Areias Maria Emília, Peixoto Bruno, Santos Ivone, Cruz Lígia, Regadas Ana, Pinheiro Carolina, Monteiro Helena, Araújo Sara, Carvalho Tânia, Miranda Joana, Moura Cláudia, Soares Joana, Viana Victor, Quintas Jorge, Areias José Carlos
Department of Social and Behavior Sciences, Instituto Universitário de Ciências da Saúde (CESPU), Paredes, Portugal; Unidade de Investigação e Desenvolvimento Cardiovascular, Faculty of Medicine, University of Porto, Porto, Portugal.
Department of Social and Behavior Sciences, Instituto Universitário de Ciências da Saúde (CESPU), Paredes, Portugal; NeuroGen - Center for Health Technology and Services Research (CINTESIS), Porto, Portugal.
Rev Port Cardiol (Engl Ed). 2018 Nov;37(11):923-931. doi: 10.1016/j.repc.2017.11.017. Epub 2018 Nov 16.
The objectives of this study were to assess the neuropsychological performance (NP) of adolescents and young adults with congenital heart disease (CHD), comparing them with a group of healthy controls, to determine whether there are different neurocognitive phenotypes in CHD, and to identify their relation to sociodemographic, neonatal, clinical and psychological adjustment variables.
A total of 217 CHD patients (116 male, aged 15.73±2.68 years) and 80 controls (35 male, age 16.76±2.22 years) underwent an extensive neuropsychological assessment and analysis of psychological adjustment.
CHD patients had significantly poorer NP than healthy controls in all neurocognitive domains. Three different phenotypes of NP in CHD patients were identified: non-impaired (NI), moderately impaired (MI) and globally impaired (GI). They differed in all dimensions of NP. The GI cluster showed fewer years of schooling (p=0.025) and lower neonatal indicators such as head circumference (p=0.019), 1-min Apgar score (p=0.006), birth weight (p=0.05) and length (p=0.034) than the NI cluster. In the MI and GI clusters, there were more cyanotic forms of disease, including tetralogy of Fallot and transposition of the great arteries. The GI cluster presented more difficulties with psychological adjustment, including social (p=0.038), attention (p=0.001) and aggressive (p=0.003) problems.
CHD patients have poorer NP than controls. NP in the CHD group can be classified in three clusters that reflect different levels of neuropsychological functioning, which is sensitive to social, neonatal and psychological adjustment variables.
本研究的目的是评估先天性心脏病（CHD）青少年和青年的神经心理学表现（NP），并与一组健康对照进行比较，以确定CHD患者是否存在不同的神经认知表型，并确定这些表型与社会人口统计学、新生儿、临床和心理适应变量之间的关系。
共有217例CHD患者（116例男性，年龄15.73±2.68岁）和80例对照（35例男性，年龄16.76±2.22岁）接受了全面的神经心理学评估和心理适应分析。
CHD患者在所有神经认知领域的NP均显著差于健康对照。在CHD患者中识别出三种不同的NP表型：未受损（NI）、中度受损（MI）和整体受损（GI）。它们在NP的所有维度上均存在差异。与NI组相比，GI组的受教育年限较少（p = 0.025），新生儿指标较低，如头围（p = 0.019）、1分钟阿氏评分（p = 0.006）、出生体重（p = 0.05）和身长（p = 0.034）。在MI和GI组中，青紫型疾病更多，包括法洛四联症和大动脉转位。GI组在心理适应方面存在更多困难，包括社交（p = 0.038）、注意力（p = 0.001）和攻击行为（p = 0.003）问题。
CHD患者的NP比对照组差。CHD组的NP可分为三个聚类，反映了不同水平的神经心理功能，且对社会、新生儿和心理适应变量敏感。
