Journal article
Neurocognitive Dysfunction and Smaller Brain Volumes in Adolescents and Adults With a Fontan Circulation
Circulation (New York, N.Y.), Vol.143(9), pp.878-891
02/03/2021
PMID: 33231097
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Source: InCites
Abstract
Background:
Neurocognitive outcomes beyond childhood in people with a Fontan circulation are not well defined. This study aimed to investigate neurocognitive functioning in adolescents and adults with a Fontan circulation and associations with structural brain injury, brain volumetry, and postnatal clinical factors.
Methods:
In a binational study, participants with a Fontan circulation without a preexisting major neurological disability were prospectively recruited from the Australia and New Zealand Fontan Registry. Neurocognitive function was assessed by using Cogstate software in 107 participants with a Fontan circulation and compared with control groups with transposition of the great arteries (n=50) and a normal circulation (n=41). Brain MRI with volumetric analysis was performed in the participants with a Fontan circulation and compared with healthy control data from the ABIDE I and II (Autism Brain Imaging Data Exchange) and PING (Pediatric Imaging, Neurocognition, and Genetics) data repositories. Clinical data were retrospectively collected.
Results:
Of the participants with a Fontan circulation who had a neurocognitive assessment, 55% were male and the mean age was 22.6 years (SD 7.8). Participants with a Fontan circulation performed worse in several areas of neurocognitive function compared with those with transposition of the great arteries and healthy controls (P<0.05). Clinical factors associated with worse neurocognitive outcomes included more inpatient days during childhood, younger age at Fontan surgery, and longer time since Fontan procedure (P<0.05). Adults with a Fontan circulation had more marked neurocognitive dysfunction than adolescents with a Fontan circulation in 2 domains (psychomotor function, P=0.01 and working memory, P=0.02). Structural brain injury was present in the entire Fontan cohort; the presence of white matter injury was associated with worse paired associate learning (P<0.001), but neither the presence nor severity of infarct, subcortical gray matter injury, and microhemorrhage was associated with neurocognitive outcomes. Compared with healthy controls, people with a Fontan circulation had smaller global brain volumes (P<0.001 in all regions) and smaller regional brain volumes in most cerebral cortical regions (P<0.05). Smaller global brain volumes were associated with worse neurocognitive functioning in several domains (P<0.05). A significant positive association was also identified between global brain volumes and resting oxygen saturations (P≤0.04).
Conclusions:
Neurocognitive impairment is common in adolescents and adults with a Fontan circulation and is associated with smaller gray and white matter brain volume. Understanding modifiable factors that contribute to brain injury to optimize neurocognitive function is paramount.
Details
- Title
- Neurocognitive Dysfunction and Smaller Brain Volumes in Adolescents and Adults With a Fontan Circulation
- Creators
- Charlotte E. Verrall - Children's Hospital at WestmeadJoseph Y. M. Yang - The Royal Children's Hospital (Melbourne, Australia)Jian Chen - Murdoch Children's Research InstituteAdrian SchembriYves d'Udekem - Royal Children's HospitalDiana Zannino - Murdoch Children's Research InstituteNadine A. Kasparian - University of Cincinnati Medical CenterKarin du Plessis - Murdoch Children's Research InstituteStuart M. Grieve - University of SydneyThomas Welton - University of SydneyBelinda Barton - Children's Hospital at WestmeadThomas L. Gentles - Starship Children's HealthDavid S. Celermajer - University of SydneyChantal Attard - Murdoch Childrens Research InstituteKathryn Rice - Starship Childrens Hosp, Greenlane Paediat & Congenital Cardiac Serv, Auckland, New ZealandJulian Ayer - Children's Hospital at WestmeadSimone Mandelstam - Royal Children's HospitalDavid S. Winlaw - Children's Hospital at WestmeadMark T. Mackay - Royal Children's HospitalRachael Cordina - University of Sydney
- Publication Details
- Circulation (New York, N.Y.), Vol.143(9), pp.878-891
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 14
- Grant note
- 1047923 / National Health and Medical Research Council; National Health and Medical Research Council of Australia
- Identifiers
- 991013092667802368
- Copyright
- © 2020 American Heart Association, Inc.
- Academic Unit
- Faculty of Health
- Language
- English
- Resource Type
- Journal article