kahl, J, Schmidt, K. Health related quality of life after corrective surgery for congenital heart disease. Klin Padiatr 2014; 226: 281–286.Google ScholarPubMed
Eaton, SL, Wang, Q, Menahem, S. Determinants of quality of life in adults with CHD: an Australian cohort. Cardiol Young 2017; 27: 1571–1576.CrossRefGoogle Scholar
Bellinger, DC, Wypij, D, duPlessis, AJ, et al. Neurodevelopmental status at eight years in children with dextro-transposition of the great arteries: the Boston Circulatory Arrest Trial. J Thorac Cardiovasc Surg 2003; 126: 1385–1396.CrossRefGoogle ScholarPubMed
Bellinger, DC, Wypij, D, Rivkin, MJ, et al. Adolescents with d-transposition of the great arteries corrected with the arterial switch procedure: neuropsychological assessment and structural brain imaging. Circulation 2011; 124: 1361–1369.CrossRefGoogle ScholarPubMed
Kasmi, L, Calderon, J, Montreuil, M, et al. Neurocognitive and psychological outcomes in adults with dextro-transposition of the great arteries corrected by the arterial switch operation. Ann Thorac Surg 2018; 105: 830–836.CrossRefGoogle ScholarPubMed
Diamond, A, Barnett, S, Thomas, J, Munro, S. Preschool program improves cognitive control. Science 2007; 318: 1387–1388.CrossRefGoogle ScholarPubMed
Cassidy, AR, White, MT, DeMaso, DR, Newburger, JW, Bellinger, DC. Executive function in children and adolescents with critical cyanotic congenital heart disease. J Int Neuropsychol Soc 2015; 21: 34–49.CrossRefGoogle ScholarPubMed
Calderon, J, Jambaque, I, Bonnet, D, Angeard, N. Executive functions development in 5- to 7-year-old children with transposition of the great arteries: a longitudinal study. Dev Neuropsychol 2014; 39: 365–384.CrossRefGoogle ScholarPubMed
King, TZ, Smith, KM, Burns, TG, et al. fMRI Investigation of working memory in adolescents with surgically treated congenital heart disease. Appl Neuropsychol Child 2017; 6: 7–21.10.1080/21622965.2015.1065185CrossRefGoogle ScholarPubMed
Moher, D, Liberati, A, Tetzlaff, J, Altman, DG, The PRISMA Group (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med 2009; 6: e1000097.CrossRefGoogle ScholarPubMed
Isquith, PK, Crawford, JS, Espy, KA, Gioia, GA. Assessment of executive function in preschool-aged children. Ment Retard Dev Disabil Res Rev 2005; 11: 209–215.CrossRefGoogle ScholarPubMed
Zelazo, PD, Carlson, SM, Kesek, A. The development of executive function in childhood. In: Nelson, CA, Luciana, M (eds). Handbook of Developmental Cognitive Neuroscience, 2 nd edn. MIT Press, Cambridge, MA, 2008: 553–574.Google Scholar
Graham, S, Hebert, M. Writing to read: a meta-analysis of the impact of writing and writing instruction on reading. Harvard Educ Rev 2011; 81: 710–744.CrossRefGoogle Scholar
Cooper, H. Synthesizing Research: A Guide for Literature Reviews, 3 rd edn. Sage Publications, Thousand Oaks, CA, 1998.Google Scholar
Hedges, LV, Tipton, E, Johnson, MC. Robust variance estimation in meta-regression with dependent effect size estimates. Res Synth Methods 2010; 1: 39–65.CrossRefGoogle ScholarPubMed
Cheung, MW. Modeling dependent effect sizes with three-level meta-analyses: a structural equation modeling approach. Psychol Methods 2014; 19: 211–229.CrossRefGoogle ScholarPubMed
Scammacca, N, Roberts, G, Stuebing, KK. Meta-analysis with complex research designs: dealing with dependence from multiple measures and multiple group comparisons. Rev Educ Res 2014; 84: 328–364.CrossRefGoogle ScholarPubMed
Jackson, WM, Davis, N, Calderon, J, Bellinger, DC, Sun, LS. Children and adults with univentricular hearts score lower on full scale intelligence testing compared to children with biventricular congenital heart disease: a meta-analysis. Anesth Analg 2018; 126(4 Suppl): 511.Google Scholar
Hozo, SP, Djulbegovic, B, Hozo, I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 2005; 5: 13.CrossRefGoogle ScholarPubMed
Hedges, LV, Olkin, I. Statistical Methods for Meta-Analysis, 1 st edn. Academic Press, Cambridge, MA, 1985.Google Scholar
Daliento, L, Mapelli, D, Russo, G, et al. Health related quality of life in adults with repaired tetralogy of Fallot: psychosocial and cognitive outcomes. Heart 2005; 91: 213–218.CrossRefGoogle ScholarPubMed
Mittnacht, J, Choukair, D, Kneppo, C, et al. Long-term neurodevelopmental outcome of children treated with tri-iodothyronine after cardiac surgery: follow-up of a double-blind, randomized, placebo-controlled study. Horm Res Paediatr 2015; 84: 130–136.CrossRefGoogle ScholarPubMed
Gaynor, JW, Gerdes, M, Nord, AS, et al. Is cardiac diagnosis a predictor of neurodevelopmental outcome after cardiac surgery in infancy? J Thorac Cardiovasc Surg 2010; 140: 1230–1237.CrossRefGoogle ScholarPubMed
Miatton, M, De Wolf, D, Francois, K, Thiery, E, Vingerhoets, G. Intellectual, neuropsychological, and behavioral functioning in children with tetralogy of Fallot. J Thorac Cardiovasc Surg 2007; 133: 449–455.CrossRefGoogle ScholarPubMed
Sahu, B, Chauhan, S, Kiran, U, Bisoi, A, Ramakrishnan, L, Nehra, A. Neuropsychological function in children with cyanotic heart disease undergoing corrective cardiac surgery: effect of two different rewarming strategies. Eur J Cardiothorac Surg 2009; 35: 505–510.CrossRefGoogle ScholarPubMed
Bergemann, A, Hansen, JH, Rotermann, I, et al. Neuropsychological performance of school-aged children after staged surgical palliation of hypoplastic left heart syndrome. Eur J Cardiothorac Surg 2015; 47: 803–811.CrossRefGoogle ScholarPubMed
Ilardi, D, Ono, KE, McCartney, R, Book, W, Stringer, AY. Neurocognitive functioning in adults with congenital heart disease. Congenit Heart Dis 2017; 12: 166–173.CrossRefGoogle ScholarPubMed
Calderon, J, Angeard, N, Moutier, S, Plumet, MH, Jambaqué, I, Bonnet, D. Impact of prenatal diagnosis on neurocognitive outcomes in children with transposition of the great arteries. J Pediatr 2012; 161: 94–98. e1.CrossRefGoogle ScholarPubMed
Calderon, J, Bonnet, D, Courtin, C, Concordet, S, Plumet, MH, Angeard, N. Executive function and theory of mind in school-aged children after neonatal corrective cardiac surgery for transposition of the great arteries. Dev Med Child Neurol 2010; 52: 1139–1144.CrossRefGoogle ScholarPubMed
Sarrechia, I, De Wolf, D, Miatton, M, et al. Neurodevelopment and behavior after transcatheter versus surgical closure of secundum type atrial septal defect. J Pediatr 2015; 166: 31–38.CrossRefGoogle ScholarPubMed
Sarrechia, I, Miatton, M, De Wolf, D, et al. Neurocognitive development and behaviour in school-aged children after surgery for univentricular or biventricular congenital heart disease. Eur J Cardiothorac Surg 2016; 49: 167–174.CrossRefGoogle ScholarPubMed
Sterken, C, Lemiere, J, Van den Berghe, G, Mesotten, D. Neurocognitive development after pediatric heart surgery. Pediatrics 2016; 137. pii: e20154675.CrossRefGoogle ScholarPubMed
Stroop, JR. Studies of interference in serial verbal reactions. J Exp Psychol 1935; 18: 643–662.CrossRefGoogle Scholar
Bellinger, DC, Watson, CG, Rivkin, MJ, et al. Neuropsychological status and structural brain imaging in adolescents with single ventricle who underwent the Fontan procedure. J Am Heart Assoc 2015; 4. pii: e002302.CrossRefGoogle ScholarPubMed
Muñoz-López, M, Hoskote, A, Chadwick, MJ, et al. Hippocampal damage and memory impairment in congenital cyanotic heart disease. Hippocampus 2017; 27: 417–424.CrossRefGoogle ScholarPubMed
Murphy, LK, Compas, BE, Reeslund, KL, et al. Cognitive and attentional functioning in adolescents and young adults with Tetralogy of Fallot and d-transposition of the great arteries. Child Neuropsychol 2017; 23: 99–110.CrossRefGoogle Scholar
Schaefer, C, von Rhein, M, Knirsch, W, et al. Neurodevelopmental outcome, psychological adjustment, and quality of life in adolescents with congenital heart disease. Dev Med Child Neurol 2013; 55: 1143–1149.CrossRefGoogle ScholarPubMed
Simons, JS, Glidden, R, Sheslow, D, Pizarro, C. Intermediate neurodevelopmental outcome after repair of ventricular septal defect. Ann Thorac Surg 2010; 90: 1586–1591.CrossRefGoogle ScholarPubMed
Sommariva, G, Gortan, AJ, Liguoro, I, et al. Neurocognitive impairment in children with congenital heart disease. Eur J Pediatr 2017; 176: 1458.Google Scholar
Quartermain, MD, Ittenbach, RF, Flynn, TB, et al. Neuropsychological status in children after repair of acyanotic congenital heart disease. Pediatrics 2010; 126: e351–e359.CrossRefGoogle ScholarPubMed
Bellinger, DC, Rivkin, MJ, DeMaso, D, et al. Adolescents with tetralogy of Fallot: neuropsychological assessment and structural brain imaging. Cardiol Young 2015; 25: 338–347.CrossRefGoogle ScholarPubMed
Fuller, S, Rajagopalan, R, Jarvik, GP, et al. Deep hypothermic circulatory arrest does not impair neurodevelopmental outcome in school-age children after infant cardiac surgery. Ann Thorac Surg 2010; 90: 1985–1995.CrossRefGoogle Scholar
Miatton, M, De Wolf, D, Francois, K, Thiery, E, Vingerhoets, G. Neuropsychological performance in school-aged children with surgically corrected congenital heart disease. J Pediatr 2007; 151: 73–78. e1.CrossRefGoogle ScholarPubMed
Brosig, CL, Bear, L, Allen, S, et al. Preschool neurodevelopmental outcomes in children with congenital heart disease. J Pediatr 2017; 183: 80–86. e1.CrossRefGoogle ScholarPubMed
Gerstle, M, Beebe, DW, Drotar, D, Cassedy, A, Marino, BS. Executive functioning and school performance among pediatric survivors of complex congenital heart disease. J Pediatr 2016; 173: 154–159.CrossRefGoogle ScholarPubMed
Sanz, JH, Berl, MM, Armour, AC, Wang, J, Cheng, YI, Donofrio, MT. Prevalence and pattern of executive dysfunction in school age children with congenital heart disease. Congenit Heart Dis 2017; 12: 202–209.CrossRefGoogle ScholarPubMed
Daunhauer, LA, Fidler, DJ, Hahn, L, Will, E, Lee, NR, Hepburn, S. Profiles of everyday executive functioning in young children with down syndrome. Am J Intellect Dev Disabil 2014; 119: 303–318.CrossRefGoogle ScholarPubMed
Germain, S, Collette, F. Dissociation of perceptual and motor inhibitory processes in young and elderly participants using the Simon task. J Int Neuropsychol Soc 2008; 14: 1014–1021.CrossRefGoogle Scholar
Marino, BS, Lipkin, PH, Newburger, JW, et al. Neurodevelopmental outcomes in children with congenital heart disease: evaluation and management: a scientific statement from the American Heart Association. Circulation 2012; 126: 1143–1172.CrossRefGoogle ScholarPubMed
Calderon, J, Bellinger, DC, Hartigan, C, et al. Improving neurodevelopmental outcomes in children with congenital heart disease: protocol for a randomised controlled trial of working memory training. BMJ Open 2019; 9: e023304.CrossRefGoogle ScholarPubMed
Supplementary material: File

Jackson et al. supplementary material

Tables S1-S8 and Figures S1-S3

Download Jackson et al. supplementary material(File)
File 246.9 KB