Processing Speed Partially Mediates Executive Function Impairments in Adolescents with Congenital Heart Disease: Results from a Prospective Cohort Study

Alenka S Schmid; Melanie Ehrler; Nadja Naef; Oliver Kretschmar; Valentin Rousson; Ruth Tuura; Flavia M Wehrle; Beatrice Latal

doi:10.1016/j.jpeds.2024.114091

Processing Speed Partially Mediates Executive Function Impairments in Adolescents with Congenital Heart Disease: Results from a Prospective Cohort Study

J Pediatr. 2024 May 9:272:114091. doi: 10.1016/j.jpeds.2024.114091. Online ahead of print.

Authors

Alenka S Schmid¹, Melanie Ehrler², Nadja Naef¹, Oliver Kretschmar³, Valentin Rousson⁴, Ruth Tuura⁵, Flavia M Wehrle⁶, Beatrice Latal⁷

Affiliations

¹ Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland.
² Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland; University Research Priority Program (URPP), Adaptive Brain Circuits in Development and Learning (AdaBD), University of Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.
³ Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland; Department of Cardiology, University Children's Hospital Zurich, Zurich, Switzerland; Medical Faculty, University of Zurich, Zurich, Switzerland.
⁴ Division of Biostatistics, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
⁵ Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland; Medical Faculty, University of Zurich, Zurich, Switzerland; MR Research Centre, University Children Hospital Zurich, Zurich, Switzerland.
⁶ Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland; Medical Faculty, University of Zurich, Zurich, Switzerland; Department of Neonatology and Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland.
⁷ Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland; Medical Faculty, University of Zurich, Zurich, Switzerland. Electronic address: Bea.Latal@kispi.uzh.ch.

PMID: 38734135
DOI: 10.1016/j.jpeds.2024.114091

Abstract

Objective: To assess processing speed, fine motor function, attention, and executive function (EF) impairments in adolescents with complex congenital heart disease (CHD) who underwent open-heart surgery during infancy.

Study design: We administered a comprehensive neuropsychological test battery evaluating 5 EF domains: working memory, inhibition, cognitive flexibility, fluency, and planning and primary neurodevelopmental processes (PNPs): processing speed, fine motor function, and attention. The sample included 100 adolescents with complex CHD from a previous University Children's Hospital Zurich study, with 104 healthy controls for comparison. We generated scores for each EF domain and computed an EF summary score. Group comparisons and associations were analyzed with multiple regressions accounting for parental education. Mediation analysis explored how PNPs mediate the effect between a CHD diagnosis and EF.

Results: In adolescents with complex CHD, all EF domains and the EF summary score were impaired (β = 0.20 to 0.37, all P < .05). Furthermore, they exhibited slower processing speed (β = 0.27, P < .01) than healthy controls, with no differences in attention (β = -0.07, P = .34) and fine motor function (β = 0.08, P = .34). Processing speed showed a strong association with the EF summary score (β = 0.60, P < .001) and partially mediated the relationship between CHD diagnosis and the EF summary score (β = 0.37, 95% CI [0.24, 0.50], P < .001).

Conclusion: Adolescents with complex CHD show difficulties in EFs and processing speed. Notably, processing speed is strongly associated with EFs and partly accounts for EFs disparities between patients and healthy controls. Early detection and interventions for processing speed difficulties may improve EF outcomes in these patients.

Keywords: congenital heart disease; executive functions; risk factors.