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The extent, impact and stability of cognitive functioning in adult congenital heart disease

Maharshi, M. T. (2017). The extent, impact and stability of cognitive functioning in adult congenital heart disease. (Unpublished Doctoral thesis, City, University of London)


The aim of this thesis was to establish the extent, impact and stability of cognitive functioning in Adult Congenital Heart Disease (ACHD) patients. A cross-sectional and a follow-up study were conducted to address these objectives. The aims of the cross-sectional study were to i) identify the extent of cognitive impairments ii) compare cognitive performance across structural complexity groups, iii) identify factors associated with cognition in ACHD. The follow-up study aimed to evaluate the stability of cognitive functioning over time and identify predictors of change.

Three hundred and ten ACHD patients from the Heart Hospital, London were recruited. Participants were divided into four structural complexity groups: Tetralogy of Fallot (ToF), Transposition of the Great Arteries (TGA), Single Ventricle (SV) and Simple. Each participant completed a neuropsychological (NP) test battery and psychosocial self-report questionnaires.

The results showed ACHD patients with IQ below the normative mean score. Impairment in executive function, attention and motor function were noted. The TGA group had the worst overall cognitive functioning. The Simple group performed significantly better than the TGA and SV groups on attention. Demographic, clinical and mood factors were associated with cognitive function. No association between cognitive functioning and Quality of Life was found.

In the follow-up study 153 participants were followed-up (over 4 years). The NP test battery was re-administered to assess change over time. Mood, demographic and clinical factors were assessed to identify predictors of change in cognitive functioning.

The results indicated both a decline and an improvement in performance on tests assessing attention, memory, executive functioning and motor functioning. Education and oxygen saturation levels predicted change in memory.

The results of this study address a gap in the literature and highlight the extent of cognitive impairments in ACHD. It also indicates a range of intrinsic and modifiable factors that are associated with and predict change in cognitive outcomes. The clinical implications of the findings are discussed. Recommendations for clinical practice include regular, ongoing assessment of cognition in ACHD patients.

Publication Type: Thesis (Doctoral)
Subjects: R Medicine > R Medicine (General)
Departments: School of Health & Psychological Sciences
Doctoral Theses
School of Health & Psychological Sciences > School of Health & Psychological Sciences Doctoral Theses
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